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Can Alcoholics Learn to Drink Less?

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Kern says that his approach suggests moderation as the initial goal for all drinkers, but for some, it simply will not work. When, after repeated failures, they realize that moderation is not possible for them, the idea of becoming abstinent becomes a bit easier to take than it might have been were it offered as the first, and only, option, he says. "Every single person in AA has tried moderation management," he says. "They just did it on their own, without the [World Health Organization] guidelines, techniques, and tools we provide to support them."

Among the available tools are medical alcohol deterrents -- from the old-standby Antabuse, to gentler, safer drugs like naltrexone (ReVia) and acamprosate. Already available by prescription in the U.S., naltrexone, which some believe can be used indefinitely as needed, can help curb the urge to drink and reduce alcohol intake. Acamprosate, which is expected to gain FDA approval within the year, can help weaned drinkers maintain abstinence. Unlike Antabuse, neither of these new drugs causes physical illness if taken with alcohol.

When moderation attempts fail, says Max A. Schneider, MD, clinical professor of addiction medicine at the University of California-Irvine College of Medicine, it's likely the person is among the one in 10 drinkers who are especially sensitive to alcohol's brain-altering effects.

"They may not even feel the buzz," he tells WebMD, but the brain alterations that lead to compulsive drinking "are there nonetheless." Each drink brings these individuals a step closer to addiction, he says. Schneider also is immediate past chairman of the board of directors of the National Council on Alcohol and Drug Dependence, and a past president of the American Society of Addiction Medicine.

According to Schneider, the evidence that alcoholism is a disease with genetic elements is overwhelming and undeniable. "Docs who still think [otherwise] are living in the 1950s and don't know what they're talking about," he tells WebMD. "It has nothing to do with willpower, it has to do with brain cells, and what we end up with is a disorder, a brain disease." And for these people, moderation is no more realistic a goal than trying to will oneself taller.

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