Many of those who develop problems with alcohol will live in hope of a time when they can control their intake. The idea of complete abstinence is not appealing to most heavy drinkers, and in a lot of cases it may not be required. There is plenty of evidence that people can go through a period of their life where they drink too much, but that they can later regain control. There are other individuals though, who will not be able to moderate and for them the only option will be complete abstinence. Most alcoholics will have attempted different techniques for moderation before they finally admit defeat.
Those individuals who become physically addicted to alcohol are far less likely to be able to ever regain control. This is because chemical addiction leads to actual physical changes in the body. Humans can adapt to high levels of alcohol in the blood stream so well that the body becomes dependent on it. This means that when alcohol levels in the blood stream falls the individual will begin to experience withdrawal symptoms. In severe cases they may develop a condition called delirium tremens and here the withdrawals symptoms can prove fatal.
Not everyone who abuses alcohol will develop a physical addiction. It can take time for this change in the body to occur. If the individual quits are moderates their alcohol intake before physical addiction takes hold they will not be at risk of withdrawals. They may still be able to return to normal levels of drinking. In many instances such individuals will just naturally return to safe drinking levels as they adjust to the responsibilities of adulthood. In other cases a bad experience or learning more about the dangers of alcohol abuse can lead to a change in behavior.
The disease theory of addiction views alcoholism as an incurable disease. The only possible way to treat the conditions is with complete abstinence from alcohol. Therefore controlled drinking will not be an option for the alcoholic. This is the view held by 12 step groups such as AA. Complete abstinence is the foundation principle for most alcohol rehabilitation programs. While there is some debate as to the disease theory of addiction there are few who doubt the necessity for some individuals to remain off alcohol for life.
Most of those who have made it into recovery programs will already have tried many methods for controlling their drinking. If they were able to regain control they would not have required rehab in the first place. The fact that such attempts have failed in the past makes it highly likely that the same will occur in the future. The idea of controlled drinking can be a dangerous one for people in recovery because it can lead to relapse.
It is argued that some alcoholics will never manage complete abstinence so controlled drinking may be better than nothing. It is also suggested that offering this approach will motivate more people to seek help for their problems. Critics respond to this support for controlled drinking by claiming that such an approach has only proved successful with those who have moderate drinking problems. The risk is that offering controlled drinking to alcoholics may discourage them from getting the help they really need. There is no risk involved with complete abstinence, but people will always be at risk of losing control again.
Those individuals who relapse after a period of sobriety will usually find themselves back in the midst of addiction. Some people may be able to sustain a period of controlled drinking but eventually the energy needed to keep such control wanes. When the alcoholic discovers that their attempt at controlled drinking has failed, they can also find that they are unable to return to abstinence. It is for this reason that people in recovery are strongly discouraged from attempts at controlled drinking. Their chances of success are too low and they may never have another opportunity to get sober.
It may be that some individuals who are alcohol dependent can later regain some control. One study followed the progress of a 46 year old man over 10 years. It was found that he was able to control his drinking despite his history of being alcohol dependent. It is suggested that up to one third of those individuals who develop an alcohol dependence can later return to controlled drinking. Other research is far less optimistic about the possibility of controlled drinking for people who become alcohol dependent. A 60 year study by Harvard Medical School concluded most of those who have been physically addicted to alcohol are highly likely to return to alcoholism.
A number of support groups exist for people who wish to attempt controlled drinking. Probably the most well known of these is Moderation Management. This group aims to help those who are problem drinkers regain control. One criterion for membership of the program is that the individual has not already developed a physical addiction to alcohol. This group is surrounded by controversy as its founder, Audrey Kishline, failed to moderate her own alcohol intake using this method.