Status: 12/10/2022 5:06 p.m
For a long time, abstinence was the only treatment for alcohol addiction. But staying completely dry is difficult for many. Experts therefore propose a new treatment: controlled drinking.
A glass of wine, a beer after work, sparkling wine to toast – alcohol is part of our culture. In international comparison, according to the Organization for Economic Cooperation and Development (OSCE), Germany is one of the high-consumption countries when it comes to alcohol.
More than a glass of wine every night is risky
Every tenth adult in Germany consumes an average of ten liters of pure alcohol a year. That’s 200 liters of beer or a good 80 liters of wine. The line between pleasure and addiction is narrow. Drink according to the Robert Koch Institute 14 percent of all women and 18 percent of all men consume alcohol in risky amounts. According to the German Head Office for Addiction Questions, risky means in healthy people Women more than 12 grams daily and men more than 24 grams daily of pure alcohol. For comparison: a 0.33 l beer bottle contains 13 g alcohol, a 0.2 l wine 18 g.
The number of unreported alcohol dependent people is high because the problem is often not recognized, explains Maurice Cabanis, Director of the Clinic for Addiction Medicine and Addictive Behavior at the Stuttgart Clinic. Many alcoholics do not admit their addiction for years, often out of shame.
The professional groups and social classes to which alcohol dependent people belong are as diverse as the causes of an addiction. Possible reasons can be biographical or genetic, but also learned mechanisms, for example if one beer after work turns into several or you start drinking earlier and earlier in the day. But abstinence as the only goal is a deterrent for many alcohol addicts. This is one of the main reasons why only about one in ten of them seek help and start therapy.
With controlled drinking to therapeutic success
Experts are therefore increasingly classifying controlled drinking, in which alcohol is not completely forbidden, as a new promising method in the treatment of alcoholism. Joachim Knörkel, Professor of Psychology at the Evangelical University in Nuremberg, developed the program. A large Europe-wide study with older people, the so-called Elderly Study, had refuted the need for abstinence in 2020. It has been found that many older people are not ready for abstinence, but they are ready to reduce their alcohol consumption.
After a comprehensive diagnosis at the beginning of the treatment, anyone who decides on controlled drinking learns how to deal with alcohol in a healthy manner in ten steps. This includes, for example, recognizing possible risk situations. Those affected also deal with how much alcohol is contained in certain drinks.
Another important step is to keep a drinking diary. In it, your own alcohol consumption is noted and specific drinking goals are set: How much am I currently drinking and how much less do I want to drink in the next week? The aim is to reduce consumption step by step. Participants often attend a follow-up group after the program. Exchanging ideas with others makes it easier for many to deal with dangerous situations.
Abstinence used to be the only option
For a long time, abstinence, i.e. abstaining from alcohol altogether, was considered the only treatment option. Even today, abstinence training and detoxification are still the classic therapeutic measures, which are also financed by health insurance.
This is mainly based on an understanding of the disease from the 1960s. For example, Elvin Morton Jellinek’s book “The Medical Disease Model of Alcoholism” published at the time stated that the tendency to alcoholism was largely genetically determined: either one was an alcoholic or not, there were no gradations. It was impossible to learn how to drink under control.
Better chances with combined therapies
Today, controlled drinking is not a doctrine and is not yet recognized by the pension insurance and is therefore not financed in inpatient rehabilitation. Nevertheless, it now has a firm place in therapeutic work and is spreading more and more in addiction clinics. It is scientifically studied and helps many. In the end, 20 to 30 percent of the participants achieve abstinence through the program.
In addition to controlled drinking and abstaining from alcohol, medication can also help to reduce addiction. Some even trigger alcohol intolerance – if you drink, you vomit. However, experts believe that purely medicinal treatment without accompanying therapy is not sufficient, since the probability of a relapse is very high.
Regular attendance at a self-help group is also important for many alcoholics in order to get their addiction under control in the long term. Online offers and self-learning approaches can also help. According to experts, however, it is important that people addicted to alcohol are offered various therapeutic approaches.