Still difficult to know what alcohol dependent individuals can return to controlled drinking: comments on Dawson et al. (2005).

© 2005 Society for the Study of Addiction Addiction, 100 , 293–298 challenge could now be made to leaders in the alcohol treatment field in the United States. Low-risk drinking outcomes are a documented pathway to recovery in the United States as in other countries. Importantly, having moderation services available could facilitate such recoveries. Yet, advocacy for such services, even by government agencies, is virtually non-existent. Although it could be argued that the National Institute on Alcohol Abuse and Alcoholism has advocated for drinking reduction goals in primary care settings, such recommendations have been limited to those who are not alcohol dependent. The Dawson et al . study, in contrast, focused on thousands who at some point in their lives met diagnostic criteria for alcohol dependence. National initiatives to provide moderation services for people whose problems are not severe but who meet the criteria for alcohol dependence should be a public health priority. In the remaining space, we outline what might constitute appropriate services: 1 Public information and education showing that recovery from alcohol problems without treatment is not only possible but also frequent. Such a strategy would increase the number of people attempting to change on their own, and also the number who succeed. For those who are not successful the attempt may increase their readiness to seek help, a finding demonstrated in a recent community-based mail intervention [6]. 2 Government funding to provide moderation services and to further study alternatives to abstinence. This would have the advantage of attracting people with less serious alcohol problems to treatment, which in turn would broaden the base of treatment services [7]. 3 Training health-care providers and addiction counselors to competently provide moderation services. Because many counselors in the United States have strong ideological biases against moderation goals, and because training in moderation services is not usually a part of one’s career training, it is not realistic to expect such counselors to provide moderation treatment competently without training. As shown in several studies, including that by Dawson et al. , many people with alcohol problems can and do succeed at reducing their drinking to low-risk levels. It is time for alcohol treatment providers in the United States to bridge the gap between research and practice by tearing down the wall. Such an expansion of services is necessary if we are to address comprehensively the needs of individuals with alcohol problems.