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Comment on "Normal drinking in recovered alcohol addicts. Lovibond, S. Discriminated aversive control in the moderation of alcoholics' drinking behavior. Behavior Therapy, 1, The controlled drinking controversy: A commentary. American Psychologist, 38, McCaul, M. Alcoholism treatment in the United States. Alcoholism American style: A view from abroad. Bulletin of the Society of Psy- chologists in Addictive Behaviors, 2, Prediction of abstinence, controlled drinking, and heavy drinking outcomes following behavioral self-control training.

Journal of Consulting and Clinical Psychology, 47, Relative effectiveness of bibliotherapy, individual and group self- control training in the treatment of problem drinkers. Addictive Behaviors, 5, Orford, J. Abstinence or control: The outcome for excessive drinkers two years after consultation. Evaluation of alcoholism treatment: A comparison of three facilities. Archives of General Psychiatry, 20, Abstinence and normal drinking: An assessment of changes in drinking patterns in alcoholics after treatment.

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Addiction, 90, So valabel dieser Begriff auf einzelnen Ebenen auch sein mag, er bleibt pejorativ. Kapitel 2. Wir wissen, dass eine Person kontrolliert trank, weil ihr Trinken nicht ausser Kon- trolle geriet, und wir wissen, dass ihr Trinken ausser Kontrolle geriet, weil sie nicht kontrolliert trank. Bestimmten KlientInnen kann daher empfohlen werden, das Trinken in ehemals problembeladenen Situationen d. Dies ist jedoch umstritten, da sich auch viele Menschen, die nicht an Alkoholproblemen leiden, gelegentlich betrinken. Das Zwischenziel besteht hier in einer Schadensreduzierung und nicht so sehr in der Schaffung einer prob- lemfreien Situation Marlatt, Sobell Throughout the years several different terms have been used to refer to low amounts of drinking that do not incur consequences.

In doing so, it is important to keep in mind the goal of the exercise, which is to decide which treatment goal terminology will convey what is meant most accurately while minimizing value laden connotations and minimizing the likelihood that the term will provoke objections by clinicians or clients. From an accuracy standpoint, it is difficult to understand what is meant by normal drinking, and the definition might vary from ob- server to observer and from location to location.

Does normal refer to the maximum amount con- sumed, to the ability to stop at will, to consuming alcohol without incurring negative consequences, to only drinking under certain conditions, or some other criterion. However, even if the meaning of the term were clear, its connotations would make it inappropriate for a treatment goal.

Despite the validity of the label at some level, it is pejorative. These issues could be argued infinitum, but we would lose track of our original objective of finding the term that is most specific and most likely to minimize objections. There is no need to further belabor this clearly inadequate term.

This breadth of possible defini- tions could be tolerated if the term were operationalized when used, and especially if a consensual definition could be achieved. These sorts of reactions would distract attention from the important issues of the nature of the drinking that occurred, for whom it was possible, and so forth. Specifically, negative conse- quences do not need to have occurred in order for the drinking to be considered risky. Risk means only that consequences could have occurred. The risk could be based on the amount consumed or on the situation in which the drinking occurred.

This can be in terms of amount of drinking or as drinking that occurs in situations where there is more than a very small possibility of incurring negative consequences. With regard to amount of drinking, most countries have established guidelines for what constitutes risk International Center for Alcohol Policies, , although the guidelines differ somewhat from country to country.

In this regard, it may be valuable to hold a conference to reach an international consensus on risk criteria. Finally, a very important advantage of the term "low risk drinking" is that it acknowl- edges that any drinking can be risky. At the least these include the amount of drinking, the circumstances within which drinking occurs, and the functions served by the drinking.

With regard to limits, there is interna- tional diversity not only in recommended maximum drinks but also in how a standard drink is defined. For example, in Ireland a standard drink is defined as containing eight gms of ethanol, while in Japan The World Health Organization WHO defined low risk drinking as no more than three drinks contain- ing eight gms of ethanol each per day 24 gms total , substantially lower than the New Zealand rec- ommendation of no more than 60 gms per day.

But the New Zealand standard also specifies gm per week as a maximum, which is not hugely greater than the WHO limit of gms per week. Anstie suggested a limit of three drinks per day, although not specifying the exact amount of ethanol per drink. Recently it has also become apparent that recommended drinking limits should be different for men and women. Specifically, they should be slightly lower for women because a woman will reach a higher blood alcohol level on a given amount of alcohol than a man of the same weight.

Whatever limits are recommended, clearly in order to be justified as low risk they will not allow what would commonly be considered excessive consumption of alcohol. It should be pointed out that the guidelines discussed were not derived from clinical studies, but rather from epidemiological considerations. Therefore, an important question is what role such guidelines might play with regard to limited drinking goals for persons that have alcohol problems.

