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As far as I'm concerned, yes.I am well aware many not only don't see it as beneficial, they see religious/spiritual dynamics as a distraction from effective therapy. Others are adamant religion is counter to the therapeutic process. I don't happen to.My task is to find out what aspects of their life are not working for them and what resources are able to be enlisted. Sometimes it's relatives, sometimes its determination, and sometimes it's spirituality. Each patient has levels of awareness, skill, energy, and ability which help or hinder their therapy. I always ask what level of religion or spirituality they have left. That gives me a reading as to other aspects which may have contributed to their problem. I don't care which form they have, but if it isn't being used for an asset I need to know. Also if they indicate it is part of their system of belief/faith, I'm going to insist they use it. True spiritual stuff is supposed to counteract fear. Control is directly oppositional to faith. So if spirituality is a major professed aspect of their life, then why isn't it being utilized? It's supposed to be an adjunct to therapy, not a deficit. In addition, the original meaning of Psyche is about your soul.Where I run into trouble is when they use God as a magical Santa Claus who brings presents and miracles when you are good or calamity and evil if you are bad. They are promoting the idea of 'let's make a deal' with God. Psychologically it is a form of victim. No real choice other than be a leaf in a stream floating along with the forces of nature.. That magical belief allows them to not empower themselves. They've taken the idea of there is a reason for everything, and justified not taking responsibility. But they see it as Gods hidden reason so they are not even able to make decisions. They are just a spiritual sufferer and are being tested by God for some unknown punishment or learning test. They are basicly a pawn in Gods greater plan. It's such a niëve view of both religion and spirituality.Here is a list of where religious indoctrination can go wrong and in the guise of righteousness, twisting mental health into pathology.Toxic Faith Warning Signs ModifiedWhen a religious belief views God as only a cold, critical, harsh, distant taskmaster rather than an approachable, loving deity, we deny the power of God’s compassion and grace.When we base a positive relationship with God on only upon our ability to perform specific spiritual duties and believe God does not love us because we don’t pray, read our sacred text, or attend specific places of worship. Sadly, millions of devotees think God gets mad at them if they don't perform these and other duties perfectly. As a result they struggle to find true intimacy with their God.When a religion places primary emphasis on doing external things to show others they have been accepted by God. People deceive themselves into believing that they can win God's approval through a specific religious dress code, certain spiritual disciplines, particular music styles or even doctrinal rigidity.When a religious spirit requires exacting traditions and formulas to accomplish their particular spiritual goals. They end up only trusting in specific liturgies, denominational policies or man-made programs to obtain results that God alone can give.When the religious processes becomes joyless, cynical, and hypercritical. This can turn a home or a sacred place into a controlling, bitter, resentful experience. Then, whenever genuine joy and love are expressed, it becomes a threat to those who have lost the simplicity of real faith.When a religious spirit becomes prideful and isolated, thinking that their righteousness is so special that they cannot even associate with believers who have differing standards. Churches, synagogues and mosques which allow these attitudes become extremely elitist and dangerously vulnerable to deception, power-mongers and cult-like practices.When a religious spirit develops a harsh, judgmental attitude toward what they call sinners, heathens, or Satanists. Those typically are the same people who struggle with their own internal, sinful habits which they themselves cannot admit to anyone else. These people rarely interact with any non-believers because they don't want their own superior righteous morals, possibly tainted or altered by them.When a religious spirit rejects any progressive revelation and refuses to embrace change. This is why many religious institutions become irrelevant in advancing society. They become so focused on what God did 1000, 2000, or even 4000 years ago, they become stuck in a kind of time warp, refusing to move forward when the Holy Spirit enlightens new understandings.When a supposedly spiritual person persecutes those who disagree with their self-righteous views and they become angry whenever the message of grace threatens to undermine their righteous religiosity. A threatened, angry, religious person believes they are justified in using gossip and slander to assassinate other peoples' character, and will even resort to violence to prove their point; God is only on their side.In Christianity, Jesus warned His disciples: "There will even come a time when anyone who kills you, will think he's doing God a favor" (John 16:2)NIV.For me, it seems people do this as a belief, without the real authorization. They just do what they want to and justify it.I have patients walk through their beliefs and faith, then work to get them to upgrade it so it isn't something they just talk