[This is the Foreword by Jeffrey A. Schaler to the first edition of Moderate Drinking: The New Option for Problem Drinkers by Audrey Kishline, published in 1994 by See Sharp Press. Audrey Kishline dropped this Foreword and replaced it with one by Ernest Kurtz in subsequent printings.]
to the first edition of
Moderate Drinking: The New Option for Problem Drinkers by Audrey Kishline
(originally published by See Sharp Press, Tucson, Arizona)
"The most important predictor of successful moderation," writes Audrey Kishline, "is believing that you can do it." Psychological research on self-efficacy agrees. (1,2) Self-efficacy is people's confidence in their ability to achieve a specific goal in a specific situation.
For example, the more people believe in their ability to moderate their drinking, the more likely they will moderate. The inverse is true too: The more people believe in their inability to moderate their drinking, the more likely they will not moderate it. These facts are important because most treatment programs for heavy drinking focus on abstinence, and they teach people to believe that they lack the ability to moderate their drinking. Unfortunately, the more treatment programs convince clients that this is true, the more likely the clients are to prove them "correct." Teaching that abstention is the only way to control drinking creates a problem in the name of a solution.
That's because drinking irresponsibly (like drinking moderately) involves the intention to do so. There is no force alien to oneself responsible for one's behavior. Believing that a disease makes people drink is self deception; (3) it ignores empirical findings on self-efficacy.
Still the disease concept of alcoholism remains potent, dominating public policy. Controlled drinking programs inflame the passions of disease modelists. That's why America has so few moderation programs. Thus, we'll surely hear that heavy drinkers who succeed in moderating their drinking through Moderation Management are not really "alcoholics."
That rationalization just avoids the facts. "Alcoholic" is a moralistic label applied to abusive drinkers. It implies involuntariness, or "loss of control," an unproved explanation for heavy drinking. The drinking behavior of an "alcoholic" is regarded as being in the same class as a seizure, convulsion, or neurological reflex. Heavy drinking is allegedly automatic, not strategic, reflexive, not purposeful. That kind of thinking denies the distinction between the involuntary and voluntary nervous systems. It reinforces the myth that people who drink heavily can't moderate their drinking. Lowered self-efficacy is the result.
Disease-model thinking is used to absolve individuals of accountability for their actions. Disease-model theorists describe a cycle of progressive infirmity, "the diffusion of deficit." (4) Any difficult experience or unfavorable behavior is "diagnosed" as involuntary and attributed to a "disease" requiring "treatment." At times it appears that life itself has become a disease.
An inverse movement posits that the cure for real diseases is found in "right" thinking. Across America, the number of people who believe that they are not responsible for actions for which they are responsible (such as eating, drinking, smoking and criminal behaviors) and that they are responsible for diseases they are not responsible for (such as cancer, diabetes, and epilepsy) is increasing.
The idea that a "common alcoholic" exists is fiction too. Heavy drinkers are a heterogeneous population. People abstain from alcohol, drink in moderation, or drink heavily because they either like or dislike their experience before drinking or after drinking (though not necessarily because of it!) People have diverse beliefs about what they can create for themselves through drinking. Those beliefs are important to examine if they are to be changed. (5) Diverse approaches to therapy should be matched according to the beliefs individuals hold. (6, 7, 8).
Because drinking is a choice based on personal values, people cannot be coerced into helping themselves. All therapy must be contractual.
Audrey Kishline presents a sensitive, sensible and comprehensive program with those considerations in mind. I believe that her self-help approach will eventually replace today's alcoholism treatment. Believing that you can do it is the most important predictor of successful moderation. It's also the only one. Therapy programs never work in and of themselves -- only people do. The usefulness of Moderation Management is in your hands. Keep a firm grasp.
-- Jeffrey A. Schaler, Ph.D.
1. Bandura, A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, N.J.: Prentice-Hall, 1986.
2. Strecher, V.J., McEvoy DeVellis, B., Becker, M.H., and Rosenstock, I.M. "The role of self-efficacy in achieving health behavior change." Health Education Quarterly, 13, 73-91, 1986
3. Fingarette, H. "Alcoholism and self-deception." In M.W. Martin (Ed.), Self-Deception and Self-Understanding: New Essays in Philosophy and Psychology. Lawrence, Kansas: University of Kansas Press, 1985, 52-67.
4. Gergen, K.J. "Therapeutic Professions and the Diffusion of Deficit." The Journal of Mind and Behavior, 11, 353-368.
5. Schaler, J.A. "The Addiction Belief Scale." International Journal of the Addictions, 30, 117-134, 1995.
6. Glaser, F.B. "What is Alcoholism? Treatment must be carefully matched to the individual." The Center Magazine, 18, 36-37, 1985.
7. Glaser, F.B. and Skinner, H.A. "Matching in the Real World: A Practical Approach." In E. Gottheil, A.T. McLellan, and K.A. Druley Matching Patient Needs and Treatment Methods in Alcoholism and Drug Abuse. Springfield, IL.: Charles C. Thomas, 1981, pp. 295-324.
8. Glaser, F.B. "Anybody Got a Match? Treatment Research and the Matching Hypothesis." In G. Edwards and M. Grant (Eds.) Alcoholism Treatment in Transition. Baltimore, MD: University Park Press, 1980. pp. 178-196.
Copyright J.A. Schaler, 1994.
Permission to reproduce is granted provided the article appears in its entirety with the following citation: Schaler, J.A. (1994) Foreword. In Moderate Drinking: The New Option for Problem Drinkers by Audrey Kishline. Tucson, Arizona: See Sharp Press.