Of course, the guidelines only propose quantitative limits on drinking and not the circumstances under which drinking occurs or the pattern of drinking. With regard to the pattern and circumstances of drinking, Sobell and Sobell have recom- mended that daily drinking not occur in order to avoid daily drinking as opposed to situational be- coming a habit and in order to help minimize tolerance development. They recommend consumption of no more than three drinks In addition, the circumstances within which the drinking occurs are important determinants of the level of risk.

Thus, clients might be recommended not to drink at all in situations that have previously been associated with problem drinking i. Another possible element of the goal might be not to drink for intoxication i. This could be a controversial point, because many individuals who drink without any problems occasionally do become intoxicated. The wisdom of someone who has never had a problem becoming intoxicated is a different consideration, however, from the added risk such drinking might pose to someone whose drinking has been a problem.

The potential for escalated risk is especially apparent when one considers that the phenomenon of tolerance predicts that an individual will over time need to increase the dose consumed in order to achieve the desired effect this being the very definition of tolerance. For this reason, a sensible recommendation would be not to drink for effect; that is, the purpose of drinking should be as a social convenience and not to become intoxicated. The interim objective here, then, is harm reduction rather than seeking a problem-free outcome Marlatt, Harm reduction is a very different concept from moderation treatment goals.

For example, the use of air bags and seat belts in automo- biles is a harm reduction strategy. Rather than assuming accidents will not occur, it is assumed that accidents will occur and on that basis efforts are taken to reduce the harm that will result when there is an accident. Similarly, harm reduction measures with regard to the use of illicit drugs involve efforts such as having beer in pubs served in plastic rather than glass containers broken glasses used in fights can so lead to damage and the use of needle exchanges to lessen the risk of HIV transmission among injection drug users.

For example, a client having great difficulty reducing drinking might stay in treatment longer if the goal is a reduction in drinking rather than stopping drinking. Similarly, it is possible that for such clients abstinence would be achieved most quickly using a tapered reduction strategy rather than having an abstinence goal at the outset. These sorts of questions are readily amenable to research, but little research has been done in this regard.

References Abel, E. How do physicians define "light", "moderate", and "heavy" drinking? Alcoholism: Clinical and Experimental Research, 22, Babor, T. Social drinking as a health and psycho- social risk factor. Anstie's limit. Bondy, S. Low-risk drinking guidelines: The scientific evidence. Canadian Journal of Public Health, 90, Dupont, R. Drug legalization, harm reduction, and drug policy. Annals of In- ternal Medicine, , Graham, K. Should alcohol consumption measures be adjusted for gender differences? Addiction, 93, International Center for Alcohol Policies.

International Drinking Guidelines, Washington, D. Blood Alcohol Concentration limits worldwide, Wash- ington, D. Harm reduction: Pragmatic strategies for managing high-risk behaviors. Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive Behaviors, 27, Mills, K. Training social drinking as an alternative to absti- nence for alcoholics. Behavior Therapy, 2, Nadelmann, E. Drug prohibition in the United States: Costs, consequences, and alterna- tives.

Popham, R. Some factors affecting the likelihood of moderate drinking in treated alcoholics. Journal of Studies on Alcohol, 37, Sanchez-Craig, M. How much is too much? Estimates of hazardous drinking based on clients' self-reports. British Journal of Addiction, 81, Nonproblem drinking as a goal in the treatment of problem drink- ers. Taylor Eds. New York: Spectrum Publications. Stockwell, T. Towards guidelines for low-risk drinking: Quantifying the short- and long-term costs of hazardous alcohol consumption. Alcoholism: Clinical and Experimental Research, 22, 2 suppl.

Tatarsky, A. An integrative approach to harm reduction psychotherapy: A case of problem drinking secondary to depression. In Session: Psychotherapy in Practice, 4, Erhebungen bei unbehandelten Stichproben haben gezeigt, dass Kontrolliertes Trinken durchaus auch spontan, d. Jahrhunderts propagiert wurde. Hinter dieser Theorie steht die Hypothese, dass mit der Zeit diverse unterschiedliche Signale mit dem Verlangen nach Alkohol und exzessivem Alkoholkonsum in Verbindung gebracht werden. Wie der untere Teil von Abb.

Eine betroffene Person kann beispielsweise gesellschaftlichem Druck nachgeben und Alkohol konsumieren oder mehr trinken, als sie eigentlich will. Rosenberg As other chapters in this report indicate, subsets of both chronic alcohol-dependent persons and less severely impaired alcohol abusers are able to moderate or control their drinking, although moderate consumption is often interspersed with periods of both abstinence and problematic drinking e.

Surveys of untreated samples have revealed that controlled drinking also occurs naturally in the absence of any apparent professional intervention e. Nonetheless, controlled drinking has been controversial because it stands in contradiction to the American disease model promulgated in the latter half of the 20th century.