about or mechanically recite. I want it to be where where the rubber meets the road and they utilize it functionally as a lifestyle. They have everyday life problems and are supposed to be using their religiosity as a model for improving that life by making it function for them when calamity occurs. I have a background in world religions so this is an area I am comfortable working without having to impose my specific beliefs. I see their spiritual journey as an adjunct to their mental health development.Here are therapist spiritual competencies endorsed by the American Counseling Association (ACA)Addressing Spiritual and Religious Issues in Counseling(ASERVIC)Culture and Worldview1.The professional counselor can describe the similarities and differences between spirituality and religion, including the basic beliefs of various spiritual systems, major world religions, agnosticism, and atheism.2.The professional counselor recognizes that the client’s beliefs (or absence of beliefs) about spirituality and/or religion are central to his or her worldview and can influence psychosocial functioning.Counselor Self-AwarenessThe professional counselor actively explores his or her own attitudes, beliefs, and values about spirituality and/or religion.The professional counselor continuously evaluates the influence of his or her own spiritual and/or religious beliefs and values on the client and the counseling process.The professional counselor can identify the limits of his or her understanding of the client’s spiritual and/or religious perspective and is acquainted with religious and spiritual resources, including leaders, who can be avenues for consultation and to whom the counselor can refer.Human and Spiritual DevelopmentThe professional counselor can describe and apply various models of spiritual and/or religious development and their relationship to human development.CommunicationThe professional counselor responds to client communications about spirituality and/or religion with acceptance and sensitivity.The professional counselor uses spiritual and/or religious concepts that are consistent with the client’s spiritual and/or religious perspectives and that are acceptable to the client.The professional counselor can recognize spiritual and/or religious themes in client communication and is able to address these with the client when they are therapeutically relevant.AssessmentDuring the intake and assessment processes, the professional counselor strives to understand a client’s spiritual and/or religious perspective by gathering information from the client and/or other sources.Diagnosis and TreatmentWhen making a diagnosis, the professional counselor recognizes that the client’s spiritual and/or religious perspectives can a) enhance well-being; b) contribute to client problems; and/or c) exacerbate symptoms.The professional counselor sets goals with the client that are consistent with the client’s spiritual and/or religious perspectives.The professional counselor is able to a) modify therapeutic techniques to include a client’s spiritual and/or religious perspectives, and b) utilize spiritual and/or religious practices as techniques when appropriate and acceptable to a client’s viewpoint.The professional counselor can therapeutically apply theory and current research supporting the inclusion of a client’s spiritual and/or religious perspectives and practices.None of this indicates it is appropriate to say: "Have you been saved?"Thanx for the A2A by Pete

A2A. (See, I promised that I’d come back and give a thorough answer!)Some housekeeping:First, I have UN-MERGED this question. Someone had merged it with “what do forensic psychiatrists do?” I have reversed the merge because the questions are not the same. We may do similar things, but hardly the same.Second, as I stated in my comment to the OP above, there are actually quite a few questions along this line already answered on Quora, but the answers vary considerably from useless to thorough. And, there are more that are useless than thorough. I would say that Dr. Brams’ answers on this topic are always spot on, and I see that she has also provided an answer here. So I’ll add my two-cents, along side hers.Third, please consider that my answer will be long winded because I am providing my answer based on my unique training as both lawyer and psychologist.On to my answers…So… your client would be whom?I would agree that the biggest difference between neuro/clinical/counseling psychology and forensic psychology is the client. Rather than a doctor/patient relationship, the relationship obligation is USUALLY to the court. But this isn’t always the case either. Sometimes it’s a correctional facility. Sometimes it actually IS the patient themselves. For example, in a small town you may have been treating a patient for 1+ years, and then be called to court. In that case things get tricky, but your obligation remains to your patient; even though you may be a forensic psychologist, your duty in that unique situation is to your patient. However, usually, the court has referred to you, and the court is expecting that you are making psychological conclusions that will benefit it - the court. As you might expect, this invites some consent issues with patients. The issue of consent is a bit different in forensic cases.So… where would you work?You could be (as is most often the case) in private practice. I would certainly argue that private practice is the most lucrative option. In other words, there is money to be made in private practice. However, rare is the newly