Booze for Alcoholics?

Doctors, social workers and psychologists have generally agreed that for alcoholics the only road to recovery and a sober life is total abstinence. In fact, Alcoholics Anonymous, which has an excellent record of rehabilitating heavy drinkers, defines an alcoholic as a person who can never drink again. Last week that abstinence concept was boldly challenged by three social scientists from one of the nation's best-known think tanks, the Rand Corp. In a report to the National Institute on Alcohol Abuse and Alcoholism (N.I.A.A.A.), David Armor, J. Michael Polich and Harriet Stambul claimed that many former alcoholics can begin drinking in moderation without sliding all the way to their previous alcoholic depths.

The Rand scientists based their conclusion on an 18-month study of people admitted to N.I.A.A.A. treatment centers across the country. First they conducted a survey of patients at 45 centers six months after they had begun treatment. Then they went back to eight of the centers to interview in depth 1,340 patients 18 months after their initial treatment. In the latter group, which consisted of those who had been downing more than nine times the alcoholic consumption of the average drinker, more than half were unemployed and separated or divorced. After a year and a half, about 70% had shown significant improvement. While about a third of the improved had abstained for at least six months, another third were drinking normally, and the remaining alcoholics were imbibing heavily on occasion but abstaining much of the time. What struck the researchers most was that the relapse rate among the "normal" drinkers--who consumed an average of one drink per day--was no higher than among those who tried to abstain. Thus, they concluded, normal drinking may now have to be accepted along with abstinence as "a form of remission" from acute alcoholism.

Flexible Goals. Concerned that their findings might be construed as a green light for abstaining alcoholics to begin drinking again, the Rand group warned that there is no known way to distinguish between those who can safely begin to drink in moderation and those who might immediately go off the deep end into alcoholism again. Their recommendation: "Alcoholics who have repeatedly failed to moderate their drinking or have irrevocable physical complications due to alcoholism should not drink at all." Instead, they said, their findings suggest that in treating alcoholism, goals be set that are more "flexible" than only abstinence. Their views were shared by Dr. Morris Chafetz, former director of N.I.A.A.A., who calls current thinking about the treatment of alcoholism "rigid, stereotypic and possibly self-defeating. For a person who lives in a drinking society to think that he must stop drinking entirely to stop his alcohol problem may discourage him from seeking treatment until he is really down in the dumps."

Many experts remain unconvinced by the Rand study. Dr. Marvin Block, a Buffalo, N.Y., physician who persuaded the American Medical Association to define alcoholism as a disease, was concerned that the report would prompt people "who cannot go back to drinking to try it just because a few have done it." Executives of the National Council on Alcoholism called the report "a cruel hoax, dangerous and misleading" and said that it should not have been released. Said Dr. Luther Cloud: "Abstinence is the prime prerequisite for recovery from alcoholism. No studies --including the Rand study--have been viable enough to make us change that opinion." Alcoholics Anonymous officials were even more outspoken. "A.A. is full of the experiences of people who have tried to go back to drinking and have been unable to," said Dr. John Norris, a trustee on A.A.'s board. "An alcoholic cannot safely go back to social drinking."

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