A key feature of this model is the proposition that all alcoholics are born with or develop brain deficits that are irreversible and, because such deficits are irreversible, no alcoholic will be able to consistently or reliably control his or her drinking or other drug use. Scientists and clinicians have theorized about the multiple factors that influence the initiation, exacerbation, and maintenance of problem drinking. These factors include learning prin- ciples, cognitions memories, beliefs , personality styles, brain mechanisms, cultural rules and values, and drinking environment Orford, Some of these theories also help explain why a meaningful subset of problem drinkers is able to moderate their consumption of alcohol, for many of the factors that foster drinking problems also foster recovery, whether to an abstinent or controlled drinking out- come.

Discriminative stimuli include environmental, emotional and somatic cues that signal an opportunity to drink and increased likelihood of reinforcement for doing so. For those who develop drinking problems, the resulting intoxication may be both positively reinforcing for example, increasing a desirable emotional state and negatively reinforcing for example, as a respite from undesirable emotional states such as social anxiety, sadness, anger, or frustration, from uncom- fortable cognitions such as critical self-evaluation or unhappy memories, and from physical pain.

The rewarding effects of such drinking are often rapid and predictable, more so than the often delayed punishing effects of excessive drinking. Excessive drinking is more likely by those for whom the pun- ishing effects are either delayed or pale in comparison to the rewarding outcomes of heavy drinking. Paradoxically, to the degree that the intrapersonal or interpersonal rewards of excessive drinking are experienced only periodically, the alcoholic drinker may escalate and persist in heavy drinking in the apparent absence of regular reinforcement.

As learning experiments have demonstrated, inter- mittently reinforced and intermittently punished behaviors may be notably resistant to extinction. From this perspective, moderate drinking would be explained, at least in part, as a function of changes in the discriminative stimuli — the environments — in which the drinker consumes alcohol. If one avoids social contexts in which heavy drinking is modeled and reinforced, and instead drinks in environments in which moderate drinking is rewarded and excessive drinking is punished, moderation may supplant heavy drinking.

Furthermore, to the degree that the problem drinker finds other ways to cope with un- comfortable emotions, disturbing thoughts, and physical pain, excessive drinking no longer serves the same relief functions and may no longer be experienced as rewarding. An- other important component of learning theory is observational learning. For example, humans learn the how, when and where of drinking, in part, by observing important role models.

From this perspective, controlled drinking is explained as a function of changing the persons with whom one drinks and by observing and imitating models of social drinking. Similarly, those who attend AA have acquired models of abstinence whom they may imitate if they decide to quit drinking. Pavlovian or classical conditioning may also be em- ployed to explain why some former problem drinkers are able to moderate their consumption.

The assumption underlying this theory is that, over time, a variety of cues have become associated with craving for and excessive consumption of alcohol. As a result, cues paired with withdrawal and relief drinking, or with the initially pleasant effects of intoxication, may come to elicit a conditioned desire or craving when the experienced drinker is in the presence of those cues. Repeated exposure to these cues without engaging in the conditioned response of perseveration can weaken the connection between experience of these cues, the strong desire or craving to drink, and excessive drinking.

According to this model, over the course of time, people can learn relatively complex behaviors and perform them with little mental energy under defined environmental conditions. Examples of automatic behaviors include driv- ing a car, riding a bicycle, reading, touch-typing, and drug taking. Although these behaviors are com- prised of chains of behaviors that are initially effortful to learn, after years of practice, such behaviors can become efficient, coordinated, and require little awareness or effort after acquisition — that is, they become automatic in certain situations.

However, such behaviors may require considerable effort and attention in demanding situations — for example, driving an automobile in a snowstorm or reading a book in the presence of loud music. Changing old automatic behavior patterns such as preservative will be an effortful process for some time until the new behav- iors — in this case, controlled drinking habits — are themselves well practiced and become automatic.

Such expectancies explain not only the initia- tion and maintenance of drinking, but the restraint of drinking as well. For example, one might expect desirable outcomes from controlled or moderate drinking of wine or beer, but expect bad or uncomfortable results from excessive or uncontrolled drinking of vodka or whiskey.

Beliefs about the results of drinking are also probably influenced by where and the people with whom one drinks. Research has found meaningful correlations between posi- tive outcome expectancies and heavy drinking, and between negative expectancies and restraint. His approach to explaining drinking would hold that if a problem drinker substitutes realistic expectancies of moderate drinking in place of exaggerated positive outcomes of excessive drinking — and develops realistic expectations for the negative outcomes of immoderate drinking — he or she is more likely to drink moderately.

The roles we take on in our lives — in our families, in our occupation, in our recreational activities — also influence our behavior. Combining both behavioral and cognitive principles, this model describes two related processes: 1 why some drinkers maintain abstinence or moderate, healthy drinking and 2 why some drinkers fail to maintain their abstinence or moderate drinking goal and engage in unhealthy or relapse drinking.

The model begins with the assumption that the problem drinker — follow- ing detoxification or treatment, by participating in a mutual help group, or following a process of natu- ral recovery — has made a commitment to abstinence or moderate drinking. The first key feature in the model see Figure 3, p.

