[runarberg]

I’m sorry, but you rephrased my question:

The question is not whether “heavy alcoholics can moderately drink”, which you claim skepticism over, and I—for the record—claim ignorance.

The question is: “is complete abstinence necessary for some cases of substance abuse disorder?”

We have ample observational evidence that complete abstinence does relieve many people from the symptoms of substance abuse disorder. We also have some anecdotal evidence that that is not true for everyone.

I also have a problem with the term moderate drinking. I’m sure—although here I’m ignorant as well—that patients aren’t encourage to moderately drink. Rather they are—again I’m guessing—not told to have failed if they do drink.

Say a recovering alcoholic has a night out of heavy drinking, but that does not further negatively impact them, i.e. they won’t relapse into a constant drinking habit. I would hold on calling that a failure. In fact it might be actively damaging for their psychological well being to say that they failed, which might actually cause a severe relapse.

[placer]

The statement “by focusing on abstinence you are setting a significant part of your patients up for failure” sounds like advocating “moderate drinking” to me.

If we’re not telling alcoholics that abstinence is the goal, we’re telling them they can “moderately drink”. “moderate drinking”, simply put, is what we call non-abstinence for alcoholics.

This is very different from saying that a one-day relapse is a complete failure, and, yes, I agree that Alcoholics Anonymous is too focused on raw sobriety time.

[runarberg]

> The statement “by focusing on abstinence you are setting a significant part of your patients up for failure” sounds like advocating “moderate drinking” to me.

Sorry, that was not my intention. Like I stated earlier in the thread, it’s been awhile since I reviewed the literature. I’m not a psychologist, and I’m neither a recipient nor a practitiner of Cognitive Behavior Therapy for Substance Abuse Syndrome.

That said I’m sure therapists have a way of negatively reinforcing the damaging drinking behavior in such a way that a single night out is not considered a failure. I don’t know how they do it, but they are experts and I’m sure they know how to.