FROM UNRESTRAINED TO MODERATE DRINKING

Total abstinence is most commonly considered the main object of the treatment of alcoholics. In practice it is a common experience of patients and therapists alike that a person who has lost his ability to control his consumption of alcohol, is no longer capable of drinking moderately. It has been established, however, that here too there is no rule without exceptions. In their own investigation, Bruun & Markkanen (1961) found an alleviation of the alcohol consumption in some patients during treatment, and their observation has been confirmed by Tuominen (1966). On the basis of his observations covering 7 to 11 years, Davies (1963) reported that among 93 treated alcoholics there were seven men who, subsequent to a few months of abstinence, had started drinking once again but were entirely capable of keeping it under control. The surprising nature of this observation is demonstrated by the abundance of comments that were evoked; Selzer (1963) alone unreservedly supporting the view of Davies and presenting a similar observation of his own. Among others, Tiebout, Williams & K j ~ l s b a d (1963) criticize the diagnostic criteria of Davies. I t is, moreover, alleged that observations of this kind are detriment4 because they shatter fundamental therapeutic concepts. In his wide review of the literature, Pattison (1966) states that the indignation aroused by the observation of Davies is dictated by the ambivalence in our attitude towards alcoholism, the roots of which lie deep in our Western, Protestant culture which makes virtues of labour and renunciation and takes an ambivalent attitude towards any form of hedonism. On the basis of the results of over one hundred studies covering twenty years, Pattison presents the following summary: