Alcohol Treatment Advice from Providers in the US and UK

The traditional Alcoholics Anonymous 12 step approach to alcohol treatment suggests that one must completely abstain from all drugs and alcohol to achieve recovery. However, in an alternative to AA, a self-empowering approach is implemented where individualized treatment plans outline recommendations for problem drinkers as well as those with less severe drinking problems.

Moderate drinking or controlled drinking refers to limiting alcohol consumption to the point of no (or few) negative consequences. Previous research suggests that controlled drinking strategies are successful for many problem drinkers. In the United Kingdom, Norway, and Australia, controlled drinking is commonly recommended by healthcare providers. However, abstinence is the predominant goal for problem drinkers in alcohol treatment programs in the United States; even though surveys show that alcohol treatment providers think that moderate drinking would be appropriate for a minority of clients. Various individual characteristics may influence the recommendation of abstinence or controlled drinking. Researchers in the US and UK studied the influence of three such characteristics — including the severity of the drinking problem, the level of family and social support, and the drinkers’ sex — on alcohol treatment recommendations by healthcare providers (Cox et. al., 2004).

The researchers recruited 41 UK healthcare providers and 31 US healthcare providers, including counselors (46 percent), nurses (25 percent), physicians (11 percent), and psychologists (7 percent). The respondents were asked to read 16 different case histories and give a recommendation of controlled drinking or abstinence for each case on a 7-point scale.

The results showed that abstinence was recommended more strongly for problem drinkers with more severe problems, those with higher social support (an unexpected finding), and females. Further, controlled drinking was more often recommended in the UK compared to the US. In regard to problem severity, social support, and sex, respondents’ ratings depended on one or more other variables as well as their country. The researchers concluded that alcohol treatment advice offered by healthcare providers (in terms of abstinence versus controlled drinking as the goal) varies according to client characteristics as well as the country of the healthcare provider.

“The acceptability of controlled drinking as a goal for problem drinkers clearly differs between UK and US healthcare workers,” the authors explain. “Controlled drinking, as opposed to total abstinence, is more readily accepted in the UK healthcare system than in that of the US, even for drinkers with more severe drinking histories. In fact, prior research has shown that controlled drinking is far less accepted in the US than it is in the UK, Australia, or Norway. Thus, clients in the UK may be more inclined that those in the US to ask if they can moderate their drinking in light of population norms and assumed openness of staff to such requests. This cultural difference in the acceptability of controlled drinking is probably an outgrowth of the dominance of the US disease model of alcoholism, which advocates total abstinence from alcohol for all problem drinkers. The abstinence-only approach is more entrenched in the US than in many other countries, where harm reduction and social-learning models of alcohol misuse influence treatment providers’ attitudes.”

Cox WM, Rosenberg H, Hodgins CHA, Macartney JI, Maurer KA. United Kingdom and United States healthcare providers’ recommendations of abstinence versus controlled drinking. Alcohol and Alcoholism. 2004; 39(2): 130-134.