High-risk situations include specific environments e. For example, the drinker might switch to non-alcohol drinks; could refuse offers to buy additional drinks; or could go for a walk or play music to distract oneself from uncomfortable emotions or thoughts of continuing to drink. According to the next step in Figure 3 p. In other words, if one copes, one feels more confident that he or she can resist the tempta- tion to drink beyond his or her limit. As the bottom part of Figure 3 p.

According to the next step, failing to cope results in decreased self efficacy. That is, the drinker feels less confident that he or she can resist the temptation to drink immoderately in that situation or in other similar situations. A slip is not the same as relapse. But how the drinker interprets the slip is very important. Specifically, psychoanalysts have conceptualized addiction in terms of self-medication of emotions Khantzian, , as a variant of a compulsion neurosis Dodes, , and an unconscious effort to control feelings of loneliness and helplessness Johnson, The foundation for change is set when, either as a result of treat- ment or natural recovery, the drinker becomes conscious that substance abuse is maladaptive and more realistically appraises the negative consequences of the previously idealized addictive behavior patterns.

Theoretically, once the underlying conflict is resolved, the individual could control his or her drinking because the behavior no longer serves the same functions it once did. That is, to the degree that the problem drinker no longer needs alcohol to exert control and regulate his or her anger and other emotions, he or she will be able to abstain or drink moderately.

These models are not mutually exclusive, and several mechanisms of behavior change may operate within an individual, as well as across the population of controlled drinkers, to yield moderate drinking. Furthermore, the role of neurochemistry should be considered as we explore explanations of con- trolled drinking. For example, the effect of naltrexone — an opioid antagonist — to reduce craving and excessive drinking in some alcohol dependent patients e. We suggest that integration of these models holds the most promise for explaining this clinically interesting and important phenomenon. The structure of attitudes toward alcohol: Specific beverages differ from generic alcohol.

Psychology of Addictive Behaviors, 8, Efficacy of moderation- oriented cue exposure for problem drinkers: A randomized trial. Journal of Consulting and Clinical Psychology, 70, Dawson, D. Correlates of past-year status among treated and untreated persons with for- mer alcohol dependence: United States, Alcoholism: Clinical and Experimental Research, 20, Dodes, L. Compulsion and addiction. Journal of the American Psychoanalytic Association, 44, Elal-Lawrence, G.

Slade, P. Predictors of outcome type in treated problem drinkers. Journal of Studies on Alcohol, 47, Fromme, K. Comprehensive effects of alcohol: Development and psychometric assessment of a new expectancy questionnaire. Psychological Assessment, 5, Goldman, M. The alcohol expectancy concept: Applications to assessment, prevention, and treatment of alcohol abuse. Guarna, J. Influence of dose and beverage type instructions on alcohol out- come expectancies of DUI offenders.

Careless: The Collection

Journal of Studies on Alcohol, 61, Alcohol cue exposure directed at a goal of moder- ate drinking. Journal of Behavior Therapy and Experimental Psychiatry, 24, Hester, R. Self-control training. Handbook of alcoholism treatment approaches: Effective alternatives.

Johnson, B. Psychological addiction, physical addiction, addictive character, and addictive personality disorder: A nosology of addictive disorders. Canadian Journal of Psychoanalysis, 11, Khantzian, E. The self-medication hypothesis of substance use disorders: A reconsideration and recent application. Harvard Review of Psychiatry, 4, McMahon, J. Comparing positive and negative alcohol expec- tancies in male and female social drinkers.

Addiction Research, 1, Addiction as excessive appetite. Addiction, 96, Naltrexone improves outcome of a controlled drinking program. Journal of Substance Abuse Treatment, 23, 4 , Sartor, C. Drinking course in alcohol-dependent men from adoles- cence to midlife. Journal of Studies on Alcohol, 64, Sinclair, J.

Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Sitharthan, T. Cue exposure in moderation drinking: A comparison with cognitive-behavior therapy. Journal of Consulting and Clinical Psy- chology, 65, American Journal of Public Health, 86, Tiffany, S.

A cognitive model of drug urges and drug use behavior: Role of automatic and nonautomatic processes. Psychological Review, 97, Walters, G. Behavioral self-control training for problem drinkers: A meta-analysis of random- ized control studies. Behavior Therapy, 31, In der Forschung wurden daher die besonderen Eigen- schaften der in dieser Untergruppe vertretenen kontrolliert Trinkenden sowie ihre jeweilige Trinkumge- bung untersucht. Einbezogen wurden sowohl professionelle Behandlungsinterventionen als auch Selbsthilfemassnahmen. Es erstaunt daher nicht, dass das psy- chologische und soziale Funktionieren vor der Behandlung auch Hinweise auf das Therapieergebnis von Personen mit Alkoholproblemen liefert.

Edwards et al. Im Rahmen der Theorie des sozialen Lernens wird argumentiert, dass sowohl beim Kontrollierten als auch beim Unkontrollierten Trinken Familie, Freunde und Arbeitskollegen als Vorbilder dienen. Allerdings sind die geschlechtsspezifischen biologischen, psychologischen und sozialen Aspekte, welche den Alkoholkonsum beeinflussen, derzeit noch eher spekulativer Natur Ro- senberg, Miller et al.

