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Go on, just a small one

Is permanent abstinence the only answer to alcoholism? URSULA KENNY explores the alternatives to AA
Last week Paul Gascoigne fell off the alcohol-free wagon. He's not the first celebrity to be caught with a drink in his hand a few months after the My Booze Hell! headlines. Fellow footballer Paul Merson, comedian Caroline Aherne (who talked on The Frank Skinner Show last week about drinking socially) and Volkswagen ad model Paula Hamilton have all endured the humiliation of being seen drinking after therapy.

As soon as a celebrity drunk, or any drunk for that matter, goes back to the bottle, we are all well aware of the dire "slippery slope" implications. Our assumption is that the only truly successful way to address alcohol problems is to stop. And never start again.

This is not necessarily true, but it is a measure of the all-pervasive influence of Alcoholics Anonymous. The American organisation, with its famous 12-step theory to beating addiction, says abstinence is the key. Somehow their arguments have entered the national psyche as the only way to beat a battle with booze.

The fact is many experts in the field say that it is perfectly possible for the majority of problem drinkers to return, eventually, to moderate and stable drinking. This is fairly shocking and in stark contrast to the AA message. The difference is in starting points: a therapeutic (non- AA) approach to alcohol abuse would begin with the belief that people with problems drink. AA believes people with alcoholism cause problems. AA then goes on to say that the only answer is to stop. Forever. In therapy, the view is that your problems are the problem and you won't be able to drink until you've worked through them.

Clinical psychologist Oliver James is just one of many experts who feel this view is more helpful to more people. "There is a problem with AA in that they say alcoholism is all about genes, that you are born with it and therefore powerless to control it. But the degree to which genes contribute to alcoholism is negligible; to my mind this is just a convenient myth that encourages you to see yourself as 'poisoned' by something separate to yourself, as if alcoholism is the problem in itself."

James feels that the truth is that people abuse alcohol, and other drugs, when they have personal problems. Their drinking is a result of their problems, usually related to childhood; once they have been treated for those problems, "it is perfectly possible for them to go back to 'normal' drinking again".

He doesn't rule out AA altogether. "Of course it's also true that when you're addicted to a drug the only way to stop is to stop completely for a significant period of time. AA is very helpful for a while because it provides a new social system; new friends who don't drink. But at some point you have to go back to the real world and address the underlying causes of your alcoholism with therapy or medication - both of which AA rule out - and move on." Or abstain forever.

Last year Chris, who is 40, visited a friend and had a small brandy. Nothing out of the ordinary there, except that this was the first time she had had an alcoholic drink for three and a half years. "At first I was a little bit fearful, but it turned out that I wasn't back to being a raging alcoholic," she says. "If I'm out socialising I have two or three drinks and I'm able to stop. I fought my fear because I wanted to return to the real world."

Five years ago Chris went to AA to deal with her drink problem and spent nearly four years going to meetings, despite the fact that she always felt that AA's methods weren't really addressing her needs. "I was afraid to leave but eventually I began several years of counselling and was able to detach altogether." And return to social drinking.

"I had a difficult childhood which I'd never really dealt with, and then when my daughter was born with a life-threatening illness I started to drink a lot. I was, and am, a single mother, coping on my own, and for a long time I escaped by drinking by the bottle, on my own, every night. I drank to block out problems but now, with a therapist, I have worked through those problems and come out the other end."

Chris feels bitter about the way, as she sees it, AA actively discouraged her from getting the counselling that has sorted out her life. "It took me a while to get into therapy because AA advised me against it. They scared me by saying that if I entered in to it I might drink again. They tell you that you have a progressive illness and that you will always be an alcoholic and as such can never have a drink again." In the end Chris simply didn't believe that she was that far down the line: "When AA started, it was the last stop for people who were literally dying. I was told that if I didn't stop forever I could end up like that, but I never really believed them."

There are experts who also believe that total abstinence is better suited to those with severe and lengthy histories of alcohol abuse. Dr Nick Heather, professor of Alcohol and Other Drug Studies, is one of them, but he points out that this sort of patient is much rarer than we imagine. He finds our habit of describing any and all drink problems as "alcoholism" unhelpful. "For most people alcoholism implies extreme abuse; it is therefore better to talk in terms of 'problem drinking' which simply refers to anyone whose drinking is causing them problems.

"There are those who are highly dependent on alcohol, and this group is more likely to succeed if they abstain. But large numbers of people, indeed the majority, do not have problems of this nature; the best advice for them is moderation."

Like Oliver James, Dr Heather is at pains to acknowledge that AA does a lot of good for a lot of people. But "the trouble is the AA disease model of alcoholism has captured the public's imagination when it is actually unscientific".

Obviously, this is all irrelevant if AA stopped you destroying your life by getting you off alcohol. Of course, it does save people. But what if its extreme approach puts you off taking treatment at all?

"There are many alternatives to AA," says Heather. "In fact most treatment in this country is not based on AA principles, and evidence clearly shows that large amounts of people are able to go back to moderate drinking."

So why are these alternatives so low-profile? Mark Bennet is a press officer at Alcohol Concern, which supplies information on treatment for alcohol abuse. He acknowledges that "it is not generally recognised that you can go back to drinking because the AA way has come to be seen as the conventional treatment".

He points out, though, that as many people are successfully treated with counselling as by AA. "While a period of abstinence can be useful in that it makes people feel that they are in control, the genuine experience is that some people can stop and then start again without problems if they get the right support."

Of course, how do you know when you are genuinely unable to abstain and when you're just using it as an excuse? And how do we address the irony that having to abstain forever puts off people who need help from asking for it? If you are locked in to questions of this ilk, give counselling a go.

For information about all available treatment, call the National Alcohol Helpline's Drinkline: 0800 917 8282.


Paul Merson, Paula Hamilton (top row), Caroline Aherne and Paul Gascoigne were all spotted drinking after therapy