Conceptual Issues Regarding Goals in the Treatment of Alcohol Problems

Abstract

Current disputes regarding appropriate goals in the treatment of alcohol problems are symptomatic of deeper problems in the alcohol field involving differing views about how alcohol problems should be conceptualized. Both the goal controversy and attempts to salvage elements of conventional wisdom have become serious impediments to the development of a comprehensive and heuristic model of alcohol problems. In reviewing these issues, it is noted that: the field must come to grips with repeated findings that conventional treatments have not proven effective; there is a marked deficiency of clinical services for individuals who have alcohol problems but who are not severely dependent on alcohol; and, several very recent studies have demonstrated moderation outcomes for severely dependent individuals and found no relationship between severity of dependence and type of successful outcome (abstinence versus nonproblem drinking). Other conceptual issues regarding the use of treatment goals are also discussed, including definitional problems in the outcome literature, the relationship between client and therapist beliefs and treatment goals, how goals relate to the facilitation of behavior change, and the morality of abstinence and moderation goals. A new approach to the study and remediation of alcohol problems is needed; an approach that is comprehensive, multidimensional and consistent with the available evidence.