minted graduate that hangs out a shingle and starts a practice as a forensic psychologist! To get into private practice you’d need either very specific post-gradate training in the field of forensics, or need to have a working relationship with a seasoned forensic psychologist. However, it isn’t impossible. If you were in a small town (as I am) and the judges know that you are available, and if you have adequate supervision to conduct forensic assessments, you might very well be able to build a practice from the ground up. However, most forensic psychologists have years and years - decades even - of building up time in courtrooms, familiarizing themselves with the system and the concepts. I also know at least a handful of psychologist/attorneys… so that’s certainly another fast-track to understanding the overlap. I discuss the unique legal services a Ph.D./J.D. can offer, way down below.You might also work only in a correctional facility and never see a court room, however most of these folks would consider themselves “correctional psychologists.” Additionally, a forensic psychologist may spend most of their time in a state hospital. For example, Terrell State Psychiatric Hospital in Texas has a forensics wing, where adults are housed who are either waiting to stand trial on competency issues, or who have been found NGRI or some variation thereof (not guilty by reason of temporary insanity). I’ll note, however, that this defense is not very often successful.Lastly, you can technically be a forensic psychologist that works primarily in research and public policy - although this is much less common. This person would spent a lot of time researching and publishing on forensic psych science, or, might be a faculty at a university’s psychology department, be a forensic faculty member at a medical school’s forensics residency program, or possibly on the faculty of a law school.The simple answer: usually time split between office/courtroom/airplane/car.So… what would you actually be doing?Unfortunately, the term “forensic psychology” is such a massive umbrella that if you were to see “Ryan R. Cooper, Ph.D. | Forensic Psychologist,” you’d haven’t a clue what the hell I ACTUALLY did. By far, the most common thing a forensic psychologist “does” is psychological evaluation.Mental State. This would be anything from determining whether a defendant understands the court system and his or her role in it (that they’ve been accused, what the judge does, etc.) and this is usually known as competency to stand trial, or “competency evaluations.” Another type of evaluation is a “capacity evaluation” to determine whether the defendant had the capacity to appreciate his crime… this might be referred to as mental capacity, mental culpability, or mens rea - as opposed to actus reus - or, the act of the crime (for most crimes the state must prove the act and the mindset both… the latter is where a psychologist can help). The mental aspect required in a criminal trail, say for homicide or theft is NOT the same as that for a tortuous action, like assault/battery… and a psychologist can help with all of these areas. Negligence is another realm.Custody. Another type of evaluation commonly conducted by forensic psychologists is custody... this might be the MOST common; I’m not sure. These are usually very lengthy and are best described in this way: a hot mess. This is the sh*t that judges are like… “omg… please leave my courtroom and go let someone else hash this mess out, I can’t make heads or tails of anything.” Enter, the awesome forensic psychologist. All states that I’ve looked into have VERY strict laws surrounding the ethics of what must be included in a custody evaluation. For example, psychologist are sanctioned EVERY SINGLE MONTH in Texas for performing inadequate custody evaluations. Usually, it’s because a psychologist (or counselor) didn’t realize they were conducting a custody evaluation. But every time you get the stand and opine as to whether one parent is as fit as another (and sometimes even if you opine as to only one!), then you’re giving testimony related to custody and the ethics of custody evaluation come in. For example, you must evaluate BOTH parents, equally. You should evaluate the children as well. You cannot give an opinion having only seen one parent. Nope. Sounds like common sense, but you’d be surprised. Custody evaluations are very lengthy, require a lot of paperwork, and a lot of mental energy. For this reason, they are very EXPENSIVE. One anonymous psychologists’ “custody evaluation” I once reviewed consisted of a single MMPI-2 given to mom, and to dad, and 30 minutes of an “intake” with each. The cost was $500 to mom, $500 to dad. This is an example of how NOT to perform a custody evaluation. At the forensics firm I’m associated with, our custody evaluations are VERY extensive and consists of often 10–20 tests. I would say it is more common to see a custody evaluation cost 1000–2000 for evaluating mom, the same for dad, and about the same or slightly less per child. So a good thorough evaluation will cost more like $5,000+ for the family.Lie Detection. Though not really always in the tool belt of forensic psychologists, many do offer this service. I’ve considered getting training in this area, but don’t have the time. I am fascinated by it, but the key to being a good forensic psychologist is knowing more than how to read out results… but understanding what the hell they DO and DON’T mean. E.g., just because a lie detector says someone is lying, doesn’t mean they are; it means that their