Elal-Lawrence et al. Ein Hauptvorteil von behavioralem Selbstkontroll-Training liegt darin, dass es bei vielen Problemtrinke- rInnen funktioniert. Wie von Heather festgestellt, ist Abstinenz, obwohl exzessiver Alkoholkonsum oft einen schlechten Gesundheitszustand und schlechte psychosoziale Anpassung zur Folge hat, nicht der einzige oder der automatische Weg zu einem guten Gesundheits- zustand und Anpassung. Auch in Skandinavien werden Nicht-Abstinenz-Ziele akzeptiert.

Unseres Erachtens beeinflussen auch andere Eigenschaften der KlientInnen z. Rosenberg Given that controlled drinking occurs only in a subset of alcohol abusing and alcohol dependent drinkers, the search has turned to assessing those characteristics of the problem drinker and drinking environment, and those professionally-administered and self-guided interventions, that predict and support controlled or moderate drinking.

This chapter will review variables that have been correlated with controlled drinking, characteristics that are contra-indications for a controlled drinking goal, ad- vantages of offering controlled drinking to clients, and interventions that hold promise to assist prob- lem drinkers to moderate their consumption. However, a recent meta-analysis by Walters evaluating the impact of behavioral self-control training for controlled drinking found that effect sizes did not differ significantly by severity of client drinking that is, alcohol abuse versus alcohol depend- ence.

The inconsistency with which severity of dependence predicts controlled drinking across studies is probably a function of how severity is measured and the range of severity represented in any one sample. Also, even though the frequency of moderate drinking may decline as severity of dependence increases, there may be a broad range of moderate severity within which the likelihood of controlled drinking remains relatively constant. The biomedical health of a drinker — indicated by such factors as liver function tests, pancreatic dis- ease, hypertension, etc.

Because the intended effects and metabolism of some medications — both those prescribed for psychiatric disor- ders and for various medical conditions — are negatively impacted by alcohol, clients should be edu- cated about the disadvantage of even moderate drinking if taking such medications. Women who are pregnant should also be advised to consider abstention. The self-conceptualization of the problem drinker, often represented by acceptance or rejection of the label "alcoholic," also appears associated with moderate drinking.

To the degree that a problem drinker takes on the role and identity of an alcoholic, and believes that controlled drinking is not at- tainable, abstinence would seem a more suitable outcome goal. However, both research and clinical experience indicate that the number of problem drinkers who want to moderate their drinking and the number who want to abstain is often larger than the number who will achieve their desired outcome, which reduces the value of goal choice alone as a predictor of outcome.

In light of research showing that premorbid functioning predicts outcome in a variety of psychological disorders, it is not surprising that pretreatment psychological and social functioning also predict out- come in persons with alcohol problems. Specifically, psychological adjustment and better social func- tioning e. Although social and psychological stability may influence outcome independently of severity of dependence, goal choice and self- conceptualization, psychosocial functioning probably influences, and is influenced by, such factors.

Social learning theory argues that family, friends and co-workers serve as models for both controlled and uncontrolled drinking. Some investigators who have included both genders found a larger proportion of those controlling their drinking during follow-up were women, but the biological, psychological and social aspects of gender that influence drinking outcome are quite speculative at this time Rosenberg, Although there has been considerable attention to the hypothesis that a predisposition to alcoholism is inherited, family history of drinking problems does not appear to be a consistent predictor of out- come.

Some studies report that moderate drinkers have fewer relatives with histories of alcohol abuse e. Their model posits that it is the congruent or incongruent interrelationship among cognitive, behavioral, and physiological characteris- tics that predicts controlled drinking, abstinence or relapse. Specifically, their model holds that con- trolled drinking will be more likely if a problem drinker does not hold an abstinence-only ideology, be- lieves he or she can control his or her drinking, and is in good physiological health.

Abstinence will be more likely if the problem drinker holds an abstinence ideology, believes he or she can abstain from drinking, and is physiologically healthy. The model predicts relapse will result when the problem drinker has a poor physiological history i. There is still considerable need for research on how to best match clients to specific therapies and specific envi- ronments to help them achieve specific drinking outcomes Project MATCH, Many would encourage or require problem drinkers to abstain as a condition of treatment.

Although abstinence might seem the easier and safer goal choice for those who abuse or are dependent on alcohol, there are notable advantages of offer- ing moderation as an outcome goal and moderation training as an intervention for persons with drink- ing problems Ambrogne, ; Larimer et al.

One key advantage of offering behavioral self-control training is that, for many problem drinkers, it works. Both therapist-guided and self-guided interventions result in reductions of quantity and fre- quency of harmful drinking — sometimes to the point of abstinence — and in fewer drinking-related negative life consequences e.

