Controlled Drinking — an Approach to Management

The aim of this paper is to give an account of controlled drinking ‐ its origins, its clinical and experimental basis, its role in treatment, education and public health policy. There follows a discussion of the practicalities of implementing controlled drinking treatment regimes. The origins of the disease model of alcohol problems in the AA movement of the 30's and 40's which had close links with the Yale Center of Alcohol Studies, are covered briefly. The explosive response in the USA to the publication of D. L. Davies' paper and to the release of the Rand Report are discussed in the context of the recent history of the disease model movement. The most recent controversy, that surrounding the Sobells' studies, is briefly discussed. A number of experimental drinking studies which throw light on such mechanisms as loss of control and craving are reviewed and the arguments for an alternative theoretical framework for alcohol use, grounded in social learning theory, are presented. The work of Mello, Mendelson, Bigelow, Hodgson, Rankin and several others are figured in this overview. The first controlled drinking studies in Australia and the USA are described in the context of this behavioural research, and subsequent clinical research on controlled drinking, including some recent unpublished Scottish work, is outlined. The advantages of including controlled drinking as a therapeutic and health education option are discussed. In particular, the possibilities for recruiting less severely dependent problem drinkers, for breaking down theoretical and practical boundaries between health education and treatment services and for improving treatment outcome results are considered. Finally, some of the practicalities of carrying out controlled drinking treatement and advice are reviewed. A study of the effects of a controlled drinking self‐help manual is briefly described. Some recommendations about future directions for policy and research are then made.