heart rate went up, and they started sweating, etc. Funny: A woman walks into the room wearing a purple dress, and leans against the wall. The Judge says to two psychologists: “what is the color of the woman’s dress?” The clinical psychologist says “purple.” The forensic psychologist says “well, all I can tell you for certain is that the front half is purple, because that’s all I can see.” That story beautifully illustrates the savvy a forensic psychologist needs to understand and explain how testing actually works!Sex Offender Evals. Exactly what it sounds like. Psychologists are often called upon to help predict - to the limited extent possible - the chances of recidivism for sex offenders. We can also help courts understand what is possible and what isn’t… for example, there is no real “cure” for pedophilia, and a psychologist can get on the stand, or meet in chambers to help explain the reality of pedophilia, or sex addiction, and such explanation can help the judge do their job better. One form of testing in this realm that remains in use (not by me fyi lol) is the penile plethysmograph. Often used to determine whether a sex offender can control their arousal, it’s most certainly a way to test the truth of a defendant saying: “I’m cured, I’m now disgusted by rape” or “ I’m cured, I’ll not longer attracted to children.” The test will absolutely verify the truth of such a statement. However a good forensic psychologist will be able to explain these limitations. For example, does getting an erection MEAN that the defendant will act on the arousal? No. Could people NOT so inclined be aroused by suggestive stimuli? Yes. So there are a lot differing opinion in the evaluation of sex offenders, and the forensic psychologist must be very familiar with all perspectives… and check their own biases at the door. Also pencil/paper tests for sexual deviancy are not that great, either, psychometrically.Police Evaluation. This is, again, not done by all forensic psychologists, and sometimes a non-forensic private practice psychologist will do this. This could entail evaluating a new police officer to determine whether they are a good candidate to serve on the force (L3 Eval in Texas). It could also entail re-evaluating a police officer to determine whether they are fit for duty after xyz event, or just after xyz number of years. The American Board of Professional Psychology (ABPP) actually offers a board certification in Police and Public Service Psychology (as well as board certification in, obviously, Forensic Psychology).Neuropsychology. This is a highly specialized area, and I only know of one psychologist that is extremely - I mean EXTREMELY - familiar with both forensics and neuropsych… and I’m lucky to count him among my list of mentors and friends. To offer neuropsych testimony, a psychologist needs to have not only the same understanding of the legal system that a forensic psychologist has, but also a savvy understanding (well beyond grad school) of the human brain and how it affects certain behaviors (and the ability to discuss it in layman’s terms!). While some non-neuropsychologists may be able to hold their own in an advanced discussion of Autism or ADHD, diagnosing a brain disorder is a big deal, and very few psychologist will make such a diagnosis without extensive neuropsych training. A neuropsychologist will be prepared to talk about Broca’s area and how it is indicated in test results… or a severe visuospatial deficit and how it affects daily living… or Theta/Beta Ratio and how it can help explain a dx of ADHD, more so than rating scales, like the Conner’s can (not very diagnostically useful, IMO).Trial Sciences. This area is not reserved to psychologists by any means. The National Association of Trial Consultants, for example, is open to LOTS of types of professionals. However, I’d say over half are probably psychologists. Trial sciences is probably more of what I’d consider the true PSYCHOLOGIZING of LAW… rather than merely offering psychological service, in a legal context. Trial sciences applies psychological principles to the legal system itself, rather than just the defendant or the players in that system. What is this judge like… what result can we predict from her or him based on their rulings, their personal life, their demeanor? What about jury members? Do you want blue collar? White collar? Do you want parents on the jury, or bachelors? … some of this is dramatized in the HBO series Bull. I find the show to be rather boring and unbelievable. However, it has moments of truth. In fact, it’s a dramatization of Dr. Phil’s early days as a trial consultant (which is how he met Oprah, btw). While the show is BS in a lot of ways, it’s underpinnings are spot on. GOOD trial consultants will apply psychological principles to the “players” in the court. I once published an article on applying psychodynamic principles to the process of voir dire.Therapy. I’m throwing this in here, because I’ve personally had attorneys reach out to me, expecting that I can offer some magical therapy to them, since I’m familiar with “their world” in a way that a non-me therapist wouldn’t be. But the reality is this: REAL therapy requires no such familiarity. In fact, such a pre-existing schema might actually hamper therapy. I’m not sure. Would depend on the therapist’s own level of self-awareness I suppose. Now, on the other hand, a “forensic psychologist” may very well offer true individual therapy, or even group therapy, in the state facility to inmates. For example, most of the pre-doc internships in “forensic psychology” at the US Department of Corrections will have interns doing both assessment/evaluation as well as individual and group therapy in the institution.Teaching/Research. This applies to all psychologists, but forensic psychologist (in my personal opinion) are in a uniquely higher demand because they have the same training as the clinical psychology professor (they can teach personality theory, history and systems, psychometrics, etc.) but they also have this rare perspective to add on to their instruction and mentorship (particularly suited to teach courses in legal psychology, professional ethics, comprehensive assessment, etc.).You didn’t ask this, but I’ll answer it for any Quoran’s who may stumble upon this discussion:We’ve explored how psychology can spill over into law……………HOW DOES THE LAW SPILL OVER INTO PSYCHOLOGY?A psychologist who also holds a J.D. and a license to practice law can be VERY helpful to the field of psychology.First, they will make great forensic psychologists, as I’ve discussed above.Second, they MAY also be uniquely qualified to represent patients and practitioners in malpractice claims. If you were suing a psychologist (or you were a psychologist being sued) wouldn’t it make you feel better to know that your attorney was also a psychologist and understood all of the ethical principles, training models, personality theories, therapy interventions that you use in everyday practice? Hell yes!Third, they will be very helpful in dealing with insurance companies (think, whether the contract between Dr. X and Insurance X is ambiguous or clear? Did a renewed contract have adequate consideration?) and licensing boards (if a psychologist is sanctioned or in jeopardy of having their license suspended).Fourth, they will be helpful at advising on small legal matters that other attorneys would be just fine at, but psychologist/attorneys will be more empathic to. For example, should you set up your practice as a LLC? Corporation? And if so, S-Corp or C-Corp? What about your business name? Must it be registered? Should you trademark anything? If you are a research psychologist developing psychometrically sound assessment of malingering on ADHD scales, how and when do you copyright it, and should you get a patent on your process? What if it’s all online? Is that intellectual property? What if you die? Correction… lol… since you WILL die… what happens then? Have you told your patients? (Hint: all my patients know exactly what happens to their charts if I’m struck by lightening today!) If you are subpoenaed by a court to turn over your chart must you? What about your raw testing data (like raw IQ subtest scores)? What about your personal working notes? What about copyrighted test material that Pearson or PAR or MHS, the publishers, have copyrighted? If you do turn it over, can Pearson then sue you? Can you do therapy on Skype? (Hint: NO). If you find a HIPAA-compliant service (Hint: Telehealth 365 is free), can you then see people for therapy in other states using it? These are just SOME questions of a legal nature that will come up in practice.… wouldn’t it be nice if there was a psychologist out there that understood all of this, AND was a lawyer? The good news… there’s a small population of PhD/JD or PsyD/JD folks in the United States… but it’s certainly a small population.Wait… why did you un-merge the question from psychiatry?In brief, I do not believe that forensic psychiatry and forensic psychology are at all alike. The ONLY way a forensic psychiatrist gets training in the MMPI-2, MMPI-A, PAI, PAI-A, PAI-RF, all the wack rating scales that they (and we) use, and the hundred or so other tests that I keep in my office… is if they do a residency that includes psychometric training. Psychologists use a lot of measures because it’s the best we have… but we KNOW the limitations (or should). There’s a great book on this: Correcting Fallacies in Educational and Psychological Testing. A psychiatrist is not usually going to be able to explain anything other than “he had a full scale I.Q. of 97, and that’s average.” If you said, “wait, wait, what does that MEAN?” … they probably won’t know. Because they are physicians… not academic researchers trained in test construction.The way in which a psychologist makes an assessment of a person is extremely complex… we don’t spend ten years in school designing ink blots (ok, I did when I got bored once in History & Systems). And differential diagnosis is the BREAD AND BUTTER of a psychologist. It’s what we do. We live and breath “taking complex cases” and “making sense of them.” … and then “explaining the intricacies of doing so in easy-to-understand terms.” While I’m sure some psychiatrists have been trained to do this, I have never met one. Then again, I’m young and my time in the field is fairly short so far. However, I’ve networked a lot… and have not met a forensic psychiatrist who can explain the processes and psychological workings of the human mind the way a psychologist can.Probably because they study the human brain, primarily… not the psychological, sociological, philosophical, and spiritual essence of mind that better explains that brain.So… (1) I told you my answers were long-winded, but usually very informative and well-thought out. (2) This answer only scratches at the surface.I also didn’t go into the kind of money that you can earn as a forensic psychologist because I have contracts that prevent me from talking about that specifically. But is is an important aspect of deciding whether you want to go into the field of forensics.If you have any other specific questions, please let me know… I really love helping people understand our profession(s).All my best on your journey to determining where your interests lie my friend!Reach out anytime,-R.