Controlled drinking training may also benefit heavy drinkers who might not otherwise go on to develop drinking problems, but who would still benefit from reducing their consumption Heather, Furthermore, as noted above, there is growing evidence of the cardiovascular benefits of moderate drinking over both abstinence and excessive consumption e. An abstinence-only requirement may reduce the attractiveness of treatment for many alcohol abusing and dependent drinkers.

A counselor who is open to discussion of non-abstinence outcome goals may be more likely to motivate change by problem drinkers who are ambivalent about the prospect of life-long abstinence and who would otherwise not seek or stay in treatment Marlatt, In addi- tion, controlled drinking may serve as an intermediate step on the way to abstinence for clients who might decide to abstain after successfully or unsuccessfully attempting to moderate their drinking.

A related advantage is that open discussion of controlled drinking, as either an intermediate or final outcome goal, acknowledges the reality that the ultimate decision to aim for abstinence or moderate drinking rests with the client. It is unrealistic to think that clients automatically accept abstinence treatment goals imposed on them by professionals, family members, or AA sponsors. Although AA and related programs often insist that persons with drinking problems accept abstinence as the initial step in recovery, Watson et al.

And, even for those persons for whom abstinence seems a healthier outcome goal, any reduction of whatever duration is an improvement over the excessive, un- healthy drinking that led to treatment. As Heather noted, even though excessive drinking often leads to poor health and poor psychosocial adjustment, abstinence is not the exclusive or automatic route to good health and adjustment. Just as abstinence is a more stable and functional outcome for some problem drinkers, controlled drinking appears to be a more stable or functional outcome for others.

For example, younger, male patients may be less likely to relapse, or more likely to experience healthy psychological and social functioning, if they are moderating their drinking rather than abstain- ing Polich et al. For example, abstinence is apparently the predominant outcome goal prescribed for alcoholics and problem drink- ers in American alcoholism treatment programs. Rosenberg and Davis surveyed a random sample of American treatment facilities and found that controlled drinking was considered unaccept- able for clients in almost every responding residential program including inpatient detoxification and rehabilitation services as well as halfway houses.

However, almost one-half of the responding outpa- tient programs reported moderate drinking as appropriate for a minority of their clientele e. Surveys of Canadian alcohol treatment programs also reveal limited acceptance of controlled drinking, though proportions of counselors and administrators endorsing non-abstinence goals are larger than that reported in the United States.

For example, Rush and Ogborne found that a little over one- third of the responding alcohol agencies in the province of Ontario reported non-abstinence as appro- priate for at least some of their clients, although acceptability of non-abstinence goals varied widely depending on whether the program was a residential or community-based outpatient service.

Furthermore, one-third of the respondents working in agencies that did not offer controlled drinking reported moderate drink- ing as acceptable for clients in other services or for their own clients after they left the agency. Simi- larly to the results of other surveys, acceptance rates varied by type of service, with those programs treating more severely dependent clients e.

Unlike the United States and Canada, national surveys of Australian and some Western European services have found widespread acceptance and application of controlled drinking as an outcome goal for problem drinkers. The most recent of the three studies also examined whether se- verity and finality of goal choice were associated with acceptance. Services in Scandinavian countries also accept non-abstinence goals. However, he also noted that some professional therapists, the public media, and about one-third of clients in rehabilitation pro- grams were accepting and interested in controlled drinking.

Two studies published in found controlled drinking was widely acceptable in Australia. Similarly to the results of surveys in other countries, acceptance varied con- siderably by type of service. The vast majority of community-based services and alcohol treatment units endorsed controlled drinking, but none of the private services and only about one-quarter of residential services reported controlled drinking as acceptable.

Controlled drinking was seen as appropriate for clients who selected this outcome goal, had lower severity and were younger. Clients with greater severity or duration of problem drinking, a his- tory of failed attempts to moderate their drinking, or who selected abstinence were seen as inappro- priate candidates for controlled drinking. The results of these studies reveal meaningful support for allowing clients with alcohol problems to choose controlled drinking as their outcome goal, although acceptance is much more limited in resi- dential facilities than outpatient or mixed services and is more limited in the United States than in other countries.

We expect that other characteristics of clients e. The possible influence of these other factors notwithstanding, and consistent with the past several decades of research on treatment out- come, natural recovery, and harm reduction, there is widespread and ongoing support for controlled or moderate consumption in at least some parts of Western Europe and Australia.

Drinking goal selection and treatment outcome in out-patients with mild-moderate alcohol dependence. Drug and Alcohol Re-view, 20, Ambrogne, J. Reduced-risk drinking as a treatment goal: What clinicians need to know. Journal of Substance Abuse Treatment, 2, Booth, P. Problem drinkers' goal choice and treatment outcomes: A preliminary study. Addictive Behaviors, 9, Chick, J. Can light or moderate drinking benefit mental health? European Addiction Research, 5, Journal of Substance Abuse Treatment, 14, Acceptability of the controlled-drinking goal among alcohol treat- ment agencies in New South Wales, Australia.

