Practical issues in selecting and using treatment goals with severely dependent alcohol abusers

Practical issues in considering abstinence or moderation drinking goals for severely dependent alcoholics are discussed from three different perspectives: (1) factors associated with the client; (2) therapist considerations; and (3) factors stemming from the service-providing institution’s policies and concerns. Distinctions are made between moderate drinking defined as: a goal choice, a treatment training procedure, and short-term drinking outcome, and a stable outcome pattern over a long term. While current studies show that moderate drinking is a relatively rare stable outcome pattern in severely dependent alcoholics, a sizable minority of alcoholics in treatment express a preference for moderation as a goal choice. Potential benefits and risks of moderation as a planned goal are presented. Guidelines for selecting appropriate candidates for a sanctioned moderate drinking goal are discussed.