HARM REDUCTION FOR ALCOHOL-PROBLEMS - MOVING BEYOND THE CONTROLLED DRINKING CONTROVERSY

Controlled drinking has long been a controversial topic in behavior th erapy. The historical context of this debate is reviewed, with special attention paid to the pioneering research conducted by Mark and Linda Sobell (the first behavior therapists to publish a controlled trial o f controlled drinking with alcoholics). After updating the research fi ndings and predictors of controlled drinking with alcohol-dependent dr inkers, literature on the effects of moderation training (including br ief interventions) designed to reduce the risks of alcohol abuse is re viewed. As an illustration of this approach, preliminary data are pres ented from an ongoing study investigating the effects of a stepped-car e secondary prevention program for high-risk adolescent and young-adul t drinkers. Throughout the paper, harm reduction is presented as an ov erarching model of behavior change that encompasses both controlled dr inking for alcohol dependence and moderation training in the preventio n and treatment of alcohol abuse. Unlike abstinence-only or ''zero-tol erance'' approaches, the harm-reduction model supports any behavior ch ange, from moderation to abstinence, that reduces the harm of problems due to alcohol.