Journal of Studies on Alcohol, 58, Drew, L. Alcoholism as a self-limiting disease. Cari Juncker e burocrati europei, in questi anni avete combinato disastri e avete umiliato il popolo italiano e i popoli europei e gli italiani, con grande orgoglio, finalmente tra poche settimane vi manderanno a casa. Vienen a Europa a cobrar, pero no a trabajar. Y si no existe la posibilidad de que el Reino Unido se quede y si ni siquiera se van a plantear quedarse en el futuro, no podemos volver a celebrar elecciones europeas en Reino Unido.

No nos jugamos el presente, nos jugamos las futuras generaciones. Elmar Brok PPE. Nobody wants to humiliate them. We would like to have them in the European Union; they were always very good partners. But now, to use the argument that we want to punish and humiliate them, it shows that the Brexiteers in this House have lost any other argument and want to get support with this argumentation of punishment.

I think we are ready to come to a proper deal on the basis of the Withdrawal Agreement, and we can do something on a political declaration. Aber ich glaube, dass es wichtig ist, dass nun das House of Commons zu einer Entscheidung kommt. Das ist der Weg. Das ist der normale demokratische Weg.

Am Im Rat dazu: kein Wort. Beenden Sie endlich die Blockade im Rat! The limits of uncertainty — both economic and political — were pushed to the limit during Brexit, and not by the European Union. We, the European institutions and the Member States, have spared no efforts to provide as much certainty as possible to this process. The Strasbourg agreement, approved last Thursday by the European Council, provided one more layer of legal certainty — not only to the withdrawal agreement, but to the whole process.

So let me finish by saying that if the option for a longer extension is seriously discussed, if there is in UK a cross-party debate and decision on a renewed political declaration, we urge you — the British political parties — to do it in a way respecting citizens and their rights and avoiding the creation of uncertainties for them. Backwards and forwards it boringly grinds, as May tries valiantly for a meeting of minds. Hopefully that meeting of minds can be achieved this week in the House of Commons. Above all, in doing so, they may take cognisance of the one million people who marched in London last weekend.

Above all, we hope that the House of Commons can take a decisive decision to avoid a crash—out at all costs. If that could be avoided, then we could live with anything else, be it a withdrawal agreement, an extension, or whatever. But if they do not come to that decision, the confusion will remain and everybody will continue to be worried. You will never, ever, take responsibility, Mr Farage, for the mess that you have landed your country in.

You are responsible for the national humiliation we see today. No one else. I say to you, Mr Tusk, thank you for your message of solidarity. It is very well heard and very well received. There is a mass pro—European movement in Britain and we are not going anywhere. We want to defeat these people. We are on the right side of history and we are proud to have you with us. I have one small point of order, Madam President.

That kind of language is completely unacceptable in this Chamber — or in any Chamber for that matter — and he should apologise. Paulo Rangel PPE. Richard Ashworth PPE.

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May I add, as a comment, to the European people that, for over 25 years now, no British Prime Minister ever explained to the British people what Europe did, what the benefits are and why it matters. They never defended against the untruths which were spoken and they never took ownership of the decisions that they took in Council. Because of that, the British press ran a 20—year campaign based on populist mistruths, lies and deceit. The consequence of that we see today: Britain as a sad nation divided like never before and a House of Commons in crisis.

So let Brexit stand as a cautionary tale to the people of Europe. To the people of Europe I say this: you are the generation who have lived through the longest period of peace and the greatest level of prosperity ever. Never take it for granted. Value it. Fight for it. Defend it every day.

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My decision was the right one to allow you to speak. I think we are all heeding your warning, because I think you said it with deep emotion and affection for your country. No esta vez. Un mensaje a la House of Commons: que decidan, que se aclaren. To je sramotno. I want to tell something to Mr Farage; I really wanted to tell it to you already a long time. Stop telling lies.

Even today, you continue to tell lies. I think we have to fight for Europe. I think we have to renew Europe. Fight for Europe. Protect Europe, and know what Europe does for us. Henna Virkkunen PPE. Se on monella tavalla nyt tullut konkreettiseksi kaikille Euroopan unionin kansalaisille. La casa sta bruciando ma continuiamo a pensare che il problema sia di qualcun altro.

Dzisiaj mamy kompletny chaos. By the end of , the Commission shall be presenting a long—term vision. This should take into consideration the de—industrialisation of Central and Eastern Europe over the past decades. If we want to have a balanced industrial future, it has to take into consideration this central challenge for industry, jobs and growth. At the beginning of this meeting, Mr President, you had to tackle the issue of mobility. Now, this is an example of services from Eastern Europe being driven out of the market by using legitimate social and labour concerns.

This is something which should be avoided at all costs, and I do invite you to personally pursue and oversee how this industrial future paper will be transmitted from one Parliament to the other, from one commission to the other, because this is key to the future of Europe. Joachim Starbatty ECR. Das sollte man nicht vergessen. Das ist ja das Problem! Aber sie haben ein Dilemma, aus dem sie nicht herauskommen. Sie werden nicht herauskommen! Lassen Sie mich einen letzten Satz sagen.

