Do Alcoholics Lose Control? The Results of Priming Dose Experiments Say NO

The central claim of Alcoholics Anonymous and addiction / alcoholism treatment providers is the idea that “alcoholics” literally can’t control whether they drink or how much they drink. Some differ on the matter of whether alcoholics can even choose to have the “first drink” or not, but most seem to agree that once the alcohol from that first drink gets into an alcoholic’s body, it sets off some sort of biological reaction that causes the alcoholic to keep drinking (whether by a fully automatized process, or by triggering ‘irresistible craving’).

Without this ‘loss of control’ (or allergy) theory, the demand that alcoholics must remain fully abstinent would unravel. Further, the notion of a need for medical intervention to ‘treat’ the disease of alcoholism would unravel as well. The entire treatment system is based on the idea that alcoholics literally can’t control themselves, and that they need an outside force to stop them from drinking.

The sad thing is that today, in 2013, many people will make their first walk into a 12-step meeting or rehab, and be told that they have this disease of alcoholism, of which the main feature is ‘loss of control’, yet a series of careful experiments going back as far as 1966 have proven this notion to be false. That is, desperate people who want help will be taught that they are helpless and powerless, even though this was proven to be false almost 50 years ago!

The experiments that do the most to disprove the loss of control theory are known as “priming dose” experiments. What they do, quite simply, is test the effects of a ‘first drink’ – that is, they give alcoholics alcohol (sometimes the alcoholics are aware they’re drinking alcohol, and other times the researchers have tricked them into drinking alcohol without knowing it) – and measure whether the alcoholic continues to drink more when given the opportunity and/or whether they experience increased craving for alcohol as a result.

Researchers Nick Heather and Ian Robertson reviewed 9 separate “priming dose” experiments in their classic book, Controlled Drinking. In one experiment, the researchers detoxified hardened street alcoholics in a hospital setting. Then, they gave them nasty flavored vitamin drinks each morning to nurse them back to health. Then each day they questioned them about their level of craving for alcohol. But as you’ve probably guessed, the vitamin drinks were a ruse. On various days they would sneak a shot of alcohol into the vitamin drink. What they found was that the alcoholics did not crave more alcohol after unknowingly drinking it in the vitamin drink.

In another experiment, alcoholics were asked to taste-test a tonic water. They were given the opportunity to pour themselves several glasses of the drink. The researchers set up several conditions where the tonic either did or did not contain an undetectable-by-taste amount of alcohol; and where they modified the expectations of the alcoholics so that some would be led to believe they were drinking alcohol and others would be led to believe it was just tonic. What they found was that regardless of whether they drank the alcoholic mixture or non-alcoholic mixture, they drank far less when they believed it was nonalcoholic than when they believed it contained alcohol. This added an extra dimension to the priming dose experiment design – because, as Heather and Robertson noted:

The more important point about these experiments is the implication that drinking behaviour conventionally described as loss of control is mediated by cognitive processes and not by a physico-chemical reaction to ethanol.

So what we’re dealing with, in people who sincerely feel like they lose control after the first drink, is really just an effect of expectancy – not a biologically triggered loss of control. Remember, in these experiments, the alcoholics being studied don’t display “uncontrolled” drinking or craving after unknowingly drinking alcohol. In the simplest of terms, what this means is that alcoholics feel and behave as if they’ve lost control after the “first drink” only because they believe that they will. They “lose control” because they expect to lose control.

Such a conclusion is confirmed by several other research findings. First, most people stop drinking without seeking help, and most former alcoholics become moderate drinkers – as NESARC (LINK to NESARC data and analysis) and several epidemiological studies have shown over the years. If alcoholics are unable to control themselves, how could this be the case?

Second, it has been found that researchers can do a pretty accurate job of predicting who will “relapse” after treatment, if they give them a test about their beliefs about alcoholism. The test (LINK), questions how strongly the subject believes common beliefs about alcoholism, such as the following:

• If an alcoholic has a drink, he or she loses control and is unable to keep from getting drunk.
• People can be born alcoholic.
• Once a person is an alcoholic, he or she will always be an alcoholic.
• Every alcoholic must accept that he or she is powerless over alcohol and can never drink again.
• There are only two possibilities for an alcoholic: lifelong abstinence or death.

