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Alternatives to AbstinenceReview - Alternatives to Abstinence
A New Look at Alcoholism and the Choices in Treatment
by Heather Ogilvie
Hatherleigh Press, 2001
Review by Christian Perring, Ph.D.
Dec 24th 2001 (Volume 5, Issue 52)

For the most part, Ogilvie provides a thoughtful and even-handed account of current thinking in the USA about the nature of alcoholism and treatment options. The main message of Alternatives to Abstinence is that while groups like Alcoholics Anonymous and their insistence on abstinence may help some people, there may be other equally good approaches. Specifically, some controlled drinking treatments may be preferable to some problem drinkers, especially young people, who may not be ready make the commitment to abstain from drinking altogether.

The book summarizes a good deal of information, including the history of American thought about drinking over the last two centuries, scientific approaches to the understanding of alcoholism and its treatment, and a number of different treatment programs. The book is aimed at the general reader, not experts, and the writing is clear and straightforward. Ogilvie relies heavily on Jellinek's book, The Disease Concept of Alcoholism, Valliant's books The Natural History of Alcoholism (1983) and The Natural History of Alcoholism Revisited (1995), and Heather and Robertson's Problem Drinking.

The heart of the book comes in the fourth chapter, "Why the Disease Theory Won't Hold Water." Ogilvie explains that there is no empirical support for the idea that alcoholism is irreversible. In fact, some alcoholics can return to normal drinking. Similarly, there's little evidence to support the idea that alcoholics experience uncontrollable desires; instead studies show that alcoholics are able to resist temptation when provided incentives in certain contexts.

The only problem in Ogilvie's summary is a slight tendency to suggest that all disease models of alcoholism insist that it involves irresistible desires and is an irreversible condition. All of this information she sets out will be very familiar to scientific researchers on alcoholism, and it is always important to emphasize when discussing these issues that there is still no single unified scientific theory of alcoholism. Different researchers have different theories, some focusing on social and emotional aspects, others focusing on changes in the brain, and still others focusing on genetic factors predisposing people to alcoholism. Scientists are often guilty of reductionist explanations of alcoholism, supposing that the aspect of the condition that they consider to be most important really gives the fundamental explanation. The truth is that at this stage in our research, we have to keep in mind all dimensions of alcoholism; furthermore, it is likely that reductionist approaches will always be simplistic.

Of course, Alcoholics Anonymous is the most powerful social force in how Americans think about alcoholism, and AA tends to be very intolerant of different views of alcoholism that challenge its doctrines. Ogilvie is admirably calm in her discussion of AA; she is quite ready to say that it may provide the best treatment for some people, and is merely challenging the claim that AA provides the only legitimate treatment. Her approach is in contrast with Jeffrey Schaler's recent book Addiction Is a Choice, which is far more a head-on attack of AA, and makes the rather gloomy argument that there is no evidence that any treatment for alcoholism works.

In sum, Alternatives to Abstinence is a worthwhile introductory book for anyone wanting to educate themselves about alcoholism and possible treatments.

© 2001 Christian Perring. First Serial Rights.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island. He is editor of Metapsychology Online Review. His main research is on philosophical issues in psychiatry. He is especially interested in exploring how philosophers can play a greater role in public life. He is available to give talks on many philosophical or controversial issues in mental health.


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