Those are all valid questions. My academic background is in behavioral neuroscience and I have personal experience with this issue so I am not just talking out my ass.
Unfortunately, behavioral neuroscience is still in its infancy but making strides. We do know that there are people who display the brain patterns similar to alcoholics or addicts even before they are old enough to have done anything. There is no standard medical test for that yet although there may be in 15 - 20 years.
We know that it has a strong genetic component in many alcoholics. That is determined mainly through studies on adoptees and especially identical twins separated at birth. It is also behavioral in that a potential alcoholic may avoid the problem altogether by never drinking or by arresting the problem through whatever works after it is a demonstrated problem (AA, therapy, other support groups etc.).
The dirty little secret in the addiction business is that the typical outcomes are much worse than portrayed in the media or popular opinion. The movies show people going into rehab and coming out just fine at the end. That is very rarely the case. The relapse rate for treated alcoholism is above 80% in the first year and and over 90% within five years. The average number of rehabs and/or detoxes necessary is 5 - 7 for people that have a sustained recovery.
That is a big reason why it is advised for people not to try moderation. Everyone wants that and very few long-term alcoholics can achieve it. It isn’t good to play with fire when you are wearing clothes soaked in diesel fuel. The odds are heavily against you already so there is no need to add any more risk factors.
And I don’t understand why you say that those numbers are why moderation isn’t suggested. How do we know that trying to go completely dry isn’t the reason for the horrible success rate of ‘beating’ alcoholism? How do we know that learning to drink in moderation won’t be more successful than trying to quit stone dry?
Thanks. I’m not being lazy. I actually tried to google up stuff myself and I got a little lost and couldn’t find anything I was looking for, or didn’t really understand what I found.
I used to believe that an alcoholic can drink in moderation, but I’ve come to realize that may not be true in all cases.
My father was likely an alcoholic and I drink heavily in social situations. I don’t see the point of consuming alcohol unless you’re going to get drunk. But I can easily go several months without drinking. When alone, I never have more than two or three in a six hour period.
Since I’m able to control myself, I saw no reason why others couldn’t. Then I quit smoking. It only took 24 hours and I was tobacco-free for two years. But I couldn’t drink without wanting a cigarette and I wanted to be able to go out to the pub and socialize. So I decided that I could smoke only when I went out. Then I had to have one when I was drinking at home. It went on like that for two months, then one day I went to a sports bar and smoked four packs over six hours. It took another ten years before I could quit smoking again.
I’ve learned to drink without smoking. But I know that I can’t ever pick up a pack of cigarettes and have it last more than a week. I know that if I try, I will be smoking a pack a day within a month. I can understand why some alcoholics can never have that one drink.
I have a friend who was certainly diagnosed as an alcoholic. He drank steadily all day, not binging and finished a fifth every two days. Finally, his liver was deteriorating and he went to a dryout center for a month. For a few years he didn’t drink at all. Then he very carefully started having a glass of wine with dinner. That worked, in the sense that he just had that glass of wine. Now he drinks a bit more, but I watch him and that’s all. He and his wife share a place in Barbados with me and my wife for two weeks every winter. He buys a half gallon of rum and every evening he makes a pitcher of frozen daiquiris that the four of us share. At the end of the two weeks, the half gallon is still 1/4 full and we leave it for the cleaning lady. Occasionally, he will have a beer. So he is a moderate drinker. Was he an alcoholic? I leave that to you.
I have a friend who, when he was in college, was a serious problem drinker. But then one day he realized that he was ruining his life, and just turned himself around. That was 30 years ago, and I’ve known him for over 20. In all that time, I’ve never known him to have more than one drink in a 24-hour period, and usually none at all. So yes, it’s definitely possible. But that’s not to say that it’s common or easy, and zero is a nice round number that’s easy to keep track of, so the advice to stay away from alcohol entirely is sound.
I drink more than I should. I understand the effects on my health. But i moderate such that i can run a business and care for a home, etc. At 53 I’d much rather live five more happy years, than fifteen sober ones. But that’s just me, and I don’t drink/drive. If alcohol kills me at least I won’t take anyone with me unwillingly.
ETA: I know a whole lotta people in my exact same situation.
It is my studied opinion that attempting moderated drinking leads to full-blown relapse in an alcoholic. Maybe just this one alcoholic, but the inevitability cannot be denied.
I just wonder if zero is *too *round of a number for some alcoholics. They end up not able to do it, and fall back in hard. Maybe if they had tried to moderate instead of eliminate, they may have done better. And AA has such an influence on society that their philosophy of total abstinence is the go-to advice that most people default to. Maybe we are missing an opportunity to help lots of alcoholics who would be much more successful if they had learned to moderate.
You know, it’s actually quite preferable to me to not drink at all. What are we assuming when we take as our assumption that “attaining” the ability to drink in moderation is desirable? What is it about drinking, for you, that makes you see it as unquestionably a goal?
In the very OP there is this phrase (emphasis added by me):
If it’s out of your control how are you going to regulate it? Using that definition of “alcoholic” then the recommended strategy has to become to avoid taking the chance.
It is true that many people can go from abuse to moderation. But a large number cannot. I don’t know if everyone could be given one free relapse bye in order to find out which type they are…
And on the anecdotal front, I have in my family very close and present experience that the power of will is overestimated, and that indeed it does take multiple stints in detox/rehab, even for apparently motivated individuals. Also, often the alcohol/substance abuse is accompanied by other conditions or is an expression of other disorders (e.g. Borderline Personality), that must also (or first) be addressed lest the triggers for the abuse still be there and armed.
I think it would depend why someone is an alcoholic. I am not officially an alcoholic but I probably could be one. All I know is that I have no cravings for drink at all - until I drink something. Then I can’t stop until basically I run out of booze or pass out. For this reason I don’t keep drink at home.
So how can I drink to moderation? The only way is by basically having a chaperone. In those situations I am fine.
But I would think someone who is an alcoholic in a different way, who just loves the feel of alcohol, could easily do it. The whole AA thing is bullshit, there is not the slightest bit of scientific justification for it. It is pseudo science to think that every alcoholic is the same.
Yeah, you zinged it with the “out of control” part. The definition of an alcoholic is someone who can’t rely on their ability to control their usage. So logically, they can’t be successful moderating themselves.
Your hypothesis sounds like a reasonable one to a normal person but it doesn’t make any sense to an alcoholic. The only reason to drink is to get buzzed or drunk. You can just drink anything else if you want something that tastes good.
To an alcoholic, there is no reason to drink other than the behavioral effects. Once you know those are damaging for you, it is best to stay away from it completely so that you don’t lose your judgement and fall in the trap completely.
And this is where I’m stuck. Because I keep wondering how big is that ‘large number’ compared to alcoholics who try to go straight abstinent, but fail.
