Alcoholism and drug use or alcohol and drug dependence are a serious social, economic, security and health problem that has overwhelmed drug control agencies. Professionals in the fields related to human sciences such as Sociologists, Psychiatrists, Psychologists, Medics and Counselors have established many strategies to help fight the menace of alcoholism. Many strategies and theories have been devised to deal with alcohol and substance abuse, but none has proved effective. In most cases, treatment of alcoholism and drug use involve thorough counseling that combines several theories and strategies. Behavioral Self-Control Training (BSCT) is one of the ideal ways of reducing the consumption of alcohol and drugs as well as reducing relapse triggered by withdrawal effects. BSCT is a treatment technique that employs strategies such as self-monitoring, self-evaluation, coaching, behavioral contracts, and self-reinforcement to increase a person’s self-mastery and avoid a relapse of inappropriate behaviors. Concisely, the goal of BSCT is to encourage controlled drinking and drug use, which to some extent has proved unachievable, drawing serious controversies.
Background
Alcoholism and drug use are related to the antisocial behaviors and conduct that drunken people display since alcohol and drug use depress feelings and compromise how people think and reason. Heavy intake interferes with proper management of anger and aggression. This makes it easier for young drinkers to engage in antisocial conducts such as raping, battering, and abuse of other dangerous drugs and substances. As demonstrated by Chan, Bervern, and Thomas (2004), economic problems attributed to alcoholism and drug use range from heavy expenditure on alcohol drinks; hence, leading to an inability to engage in income-generating activities due to body weakening. Based on the information given in their study, alcoholics are unable to stay sober for long, and some spend most of the active time drinking and using drugs. This trend and practice limit the time that would have been useful in employment.
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Security problems caused by alcoholism and drug use are related to the impairment of reasoning abilities among drinkers. When under the influence of alcohol, young drinkers can get involved in reckless fights and crimes. With regard to health problems, alcoholism and drug use cause numerous body complications that once developed become problematic to treat (Goldberg, 2014). Alcohol and drug use has been responsible for the development of various cancers such as the liver and lung cancers. It is due to the magnitude of these problems that proponents of Behavioral Self-Control Training agitate for the encouragement of controlled drinking and drug use.
In advancing the idea of controlled drinking and drug use, Behavioral Self-Control Training (BSCT) uses behavioral control techniques that include goal setting, managing consumption, self-monitoring, rewarding goal achievement, learning other goals, and analyzing drinking and drug use circumstances. The idea of controlled drinking entails the reduction of toxicity related to drinking. The toxicity experienced by smokers and alcohol young drinkers are as a result of addiction, which is a state where people are unable to quit alcohol and drug use absolutely (McMahon, 2010). However, the goal of controlled drinking and drug use is a combination of both the intention to encourage the reduction in the levels of consumption and abstinence — controlled drinking and drug use aims to encourage non-problematic drinking and drug use where possible and avoid the occurrence of the above-discussed problems of alcoholism and drug use (Aasved, 2003). Despite the clear goals, efforts geared toward controlled drinking and drug use have not been without challenges.
Different people, depending on their reasons to start drinking and drug use, respond differently to Behavioral Self-Control Training (BSCT) that encourages controlled drinking and drug use. Besides, different institutions and professionals hold different views and understanding regarding the idea of controlled drinking and drug use. HAMS Inc. (2009) records that many people have responded positively to controlled drinking and drug use. HAMS Inc. (2009) adds that many people find it easier, simpler, safe, and effective to abstain from drinking and drug use rather than moderate frequency and levels.
Young drinkers and smokers, especially long-term addicts, find it challenging to stop or even control their drinking and drug use habits. In most cases, long-term addicts who attempt to moderate drinking and drug use end up relapsing. The relapse cases may lead to death or serious health conditions. Research indicates that about one-third of people diagnosed with Alcohol and drug use dependence will successfully moderate their drinking and drug use. Further evidence has shown that one-third of people diagnosed with Alcohol and drug use dependence will quit drinking or drug use and about the same ratio will drink alcohol and use drugs to death. HAMS Inc. (2009) adds that when the same people are subject to alcoholism and drug use treatment, about a sixth, will successfully control their drinking and drug use, a half will abstain, and one third will drink to death in the same manner. The data presented gives higher recognition and effectiveness of treatment geared toward controlled drinking and drug use.
