A Critique of Alcoholism Treatment Concepts; With Special Reference to Abstinence

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Abstract
The epidemiological criteria of alcoholism are reviewed. The milieu of alcoholism has changed over the past 20 yr., public acceptance and professional interest have revealed different types of alcohol problems. Clinical experience and research data demonstrate that models employed in defining and evaluating alcoholism treatment require modification. Studies of alcoholism treatment indicate the need for a definition of the relationship of abstinence to therapy, the criteria of successful treatment, and the effect of various treatments. Although the studies reviewed do not justify definitive statements, the following seem tenable: return to normal drinking occurs in a significant portion of treated alcoholics; improvement in drinking and improvement in social, vocational and psychological adaptation are related but not parallel; less than total rehabilitation may be the most feasible therapeutic goal in many cases; abstinence as a necessary condition for successful treatment may be an overstatement; abstinence as a criterion of successful treatment is misleading as it may be maintained at the expense of total life functioning, as in some Alcoholics Anonymous abstainers, or may also be followed by personality deterioration; therapeutic efficacy of superficial intervention therapy indicates the need for an evaluation of the nature of psychodynamic alterations which bring such improvement. A bibliography containing 110 references is presented.