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Alcoholism and Harm Reduction

Updated on February 26, 2011

The traditional view of alcoholism is very simple and black-and-white: alcoholism is a disease and you either have it or you don't. If you have it the only cure is to go to AA for the rest of your life--maybe after a 12 step treatment program. Simple. Like all very simple answers to very complex questions, this view is simply WRONG.

Alcohol problems exist on a continuum, from mild to moderate to severe. Some of these problems are related to careless alcohol use and are best addressed by teaching people about more careful alcohol use. Other problems are related to excessive consumption of alcohol and can be addressed by reducing the amounts consumed. Quitting drinking entirely is an option which many people with alcohol problems choose with great success. But the fact is that no one needs AA to quit--people quit just as effectively on their own as with a 12 step program.

AA and 12 step group treatment programs have been assessed by number of researchers including Dr. Keith Ditman, Dr, George Vaillant, and Dr. Jeffrey Brandsma. In no case did AA or 12 step group therapy perform better than no treatment at all--i.e. a control group. By way of contrast Cognitive behavioral Therapies (CBT) performed about twice as well as did the 12 step approach or the control group.

One exception to the above is Twelve Step Facilitation (TSF) therapy which is delivered in one-on-one sessions with a professionally trained counselor. According to Project MATCH TSF performs about as well as CBT. However, since TSF must be performed by a trained professional in one-on-one sessions it is essentially unavailable anywhere--group therapy is much cheaper and treatment centers are never held accountable when treatment fails to work--hence they do not care. In the case of alcohol and drug problems--when the treatment fails--blame the patient! What kind of disease is this?

Before we leave the topic we should also mention "torture therapies" such as "tough love" boot camps, and Therapeutic Communities. In every case torture therapy has been shown to lead to increased alcohol and drug use and increased antisocial behavior. So don't go there.

By way of contrast, harm reduction programs target the harms to individuals and societies which are connected with drug or alcohol use or any other high risk behavior. Needle exchange programs do far more to lower the incidence of AIDS than do any treatment programs for drug users. Likewise condom distribution does far more to prevent STDs and unwanted pregnancy than abstinence only education. Seat belts in cars are a far more effective way of preventing traffic injuries than telling people to quit driving. And giving people information to help them stop or control alcohol use is far more effective than telling them that they need to ask a "Higher Power" to cure their "disease". That has already been demonstrated to be about as effective as using faith healing to cure cancer--i.e.: NOT AT ALL.

For more information about harm reduction for alcohol please visit the HAMS web site or get the HAMS book: How to Change Your Drinking: a Harm Reduction Guide to Alcohol.


Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Walsh. Baltimore: University Park Press, 1980.

"A Controlled Experiment on the Use of Court Probation for Drunk Arrests," by Keith S. Ditman, George G. Crawford, Edward W. Forby, Herbert Moskowitz, and Craig MacAndrew. American Journal of Psychiatry, 124:2, August 1967, pp. 160-163.

"Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH Posttreatment Drinking Outcomes," by Project MATCH Research Group. Journal of Studies on Alcohol, January 1997, pp. 7-29.

Handbook of Alcoholism Treatment Approaches: Effective Alternatives, William Miller and Reid Hester, editors. Boston: Allyn and Bacon, 1995.

Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, Maia Szalavitz, Riverhead Hardcover, 2006.

The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, by George Vaillant. Cambridge, MA: HarvardUniversity Press, 1983.


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