According to HAMS Inc. (2009), the best way to deal with alcoholism and drug abuse is to perform a cost-benefit analysis between moderating drinking and drug use and absolute abstinence. For effectiveness, HAMS Inc. (2009) recommends the performance of cost analysis benefit periodically and after a few months. In the views of HAMS Inc. (2009), training and compliance with the 12 steps of Alcoholic Anonymous (AA) is one effective way for behavior change and controlled drinking and drug use. However, there needs to be great care and observation since people subjected through the 12 steps of AA tend to self-destruct and drink to death when they resume alcoholism.
According to Saladin and Ana (2014), most US treatment strategies for alcoholism and drug use focus on encouraging abstinence. Many groups have come up to help addicts and alcohol and drug dependants recover from their condition and begin living better lives. Saladin and Ana (2014) note that the focus on abstinence has or a long time not produced desired results as some people relapse and succumb to the serious effects of alcoholism and drug use such as death and hard diseases. This trend necessitated the need for other treatment goals, and controlled drinking and drug use was the real alternative to abstinence. Saladin and Ana (2014) view controlled drinking and drug use as an intervention that emphasizes the modest consumption of alcohol and drug use in a manner that does not lead to appreciable negative consequences. Controlled drinking and drug use treatment does not assume that everyone who abuses alcohol and drug use can adhere to safe drinking and drug use patterns, but views the model as having a realistic and acceptable goal that is nearly similar to abstinence (Day, 2007).
Saladin and Ana (2014) trace controversy over controlled drinking and drug use to have started upon the publication of D.L Davis report. The report disclosed that 7/97 serious alcoholics admitted to the Maudsley Hospital in London responded well to training on moderate consumption of alcohol. The release of the report came after 7 to 11 years of follow-up on the subjects that confirmed the veracity of the outcomes of the controlled drinking and drug use treatment. Mignon (2014) substantiates that the report by Davis was in contradiction to the prevailing belief among Europeans that the only viable goal of treatment was abstinence. In response to the report and an affirmation of the prevailing belief, many authors published documents rubbishing Davies' claims as dismissive and negative.
The greater part of the commentary opposition against Davis report touched on scientific verifiability of the process. Several commentators were concerned with the odds that existed between the interest of research and interest of treatment (Saladin & Ana, 2014). One of the commentators called Bell went to the extent of writing that most of the alcohol and drug users who managed to adhere to controlled drinking and drug use would drink themselves to death while trying (Frank, 2012). In the process, Bell suggested that future researches on controlled drinking and drug use should have minimum public participation until the clinical differentiation of controlled-drinker alcoholics from alcoholics requiring abstinence. Other commentators also warned against action on a Davies’ report until effective differentiation of abstinence-requiring alcoholics from alcoholics with the potential to drink controllably.
Wanjek (2007) argues that moderate drinking and drug use contradicts the exact spirit of Alcoholics Anonymous (AA). According to Wanjek (2007), the 12 steps of AA that involve confessional meetings have proved effective and have helped millions of people stop alcoholism. An advocate of AA and Dr. Michael Levy, in particular, encourages people to observe the strategy. However, he warns that the need to strictly adhere to the 12 steps is the probable limitation of AA. Levy also dismissed claims that some of the addicts subscribed to AA could not move past step one that requires admission of powerlessness to alcohol. To Michael Levy, individual addicts can voluntarily stop alcoholism and drug use by themselves. Wanjek (2007) reports that studies on brain imaging have disclosed that heavy drinking and drug use can damage the section of the brain that is responsible for controlling drinking and drug use behavior. This fact makes the idea of moderate drinking and drug use not to be a matter of determination but simply physically impossible.
Evaluation of Previous Studies
Research findings conducted between 2001 and 2002 by the National Epidemiologic Survey on Alcohol and drug use and related Conditions indicated that moderation and abstinence had equal effects. Nearly 36% of 43000 alcoholics surveyed were in recovery with 18.2% being abstainers and 17.7% being moderate drinkers. Another controversy is the definition of alcohol and drug use dependence and abuse. Alcoholics Anonymous (AA) considers individuals who can recover from drinking and drug use moderately as non-alcoholics. Proponents of controlled drinking and drug use, on the other hand, argue that related training on the practice can be useful in treating any form of alcoholism.