"I've met some remarkable ex-alcoholics who became controlled drinkers. I sat with one woman while... she told me about how difficult it was at first for her to try a drink with her family around the Christmas holidays since she had been taught that one drink meant she would relapse. She told me that after achiving controlled drinking for several years, she realized that she would have not been able to attain a certain level of maturity and self-confidence if she had continued to believe that she had no control over her drinking. To hear her reveal her agonizing over her emotions related to her struggle to become a controlled drinker, and how prevailing dogma made it more difficult for her to become what she defined as more healthy, convinced me that controlled drinking is possible for some ex-alcoholics and that to deny that possibility is to keep a subset of people dependent and unhealed." --Rick Doblin, founder of MAPSWhile, this woman's struggle to overcome alcoholism, which ended in supposed controlled drinking appears to be clear and believable history; it is, in fact, anything but that. Complicationg the matter is controlled drinking: the belief that an abuser of alcohol can learn to safely manage his or her intake (Bruns & Hanna). Controlled drinking contrasts sharply with the disease theory of alcoholism, which maintains that complete abstinence is the only cure. Those who hold this view would conclude that, in the above case, she wasn't a true alcoholic, an issue that, as it relates to this case, is impossible to resolve. However, there have been many attempts, by various studies, to resolve this issue entirely. These studies as well as many others have fueled the conflict between controlled drinking and abstinence, labeled as an "emotionally highly charged debate.. [which] ranks with other similar furious controversies of the past" (Glatt).History of the ProblemThe origin of the total abstinence approach can be traced to Alcoholics Anonymous (AA); an intensely spiritual based treatment program that was founded in 1935, centered on the belief of powerlessness over drinking and abstinence as the only goal in recovery. A view unchallenged until the 1940s and 1950s when a variety of treatment plans emerged, including some with moderation in drinking as a goal. Several studies reported non-abstinent goals as successful in these early programs. With sucess being defined as the remission of alcohol-related problems (Bruns & Hanna).Then in 1960 Jellinek, an early pioneer in the alcoholism field published the landmark work, The Disease Concep of Alcoholism. Jellinek conceptualized alcoholism as a disease, and to encourage understanding of this theory he categorized five different types of alcoholism. Two of these, the gamma and the delta, are characterized by a loss of control. While Jellinek was clear in stating that this view was only a conception and not a delaration of actual disease, two distinct groups began to surface in the alcohol field: those that supported the disease concept and those who did not (Bruns & Hanna).Then in 1964, with the abstinence approach dominating the field, being held by AA and the American Council on Alcoholism, Davies reported that 7 out of 93 treated British alcoholics had returned to moderate drinking (Peele, 1987). Davies' report was met with extremely negative criticism, mostly from physicians that cited their clinical experience. However, a small amount of responses shared and expanded Davies' findings. Myerson and Selzer claimed that the hostile atmospher surrounding such results stifled genuine scientific debate and stemmed in part from the involvement of many recovering alcoholics in the field who tended to preach rather than practice. Selzer experienced similar hostile reactions in 1957 when he reported 13 of 83 subjects achieved modreation (Peele, 1987). Glatt also reported that among his own patients a small minority were able to return to moderate drinking usually for only a small amount of time, and under certain conditions; such as when cheerful but not when depressed or tense. Yet, in his 1965 paper he maintained that "total abstinence remains the only safe way for the alcohol addict" noting that "the occurrence of such exceptions, obviously is highly important from the research aspect, and calls for intensive research."Numerous studies through the 1060s and 70s did emerge, many revealing a substantial rate of successful non-abstinent remission from alcoholism. The outcomes of these studies showed nearly 1 year after leaving a hospital, there was 23% abstainers (Pokerny et al.). In another, conducted by Schuckit and Winokur, focusing on woman alcoholics treated in psychiatric hospitals there were 24% controlled drinkers compared to 29% at a 2 year follow-up. Also, in a study of in-patient group therapy by Anderson and Ray there wer 44% controlled drinkers compared to 38% abstainers. While these studies showed an impressive amount of controlled-drinkers there are two particular studies of the period that managed to cause the most turmoil, those of the Rand Corporation and those of the Sobells'.The Sobell study which is "the most frequently cited research on the benefits of moderation therapy" (Peele, 1986) was conducte in 1970-71 by Mark Sobell and Linda Sobell at the Patton State Hospital and studied 20 alcoholics