Page 108 - PhD GT

only be able to drink with impaired control in the future.
At the same time, clinical experience and the accounts of members of Alcoholics
Anonymous commonly contained reports of the ubiquity of the experience of loss of control. A number of suggestions were offered to deal with the difficulty of definition: based upon clinical observation that people who sometimes lost control did not always lose control, Keller (1972) described the inability of the alcoholic to be sure they could stop once started. He attributed this variability of response to the fact that cues for drinking and cues for drinking to excess are conditioned, very often without the awareness of the person who is being so conditioned. Without such awareness it would be difficult to predict in which situations control would, or would not be maintained. Moreover, when generalisation from a conditioned cue to an unconditioned cue occurs, the drinker will not always be aware which cues had been learnt by this process. Hence the unpredictability of loss of control.
Ludwig and Wikler (1974) also focused upon the variability in the occurrence of loss of control, stressing again the lack of inevitability:
“Loss of control is the behavioural state .......characterised by activities indicative of a relative inability to modulate alcohol consumption; it need not eventuate in gross intoxication or stupor” (Ludwig and Wikler 1974 p. 122)
In a study designed to test the ability of alcoholics to respond to interoceptive and exteroceptive cues for drinking and stopping drinking compared to controls who were social drinkers, both groups were offered doses of alcohol at pre-set intervals following feedback on their blood alcohol level (Ludwig et al. 1978). Both groups were asked to attempt to maintain a blood alcohol level within a given range and had been given prior training in recognising the interoceptive cues for doing so. Feedback given during the experimental sessions either under-reported or over-reported the true blood alcohol level, but regardless of which was the direction of the mis-report, alcoholics consistently took more drinks, gained higher blood alcohol levels and made progressively more errors of judgement regarding interoceptive cues throughout the drinking session than did controls. The authors thus were able to demonstrate that the experimental group were interpreting physiological cues differently, or in fact their physiological cues were different from those of the social drinker group. Whatever the nature of the difference, the result supports the idea that regulation of drinking in diagnosed alcoholics is different from regulation of drinking in
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