Must All Alcoholics Abstain?

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image by Peter O. Zierlein

In the United States, abstinence is a central tenet in treatment programs for alcohol dependence (AD). And the strategy does work, especially for a subtype of severe alcoholics who are most likely to seek help in the first place. A national survey of Americans with AD, however, throws into question whether or not abstinence is a cure-all.

The study, published in Drug and Alcohol Dependence (Dec. 2007), analyzed 1,484 individuals with AD and identified five subtypes: Young Adult, Young Antisocial, Functional, Intermediate Familial, and Chronic Severe. The last group, middle-aged individuals who start abusing early and have a family history of AD, is far and away the most likely to seek help (two-thirds do). This has led to the stereotypical “face” of alcoholism and has skewed treatment methodologies, even though the study finds that the type accounts for only 9.2 percent of alcoholics overall.

The largest group is the Young Adult subtype, 31.5 percent of people with AD. These twentysomething binge drinkers rarely seek help–they don’t see themselves fitting the classic definition of an alcoholic–and have yet to encounter social or financial problems as a result of their behavior. Consequently, “abstention is less likely to be a goal that engages them in treatment,” reports Psychotherapy Networker (Jan.-Feb. 2008). The hope is that classifying subtypes will enable the medical community to develop treatments better tailored to individual type.

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