DDN February 2021 DDN February 2021 - Page 6


Condemned as ‘ Russian roulette ’, allowing dependent drinkers non-abstinence treatment goals was tested in some of the most controversial studies ever seen in alcohol treatment . Mike Ashton dips into the fascinating history of ‘ controlled drinking ’

Your cholesterol is

high . The doctor says , ‘ No butter , no cheese , no cholesterol-raising foods – full stop .’ You complain , ‘ Can ’ t I just cut down and take some tablets ?’ The doctor yields nothing . ‘ If you want me to help , do as I recommend . Otherwise you are clearly not serious about preventing strokes and heart attacks . Maybe you ’ ll see it my way after you have one .’
Not so long ago that was the stance dependent drinkers could expect to face . It was not just a matter of what patients should be advised , but whether they should be denied treatment until revelation or deterioration impressed on them the need to stop drinking altogether .
The heat the issue generated was fired by concerns on the one hand that allowing some drinking would set the dependent up to fail , and on the other that insisting on abstinence did nothing to improve outcomes while denying treatment to all but a minority . Underlying these views were opposing visions
of dependence as a distinct disorder characterised by inevitable loss of control , or one end of a continuum of behaviour which even at its most extreme could – given the right circumstances and / or support – revert to moderation .
THE FIRST CRACK The first significant research-driven crack in the abstinence consensus opened in 1962 in the form of a report by British psychiatrist DL Davies on seven ‘ severely addicted ’ patients said to have sustained controlled drinking . These men were very much in the minority of 93 patients discharged before 1955 from south London ’ s Maudsley hospital , but that they existed at all was considered remarkable .
Davies started by restating the views of the time : due to presumed ‘ irreversible ’ changes after years of regular heavy drinking , there was ‘... wide agreement that these patients will never again be able to drink “ normally ”’. But the seven had – and for between seven and eleven years – conversions associated with major changes in their domestic or working lives that
resolved painful issues or removed them from constant contact with alcohol . Yet he ended by partially endorsing the orthodoxy he challenged : ‘... the majority of alcohol addicts are incapable of achieving “ normal drinking ”. All patients should be told to aim at total abstinence .’ Nevertheless , he claimed his findings gave the lie to the aphorism , ‘ once an alcoholic , always an alcoholic ’. With sufficiently radical changes in their lives – aided in these cases by two to five months in hospital – some who had evidenced severe dependence could ( re ) join the ranks of ‘ normal ’ drinkers .
CRITICAL EDGE For his successor at the Institute of Psychiatry , Davies had been ‘ a pioneer who made a daring exploration of what was at the time virtually forbidden territory ’, questioning ‘ not just a medical consensus , but the central and hallowed organising idea of the American alcoholism movement ’. These comments came from the prestigious figure of the late Griffith Edwards , but there was a
critical edge to this homage to his ‘ mentor ’.
That edge had become apparent in 1979 when the journal Edwards edited published an interview with Davies . The interviewer – probably Edwards himself – told Davies of a personal encounter at the Maudsley with one of the seven patients . Contrary to the impression given to Davies ’ follow-up worker , the man had confessed to ‘ drinking like a fish the whole time ’ and threatening to ‘ bash the living daylights ’ out of his wife if she contradicted his reassuring account . Significantly , Professor Davies also confessed to something – ‘ I never regarded myself ... as a research worker .’
The encounter with the patient prompted Edwards to re-check records and re-interview surviving patients , relatives and carers , and the results were published in 1985 . Having died in 1982 , Davies could not challenge findings which cast doubt on whether some of the seven had ever been severely
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