The Rand Report based on 18 months follow-up on alcoholics treated with the central goal of abstaining came to support the possibility of controlled drinking and drug use becoming an alternative treatment goal (Saladin & Ana, 2014). The report covered alcoholic men subjected to abstinence treatment in 45 centers across the US and sponsored by the National Institute on Alcohol and drug users and Alcoholism. In the report, 22% of the improved population constituted of men who practiced non-problematic alcohol and drug use consumption. The report also noted that individuals with controlled drinking and drug use behavior were less likely to relapse to problematic drinking and drug use compared to those who abstained. This finding faulted the initially widespread notion of the instability of controlled drinking and drug use. Saladin and Ana (2014) add that further evidence supporting the validity of moderate drinking and drug use as an alternative treatment goal emerged from Rand study that conducted four years follow-up on treated alcoholics. The study documented that 18% of the samples in the follow-up demonstrated moderate drinking and drug use without problems or symptoms of dependence. The credibility of the Rand study was above doubt considering the vast participation of competent research institutions and comprehensive coverage by the popular media (Frank, 2012). Despite the facts, some critics still published information faulting the Rand Report on the grounds of use of improper research methodologies.
Another report by Psychologists Linda Sobell and Mark released in the 1970s proved that moderate drinking and drug use are a practical alternative goal of abstinence. In the report, the two Psychologists recorded 40 to be the number of people trained on moderate drinking and drug use who exhibited improved outcomes after a two years follow-up and working well for 85% of the covered days. This was better than the outcomes exhibited by thirty patients subjected to abstinence-focused treatment who functioned well for only 42% of the covered days. Stokes (2007) adds that the three-year tracking study of Sobell’s patients showed that participants in moderate drinking and drug use depicted superior adjustment and drinking and drug use outcomes than those who treated to abstain. Fascinatingly, this research also encountered professional and scientific faults and criticisms. However, impartial panels and committees established to review Sobell’s report cleared it of any misconducts and unprofessionalism accusations.
Another controversial issue about controlled drinking and drug use is the framework and contents of intervention — Walters (2014) report that parties concerned with promotion of controlled drinking and drug use as an alternative treatment goal for alcoholics concluded that relevant interventions constitute strategies and treatments that address alcohol and drug use related problems, and lack abstinence as the central goal. This expands the focus of controlled drinking and drug use training from being a treatment goal of alcohol and drug use dependent persons to solving other alcohol-problems such as binge drinking and drug use as happens among many college students.
On the opinion page of the New York Times of January 5, 2014, different people, including clinicians, witnesses, former and current alcoholics expressed different views regarding controlled drinking and drug use. In the opinion page, one letter to the editor appears to acknowledge that little consumption of alcohol and drug use relaxes an average person. The letter also cautions that some people have emotional and physical tendency to crave for more alcohol and drug use when they consume any amount. The letter also claimed that the idea of controlled drinking and drug use does not apply to light consumers but is useful to heavy drinkers. In further opposition to the concept of moderate drinking and drug use, the letter suggests that people should strive to abstain from alcohol and drug use since it has little importance in life (New York Times, 2014).
Another writer on the opinion page of the New York Times of January 5, 2014, by the name David L. Hagan, appeared to counter the view of the previous letter regarding moderate drinking and drug use. According to David, who seems to operate a rehabilitation center, many people subscribing to the center’s programs have unsuccessfully tried to control drinking and drug use. David reiterates that moderation cannot be an option for an alcoholic. Instead, moderation can only be sufficient to occasional abusers who are non-dependent on alcohol. Addicted people have different wiring from those who are independent. The brains of the addicts tend to respond differently to the addition of substances that alter their moods, making moderation an inferior option or goal in treatment. In that line, David insists that abstinence is the only viable goal of focus when treating alcohol and drug use addicts.
In her letter to the editor (New York Times, January 5, 2014), Claudia Peters, who is the founder and the president of Kenneth Peters Center for Recovery testifies that controlled drinking and drug use is an inferior treatment goal for any therapist to consider. Having been in recovery for 20 years, Claudia claims that admitting defeat by alcohol and drug use and abstaining are the viable options to overcome alcoholism. Claudia adds that she tried controlling drinking and drug use for years but always resumed to heavy alcohol and drug use that led to blackouts, unhealthy relationships, and antisocial behaviors. For Claudia, the idea of moderate drinking and drug use is only workable when treating individuals who binge alcohol. Claudia also reports instances where many of her friends who were in Alcoholics Anonymous and thought to have better moderation management drunk themselves to death.
According to Bettinardi-Angres and Bologeorges (2011), the treatment and the aftercare given to the minors addicted to drugs have improved massively in the past 30 years. However, the remaining challenge is in the identification of the impaired minors and successful intervention to assist the situation. According to the American Young adults Association, chemical dependence is a big problem calling for proactive action. The issue of drug addiction and chemical abuse are addressed in the ANA codes of ethics for minors under "incompetent, unethical, illegal, or impaired practice" (American Minors Association [ANA], 2001). According to the code, a nurse who knows of chemical abuse is supposed to report the matter.
