Harm reduction for alcohol problems: Moving beyond the controlled drinking controversy

Controlled drinking has long been a controversial topic in behavior therapy. The historical context of this debate is reviewed, with special attention paid to the pioneering research conducted by Mark and Linda Sobell (the first behavior therapists to publish a controlled trial of controlled drinking with alcoholics). After updating the research findings and predictors of controlled drinking with alcohol-dependent drinkers, literature on the effects of moderation training (including brief interventions) designed to reduce the risks of alcohol abuse is reviewed. As an illustration of this approach, preliminary data are presented from an ongoing study investigating the effects of a stepped-care secondary prevention program for high-risk adolescent and young-adult drinkers. Throughout the paper, harm reduction is presented as an overarching model of behavior change that encompasses both controlled drinking for alcohol dependence and moderation training in the prevention and treatment of alcohol abuse. Unlike abstinence-only or “zero-tolerance” approaches, the harm-reduction model supports any behavior change, from moderation to abstinence, that reduces the harm of problems due to alcohol.