who were taught moderation-drinking techniques. This included problem solvign skills, stress reduction techniques, electrical aversive conditioning, and a variety of behavioral self-management techniques intended to shape moderate drinking (Bruns & Hanna). The study's primary goal was to compare the success rate of traditional abstinence based programs versus controlled-drinking therapy. The study reported that (although relapse was not uncommon for either the controlled drinking group or the abstaining group,) controlled-drinking therapy caused significantly fewer relapses (Peele 1986). The prestigious journal of Science published a refutation of the Sobells' study reporting numerous instances of relapse by controlled-drinking subjects. At least one of the authors of the repudiation, in several interviews, claimed that the Sobells had committed fraud. However, the Addiciton Research Foundation of Ontario formed a panel to investigate the charges raised in the article and cleared the Sobells of accusations that they had committed fraud. An investigation was also conducted by the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) which further claimed the Sobells didn't commit any serious wrongdoing. Meanwhile, the media attacked the Sobell study because four controlled-drinking subjects had died in the ten years following treatment, missing the fact that six abstinence subjects also had died.The other most noteworthy study was conducted by two sociologists and a psychologists at the Rand Corporation. The first Rand study "reported that those in remission at 18 months were as likely to drink without problems as to maintain stable abstinence" (Peele 1986). The report had swift public backlash. The Los Angeles Times claimed that "the lives of many persons with this disease are now endangered." Yet, the repord did receive support as well, Gerald Klerman, Professor of Psychiatry at Harvard Medical School, remarked "this is a very important document, I think the conclusions are highly justified, I understand you are under great political pressure... I would strongly urge you and the NIAAA and ADAMHA to stand firm whenever possible" (in Armor et al., 1978). Despite mixed responses, certain criticism did need to be addressed. Peele (1978) lists the criticism of the first report and how it was dealt with in the second report as follows: " (1) lenght of follow-up period (18 months), (2) completion rate of interviews (62%), (3) exclusive reliance on subject self-reports, (4) initial classification of subjects and their degree of alcoholism, (5) limiting assessment of drinking to a 30-day period, and (6) overgenerous criteria for normal or controlled drinking. The second report released in 1980, (1) extended the study to a 4-year follow-up period, (2) completed outcome data for 85% of target sample, (3) employed unannounced breathalyzer tests as well as questioniong collaterals in one-third of cases, (4) segmented the study population into three groups based on symptoms of alcohol dependence, (4) lengthened the assessment period of drinking problems to 6 months, and (5) tightened the definition of controlled drinking."The second Rand report, which responded systematically to the criticisms of the first report, also found the abstinence therapy was not inherently superior for preventing relapse than moderate drinking. Nearly 40% of the subjects who were free from drinking related problems were still drinking after 4 years (Peele, 1984). It is important to note that nearly all of the Rand subjects reported signs of alcohol dependence and the median level of alcohol consumed per day was 17 drinks (Peele, 1986). However, this did nothing to change the dominant view that abstinence was the only valid treatment. Peele (1986) concludes, quite to the contrary that "such ideas have [now] been rejected, paradoxically as a result of the Rand report itself. For the report galvanized the opposition of the dominant treatment community and began a largely successful campaign to attack any therapy that accepted moderation of drinking problems as an outcome."In light of the many studies attempting to resolve controlled drinking as well as an intense debate on the issue it may seem strange to argue that abstinence almost entirely dominated the field. There would obviously be no debate if nobody supported controlled drinking. However, in an interview Peter Nathan, former director of the Rutger Center of Alcohol Studies, stated that in 1982 "there is no alcoholism center in the United States using the technique [controlled-drinking therapy] as official policy" (Fisher, 1982). This epitomizes how abstinence firmly dominated in the United States; especially when compared to other countries. In Britain for example three-quarters of National Health Service alcohol treatment unites offered controlled drinking therapy. Canadian treatment units offered controlled drinking therapy, at a rate of 37% including about a fifth of in-patient and detoxification facilities as well as community outreach centers (Peele, 1992). In the United States the belief in controlled-driking as an applicable therapy progressively declined. Prior to the mid-1970s psychologists reported positive prospects for treating alcoholics using moderation techniques. Then "after 1976, reflecting either a chagne in terminology, in emphasis, or in their understanding of alcohol problems or desire to achieve rapprochement with disease notions, psychologists downplayed the possibility" and in 1982 totally rejected the idea (Peele, 1984).More recently however there