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Although moderation and harm reduction approaches to the treatment of alcohol problems are accepted in many parts of the world, they continue to be rare in the US. A major reason for this state of affairs has to do with the way alcohol treatment services in the US developed, and in particular the creation of a group of paraprofessional counselors many of whom attributed their recovery to the 12-step philosophy. While it is unlikely that these counselors will offer moderation services, the provision of services to problem drinkers in primary care medical settings presents a promising alternative. [ABSTRACT FROM AUTHOR]

Controlled substance use as a goal of treatment is controversial. Acceptance seems to vary by country and by type of service but has been studied mostly in hypothetical cases. Observation of regular practice in outpatient treatment services of The Jellinek, Amsterdam, reveals how often controlled use is actually chosen, how this goal is communicated and how it relates to treatment outcome. Twenty-one counsellors were surveyed and files of 202 randomly selected clients investigated. Controlled use as a treatment goal is mostly the result of negotiation; temporary abstinence is more often proposed by the counsellor and abstinence more often by the client. Factors influencing choices are described. Controlled use is related to lower dropout than temporary abstinence but temporary abstinence is related to better treatment outcome. It is concluded that controlled use can enhance treatment retention but the results discourage too lenient an attitude towards acceptance. [ABSTRACT FROM AUTHOR]