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.

Categories: Addiction

Tags: Substance Abuse