"An epochal step"

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Do without alcohol for life? For many alcoholics this hurdle is too high. The new guidelines on alcoholism therapy are now opening up an alternative to abstinence for the first time. With that a dogma falls. Addiction expert Prof. Karl Mann played a leading role in the new work.

Prof. Dr. med. Karl Mann

Prof. Dr. med. Karl Mann researches and teaches at the Central Institute for Mental Health in Mannheim. He played a leading role in the development of the nine S3 guidelines "Screening, diagnosis and treatment of alcohol-related disorders".

Prof. Mann, in specialist circles, abstinence has so far been the only option to counter alcohol dependence. The new guidelines now also include the possibility that alcohol addicts drink less - a revolution. How come?

There are now a number of studies that show that it is actually possible for someone who is addicted to alcohol to drink less. There are many who manage to reduce the amount they drink by half - over many months. I wouldn't have believed that myself ten years ago.

But abstinence is still the better option.

Drinking less is of course better than staying at the old drinking level, even if absolute abstinence is still the only way to get rid of alcohol.

In this way, you can also reach people in the future who cannot imagine a life without alcohol at first.

There are very many people who realize they have an alcohol problem but still don't seek help. Often because they cannot imagine being abstinent - this has been shown by large surveys in the USA. We have now lowered the hurdle for them.

In Germany too, only a fraction of those who need help undergo treatment.

That's right, in Germany that's just 10 to 15 percent. If we could reach 30 to 40 percent of alcoholics with the new therapy goal, an enormous amount would be gained. The fact that reduced drinking is a possible therapeutic goal is indeed an epoch-making step.

Perhaps some who initially only limit their consumption can after a while imagine giving up alcohol completely? And then switch to abstinence?

Exactly. There is the possibility of first aiming at a harm-minimizing therapy goal, which you can then build on in a second step.

Why is the decision to abstain so difficult?

If you or I had to decide now not to touch a drop of alcohol for the rest of our lives - that would be a huge undertaking. Alcohol also has a positive effect, it activates the reward center in the brain and releases certain messenger substances that we perceive as pleasant. In addition, alcohol is deeply embedded in our culture: it plays a major social role everywhere. Those who do not take part make themselves a bit of an outsider. Making such a far-reaching decision as abstinence would be difficult for me, too.

Do you already have an idea what type of person could manage to drink less despite addiction?

That is hard to say. In the studies, there was no evidence that reduced drinking, for example, works differently for men or women, old or young people, or that personality factors play a role. The only thing that can be said - and that's only a guess - is that it may be even more promising in the early stages of addiction than in people who have been addicted for 20 or 30 years. But it is impossible to predict whether someone will actually make it. So it's definitely worth a try.

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