Additionally, concerns should be communicated to the affected nurse before the matter is addressed to a medical supervisor or an equivalent higher authority. The appropriate action to take is to have minors confront the affected colleague directly in their chemical dependence. The intervening action by the colleagues is recommended because they are the first people who will notice if one of them is into chemical dependency.
Other alternative guidelines used in reporting professional misconduct also emphasize the importance of discussing with the affected nurse his or her conduct. The confrontation should be caring and direct (Bettinardi-Angres and Bologeorges, 2011). When the intervention is started on a communicative note and in a manner showing compassion and concern, the victim will be honest and with that, assisting him or her is much more comfortable. This intervention is in agreement with the fact that the expression of compassion in a firm manner is helpful in the setting of a stage upon which the affected nurse can get help. Bettinardi-Angres and Bologeorges (2011), in the literature review of their study on chemical dependency on young adult colleagues, reveal the significance of stressing on the education towards the identification and response to chemical dependence. Minors with much knowledge can confront their peers with much confidence and understanding. The absence of knowledge of chemical dependency among the minors is making many cases to go unnoticed for a long time. People without knowledge are unable to detect signs and symptoms of chemical dependency.
Studies carried out on other health sectors with similar intervention obligation as young adults also point out the failure of reporting the misconduct of colleagues as a serious issue (Epstein, Burns, & Conlon, 2010). In one research study, more than a third of the total physicians did not support the idea of peer reporting of an affected colleague. The identified reason behind this startling discovery is that most people assume that someone has identified the problem and is already taking care of everything. In as much as there is no significant research carried out to make this point clear, Bettinardi-Angres and Bologeorges (2011) note those personal accounts from professionals on young adults shows similar beliefs. Some minors reported that they fear retaliation when they confront or report about a colleague affected by chemical dependency. The leading cause of fear of reporting is the absence of administrative support. The administration should be on the forefront in supporting minors in confronting the affected colleagues. Without this assured support, minors do not oblige to intervene. The anxiety concerning what to report and unpredictability of the outcome of the report brings challenges. They make minors to be silence in the face of colleagues suffering from chemical dependency.
Bettinardi-Angres and Bologeorges (2011) did a research study in two phases. The first phase was to provide a good understanding of the variables linked to chemical dependence in the minors. These variables included the percentage of minors that divert drugs, the choice of drugs, and the question of I.V use. The second phase investigated the attitude and perception of practicing minors when it comes to confronting a colleague suspected to be a chemically dependent person and to examine the reasons for not confronting the issue. The outcomes of the two research phases reveal a lot about Drug and alcohol abuse and reporting such cases among the young adults (Bettinardi-Angres and Bologeorges, 2011). Of the total respondents, 57% of the registered minors reported being comfortable when it comes to addressing the issue of chemical dependency with the suspected colleagues despite the ANA regulations requiring that everyone should be doing the same. The reason many minors are not reporting such cases is the same as earlier identified. They assume that someone else is already doing something about the problem.
Conclusion
Alcoholism and drug use is a serious global problem that has proved hard to overcome. This view is in line with the nature of efforts exerted by psychologists, researchers, clinicians, and therapists in discouraging excessive use of alcohol and drug use and related health, social and economic effects. With regard to health effects, alcoholism and drug use lead to the development of hard diseases such as cancers of the lungs, liver, and blood-related diseases. American treatment model of alcoholism and drug use has been focusing on abstinence as the central goal. Generally, absolute abstinence from alcohol and drug use is not possible in heavy drinkers and drug consumers. Many have tried to abstain through systems such as Alcoholics Anonymous but ended up resuming alcoholism and drug use and drinking themselves to death. This fact necessitated the search for another simple and effective treatment goal for alcoholics. Controlled drinking and drug use have been the immediate and effective alternative goal of abstinence during treatment. Controlled drinking and drug use intend to reduce dependence on alcohol and drug use and encourage infrequent and non-problematic drinking and drug use behaviors. Many approaches, including Behavior Self-Control Training (BSCT), Moderation-oriented cue exposure (MOCE) and Guided Self-Change can lead to controlled drinking and drug use. The idea of controlled drinking and drug use as the goal of treatment for alcoholics has encountered applauses as well as oppositions that have created serious controversies.
References
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