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.

SECOND OFFENDERS

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

Voices
On the last day of campaigning before the polling booths open, the SNP leader has written to voters in a final attempt to convince them to vote for independence
voicesIs a huge gamble on oil keeping the First Minister up at night?
Life and Style
tech

Apple has been hit by complaints about the 1.1GB download

Arts and Entertainment
Pointless host Alexander Armstrong will voice Danger Mouse on CBBC
tv

Much-loved cartoon character returns - without Sir David Jason

Arts and Entertainment
Liam Neeson said he wouldn't
tv

Liam Neeson's Downton dreams

PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Arts and Entertainment
Actor and director Zach Braff
tv

Arts and Entertainment
Rosalind Buckland, the inspiration for Cider with Rosie died this week
booksBut what is it like to be the person who inspires a classic work of art?
Arts and Entertainment
tv

Life and Style
i100

Arts and Entertainment
The former Doctor Who actor is to play a vicar is search of a wife
film

Matt Smith is set to join cast of the Jane Austen classic - with a twist

Arts and Entertainment
Lionel Messi in action for Barcelona
filmWhat makes the little man tick?
Arts and Entertainment
Meera Syal was a member of the team that created Goodness Gracious Me
tv

Actress to appear in second series of the hugely popular crime drama

Arts and Entertainment
tvReview: An undercooked end (spoiler alert)
News
i100
Arts and Entertainment
Pharrell dismissed the controversy surrounding
musicThe singer said 'the last thing I want to do is degrade'
Sport
Cesc Fabregas celebrates his first Chelsea goal
footballChelsea vs Schalke match report
Arts and Entertainment
Toby Jones (left) and Mackenzie Crook in BBC4’s new comedy The Detectorists
tvMackenzie Crook's 'Detectorists' makes hobby look 'dysfunctional'
Life and Style
fashion

Olympic diver has made his modelling debut for Adidas

News
i100
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

ES Rentals

    iJobs Job Widget
    iJobs General

    Network Infrastructure Technical Lead - up to £45k DOE - Surrey

    £35000 - £45000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

    Technical Architect - Surrey - £35k-£45k DOE - Permanent

    £35000 - £45000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

    Year 5 Teachers needed for supply roles

    £110 - £130 per day + Competitive rates of pay: Randstad Education Reading: Ye...

    Year 5 Teacher Plymouth

    £23500 - £40000 per annum: Randstad Education Plymouth: Year 5 Primary Teacher...

    Day In a Page

    Mystery of the Ground Zero wedding photo

    A shot in the dark

    Mystery of the wedding photo from Ground Zero
    His life, the universe and everything

    His life, the universe and everything

    New biography sheds light on comic genius of Douglas Adams
    Save us from small screen superheroes

    Save us from small screen superheroes

    Shows like Agents of S.H.I.E.L.D are little more than marketing tools
    Reach for the skies

    Reach for the skies

    From pools to football pitches, rooftop living is looking up
    These are the 12 best hotel spas in the UK

    12 best hotel spas in the UK

    Some hotels go all out on facilities; others stand out for the sheer quality of treatments
    These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

    Widespread fear of Isis is producing strange bedfellows

    Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
    Topshop goes part Athena poster, part last spring Prada

    Topshop goes part Athena poster, part last spring Prada

    Shoppers don't come to Topshop for the unique
    How to make a Lego masterpiece

    How to make a Lego masterpiece

    Toy breaks out of the nursery and heads for the gallery
    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
    Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

    Ian Paisley’s decision to make peace with his IRA enemies

    His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    Exclusive extract from Janis Winehouse's poignant new memoir
    Is this the role to win Cumberbatch an Oscar?

    Is this the role to win Cumberbatch an Oscar?

    The Imitation Game, film review
    England and Roy Hodgson take a joint step towards redemption in Basel

    England and Hodgson take a joint step towards redemption

    Welbeck double puts England on the road to Euro 2016
    Relatives fight over Vivian Maier’s rare photos

    Relatives fight over Vivian Maier’s rare photos

    Pictures removed from public view as courts decide ownership
    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    Donatella Versace at New York Fashion Week