The researchers found that those who scored higher on the dimension of the test that included the beliefs above were more likely to relapse following treatment. That is, if you believe in this loss of control and powerlessness garbage, you’re more likely to relapse (LINK to abstract).

Third, a careful randomized controlled trial of 300 alcoholic men found that those assigned to an AA based treatment, which teaches loss of control, became 9 times more likely to binge drink than those assigned to a Cognitive Behavioral type of treatment which teaches alcoholics that they are in control of themselves. What’s more, there was a third group in the study that received no help at all, and the AA group became 5 times more like to binge drink than those who got no help. So quite literally, learning that you have no control leads to drinking as if you have no control (LINK to analysis of research).

Alcoholics do not lose control of their drinking, but when they expect this to be their response to a single drink of alcohol (or dessert containing alcohol, or use of mouthwash or other alcohol containg products), seeing “triggers” or “cues”, or the common human experiences of Hunger, Anger, Loneliness, or Tiredness – then they may indeed become more likely to drink in a manner usually described as “uncontrolled” and they will certainly have the subjective experience of feeling out of control. In light of what the research shows us, and what we know about response expectancies, we should stop teaching people with alcohol use problems that they are fatally flawed to lose control of their drinking, because it is this very teaching that will make their problems worse (not to mention the fact that it’s simply untrue).

These negative beliefs are deeply entrenched in our culture. Please share this post and spread the word – if we could destroy the myth of loss of control, we’d do our world a lot of good, and save a lot of people a lot of trouble.

The information on priming dose experiments referenced in this article comes from:

• Heather, N., & Robertson, I. (1983). Controlled drinking. London; New York: Methuen.

Of the 9 explicit priming dose experiments discussed in Controlled Drinking, the following 6 experiments seemed to disconfirm the loss-of-control model:

• Cutter, H. S., Schwaab, E. L., Jr, & Nathan, P. E. (1970). Effects of alcohol on its utility for alcoholics and nonalcoholics. Quarterly journal of studies on alcohol, 31(2), 369–378.
• Engle, K. B., & Williams, T. K. (1972). Effect of an ounce of vodka on alcoholics’ desire for alcohol. Quarterly journal of studies on alcohol, 33(4), 1099–1105.
• Marlatt, G. A., Demming, B., & Reid, J. B. (1973). Loss of control drinking in alcoholics: an experimental analogue. Journal of abnormal psychology, 81(3), 233–241.
• Merry, J. (1966). The “loss of control” myth. Lancet, 1(7449), 1257–1258.
• Paredes, A., Hood, W. R., Seymour, H., & Gollob, M. (1973). Loss of control in alcoholism. An investigation of the hypothesis, with experimental findings. Quarterly journal of studies on alcohol, 34(4), 1146–1161.
• Paredes, A., Ludwig, K. D., Hassenfeld, I. N., & Cornelison, F. S., Jr. (1969). A clinical study of alcoholics using audiovisual self-image feedback. The Journal of nervous and mental disease, 148(4), 449–456.

The following 3 fail to confirm the loss of control model:

• Hodgson, R., Rankin, H., & Stockwell, T. (1979). Alcohol dependence and the priming effect. Behaviour research and therapy, 17(4), 379–387.
• Ludwig, A. M., Wikler, A., & Stark, L. H. (1974). The first drink: psychobiological aspects of craving. Archives of general psychiatry, 30(4), 539–547.
• Stockwell, T. R., Hodgson, R. J., Rankin, H. J., & Taylor, C. (1982). Alcohol dependence, beliefs and the priming effect. Behaviour research and therapy, 20(5), 513–522.

And of those listed above, the following 4 studies provide support for the significance of cognitive factors such as expectancy:

• (Stockwell, Hodgson, Rankin, & Taylor, 1982)
• (Engle & Williams, 1972)
• (Marlatt, Demming, & Reid, 1973)
• (Ludwig, Wikler, & Stark, 1974)