The book starts off by sourcing a huge number of studies and examining them within a logical framework, the author proves that alcoholism isn't as disease and shouldn't be thought of or treated as such. In fact, the author says that for people who drink heavily, drinking has become a central activity in their life. These central activities are "any hub of activity (job, religious practice, serious hobby, family or community role) that in part defines and inspires a person's identity, values, conduct, and life choices." (p 99)
Heavy drinkers are living with the results of one of their central activities. And if those results are not always positive, well, people make mistakes and don't always choose the best things for themselves in any area of their lives let alone with respect to their central activities.
So when a heavy drinker tries to stop, they're in effect cutting out a central activity in their life and that's hard. Think of how hard it is when someone is laid off from the job that defined them, or they retire. There's an adjustment period where nothing feels right and the person wants to go back to the way things were even if it was bad.
Therefore when it comes down to trying to cut down or stop drinking, of course it's going to be difficult and of course people will relapse. It takes a lot of courage and help to see oneself in a new way and to let go of a central part of themselves. Really, the last thing someone in this position needs is to say that they are powerless over their drinking (as in AA), because they're not. They need to take responsibility for their choices and behaviour in order to change it. However, during the transition period some people will benefit from a treatment program but of course no one treatment works for everyone.
The book concludes with some ideas about how public policy could be changed to better encourage heavy drinkers quit or reduce drinking. The author favours a multi-faceted approach because different people will respond to different policies as was done with cigarettes.
The idea that for drinking is a central activity for drinkers is a new and interesting perspective on the problem of heavy drinking. Thinking of drinking as a central activity in the drinker's life - rather than as a disease, which really does make no sense - is eye-opening and makes perfect sense to me. I used to drink heavily and when I did it was definitely part of who I was - it was as central an activity as my work or family. I structured my life around it and chose my friends and activities accordingly.
As well, I've long thought that AA's 12 steps are all backwards. They were written after AA's founders had a spiritual awakening and they're designed to help the person have their own spiritual awakening. However, as someone who's had a spiritual awakening (not through AA), I can tell you that the 12 steps are very naturally the things you do once you've had the awakening. Seriously - I was quite surprised when I realized this. So awakening leads to the 12 steps but the reverse, that the 12 steps lead to a spiritual awakening, isn't true and doesn't really make sense.
Having a spiritual awakening and then quitting drinking also supports the idea that drinking is a central activity for heavy drinkers. Removing a central activity in someone's life requires fundamental changes to be made to the person's values, inspirations, and thoughts. A spiritual awakening is that kind of fundamental change.
Although this book was first published in 1989, its conclusions are still relevant. I believe that the conclusions and ideas expressed in this book are the direction that alcoholism treatment should be going, and that it is time to retire the idea and treatment model of heavy drinking as a disease or allergy. I highly recommend this book if you're at all interested in this approach to understanding why some people drink heavily.