has been a small rekindling of controlled drinking therapy. The Center of Alcohol Studies has created a brief intervention clinic which practices controlled drinking therapy, despite strong opposition in the past (Peele, 1992 afterward). The most drastic change has been the introduction of support group and treatment approaches such as Moderation Management (MM) . Ironically, MM was founded in much the same was as AA. Audrey Kishline, founder of MM, was actually a member of AA since her late twenties but became angry after discovering that much of the dogma preached by AA was not relevant to her and she could in fact learn moderation (Gorman & McLaughlin). Her program begins with a month of abstinence, and has strict rules, similar to AA but without the abstinence underpinnings.All of the previously mentioned studies, particularly the second Rand report have definitely landed a solid attack on the disease theory of alcoholism. A minimal conclusion that can be drawn from the large amount of studies is that controlled drinking therapy can lead to a withdrawal of alcohol related problems at a similar rate as that of abstinence approaches, even when severely dependent alcoholics are factored in. There is no shortage of such studies. An additional two for example are summarized by Peele (1992):"McCabe (1986) in Scotland and Nordstrom, and also Berglund (1987) in Sweeden: found that alcohol-dependent individuals displayed substantial moderation outcomes over follow-up periods of 16 years to two decades or more. Futhermore, alcoholics in these studies became better able to moderate their drinking the longer after their treatment they were examined. Nordstrom and Berglun found that for their subjects, all of whom had been hospitalized and were categorized as alcohol-dependent, controlled drinking was less likely to lead to relapse over time than was abstinence."At the same time studies focusing on certain social and cognitive factors of alcohol use have pointed out more limitations of the disease concept. The results of these studies, which the disease concept are unable to account for include:"1) The best predictor of a subject's success rate in a controlled-drinking program is not the level of dependence but rather the patient's own cognitive orientation. (Orfortd & Keddie; Elal-Lawrence, Slade, & Dewey) Alcoholics who rejected the axiom "one drink, one drunk" were more likely to be successfull at moderation (Heather, Winton, & Rollnick).2) Even when intoxicated alcholics regulated their levels of drinking and responded to external rewards, thus they hadn't lost control but rather shaped their behavior by the same kind of rules which apply to normal drinking behavior (Heather & Robertson).3) Youth, lower socioeconomics status, and minority status are important factors in predicting drinking problems. The most powerful predictor for Cahalan and Room was not social background, but current social environment.4) Alcoholics and problem drinkgers have a more external locus of control (Rohsennow).5) Alcoholics respond with alcoholic behavior when told that they are drinking liquor but ar not, while they behave normally when they drink disguised alcoholic beverages (Peele, 1983)While the disease theory is "surprisingly amorphous and variable" (Peele 1984) it can not escape all the contradicting research. More importantly replacing the disease theory, and therfore abstinence as the only goal in treatment, has numerouse benefits to the patient. Creating a client centered treatment therapy with the goal of reducing alcohol-related problems should be the goal; ending the one-size-fits-all approach, an approach that when aiming for either abstinence or controlled drinking is narrow and ineffective as treatment (Bruns & Hanna). Miller's (1989) six-step matching system is designed to help determine which approach should be attempted, these steps are: (as cited in Bruns & Hanna) (a) comprehensive assessment, (b) negotiation of treatment goals, (c) selection of level of intervention, (d) choice of type of intervention, (e) maintenance arrangements, and (f) follow-up assessment. Complains have been made against the role that the client plays to determine the treatment plan when using Miller's 6 steps (Bruns & Hanna). However, I feel they are missing perhaps the most important factor in alcohol treatment: that if the patients own cognitive beliefs disagree with the treatment he or she will not follow the treatment guildlings. Accordign to Peele (1984) "clients regularly act on thier own agendas within a larger treatment framework." Rather than fighting the patient's belief about alcoholism treatment, the treatment should be centered around them, with removal of alcohol related problems the overall goal.sourcesAnderson, W., & Ray, O., (1977). Abstainers, non-destructive drinkers and relapses: One Year after a four-week in-patient group-oriented alchololism treatment program. Currents in Alcoholism (Vol. 2) [as cited in Peele 1987]Armore, D.I., Polich, J.M., & Stambul, H.B. (1978). Alcoholism and treatment. New York: Wiley [as cited in Peele 1984]Bruns, J.A., & Hanna, F.J. (1995) Abstinence Versus Controlled Use: Fresh Perspectives On a Stale Debate. Journal of Addiction & Offender Counseling, Oct 95, Issue 1 [online]Cahalan, D., & Room, R. (1974) Problem drinking among American men. New Brunswick, NJ: Rutgers Center of Alcohol Studies [as cited in Peele 1984]Elal-Lawrence, G., Slade, P.D., & Dewey, M.E. (1986). Predictors of outcome type in treated problem drinkers. 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