What You Can Change _. And What You Can't - Martin E. Seligman [112]
Controversy still reigns about whether—in the long run—controlled drinking works as well as abstinence. In 1972, two bold alcohol researchers, Mark and Linda Sobell, published successful results of a controlled-drinking program. Numerous defenders of AA scorched the Sobells. Mary Pendery and her colleagues, for example, argued that the Sobells’ results, looked at more closely ten years later, were grim: For example, a number of the “successes” had died, probably of alcoholism. But in turn, Pendery has been attacked for failing to mention that in the Sobells’ abstinence control group, a number had died in the ten intervening years. And so it goes. The issue is still unsettled.27
Surely, the goal of total abstinence has one main virtue. Believing in it keeps severe alcoholics on the path most likely to lead to recovery. Even if it is true that some alcoholics can recover and still drink a little, the goal of total abstinence, like the disease label, is probably a good tactic.
The goal of abstinence has one disadvantage, however. When the alcoholic believes that taking a single drink means he has fallen back into his old habit, one lapse can bring down his house of cards. A binge becomes very likely. In one study, the total-abstinence goal was compared to the controlled-drinking goal. After a year, the two groups had the same rate of abstinence—about one-third. But among the nonabstinent (the “failures”), the abstinence treatment resulted in three times as much drinking as the controlled-drinking approach.28
Many people who eventually recover from alcoholism slip occasionally along the way. Rather than viewing this as “I’m in relapse,” “My disease has won,” or “I’ve lost it,” there is a more optimistic way of thinking. A slip can instead be seen as a temporary setback triggered by external events, not as a lack of willpower. Lapses are opportunities to learn better how to cope, not signs that the alcoholic is once more powerless before his disease.29
The abstinence goal accords with the myth that alcoholics suffer from uncontrollable drinking. But in the natural course of alcoholism, alcoholics frequently control their drinking—in the short run: Sometimes one drink leads to the next and the next, but on some occasions the alcoholic chooses to stop. Alcoholics frequently control how much they drink—not drinking right before a job interview, for example. Most alcoholics have gone on the wagon several times but have eventually fallen off. The problem is not that one drink always leads to loss of control, but that in the long run, most alcoholics start drinking again—even after repeated successful control of drinking. Alcoholism has immense momentum, but total loss of control is not an accurate description.
Change: Alcohol, Cigarettes, Drugs
Alcohol presents a picture similar to that of most commonly abused drugs: cigarettes, cocaine, and opiates. First, some people are very vulnerable to any one of these appetites, probably for genetic reasons. There is no evidence, however, of an “addictive” personality that is vulnerable to all of them. Second, in the natural course of things, if the abuse is severe, fewer than half (only a third for alcohol) will be able to give it up. This means the problem is certainly not incurable, but the outlook is not rosy. Third, no medical or psychological treatment yet devised much improves on the natural recovery rate. If your first impulse is to get expensive hospital treatment, psychotherapy, or medication, think again. There is no secret expertise about alcoholism. Family, friends, and support that provides pressure and hope—not the least being AA, religion, and work—and, crucially, the individual himself are the site of the cure.
Heavy drinking, it must always be remembered,