Marek Jurek ECR. Et nous trouverons le moyen de garantir ces droits. Mr Nicholson, just a few words in the case of a no deal. In all scenarios, the Good Friday Agreement will continue to apply. The United Kingdom will remain a co-guarantor of that agreement and is expected to uphold it in spirit and in letter. The Commission is ready to make additional resources available to Ireland — technical and financial — to address any additional challenges.

Ce processus est un processus de sortie. Jyrki Katainen, Vice-President of the Commission. I would like to comment on a couple of other points which were also part of the European Council agenda, namely industrial policy and especially the EU-China relations. Very briefly, on industrial policy, the Commission has already set up a working group. The target is and this group has already been working more than a year. So this paper is at the disposal of the next Commission and the next Parliament. The aim is to identify the most crucial points, how to modernise the European industry.

Another very important topic is the EU-China relationship. We appreciate a lot that the Council paid attention to our proposals and endorsed many of our proposals because the EU and China are strategic partners and strategic partners usually do things together, not only speak together on the issues. This situation is currently a little bit problematic. We share many views with the Chinese authorities on various policy issues and we have also done some things together, but there are many issues which we have mostly been talking about, but not doing that much and this happens mostly in the field of economy.

China is a political superpower — a foreign policy superpower, a military superpower. This is what the EU is expecting from the Chinese side — a strategic partnership based on reciprocity, especially when we talk about market access policies. The European Council also asked the Commission to come with concrete proposals on how to improve our business and economic relationship with China, and this is under our work at the moment. We are preparing, for instance, state aid rules to third country acquisitions.

We want to make sure that there is a level playing field, that there is hard competition, but not unfair competition. So we have to make sure that our single market is open for everybody, but is fair for everybody. We cannot allow unfair competition to happen or take place in Europe. This is of utmost importance. It will help Chinese and European investments to flourish.

Also, we expect China to accept the geographical indications agreement, which has already been negotiated but unfortunately not approved yet. Honourable Members, as I said, we are strategic partners. We work very closely in many political areas, but economic cooperation is one of the particular areas where improvements are needed in order to maintain a level playing field and in order to allow European companies to do the same things in China as Chinese companies are doing in Europe.

The first one for clarification, dear Maria, this was not the last European Council before the elections to the European Parliament. It is pretty likely that we will meet still in April to discuss Brexit, and for sure we will also meet on 9 May in Sibiu to discuss our long-term EU strategy.

It will be in an informal meeting, but also dedicated to absolutely crucial topics. Mr Farage, you have presented passionate arguments against the second referendum. But the truth is that the second referendum took place in , because the first one took place in Then, a vast majority of the British public decided that the place of the UK was in the European Communities. It was you who thought three years ago that it would be possible to organise a referendum in order to invalidate the previous one.

Please be consistent today too. Yet Westminster has treated the views of Scotland with contempt. May is in office but not in power. SNP MPs will support an amendment that will see a series of indicative votes on Brexit next steps, including the option to revoke the Article 50 application. The crisis highlights what the Westminster government really thinks about Scotland. They have continually ignored strong Scottish opinion on remaining an EU member, and put the narrow interests of the Tory Party first. Scotland deserves better and the argument for Scottish independence gets stronger every day.

De Britse regering moet nu op de kortst mogelijke termijn duidelijkheid verschaffen en met een concreet plan komen of en hoe zij de Unie willen verlaten. Hoe de Britten de Unie ook willen verlaten, de rechten die mensen nu hebben, moeten in die situatie gewaarborgd worden. Het kan niet zo zijn dat gegevens van Europeanen zomaar op straat komen te liggen als het Verenigd Koninkrijk niet meer onder de Europese privacywetgeving valt. Ik vind het belangrijk dat de standaarden die wij in de EU hebben opgebouwd ook na de brexit gewaarborgd worden. Inkomens, werknemersrechten en sociale voorzieningen in het Verenigd Koninkrijk moeten beschermd worden in de uiteindelijke overeenkomst.

Wij willen geen eiland voor de kust dat tornt aan de sociale standaarden die wij met elkaar hebben opgebouwd. Samen, het Verenigd Koninkrijk en de lidstaten van de EU, delen we een rijke geschiedenis. Keer op keer blijkt dat wij door samenwerking stappen verder komen. Of het nu gaat om vrede of om welvaart. Die samenwerking moet ook na de brexit worden voortgezet, want alleen op die manier kan een vechtscheiding voorkomen worden.

However they fail to link this priority to the allocation of resources to research in the fundamental sciences. Their commitment places Europe midstream in the flow from fundamental science to applied research. So, our best graduates in fundamental science drift towards the US and Asia. Meanwhile, economic and social divergences within the Union continue to grow. The European Council remains elusive on this. Economic reform programmes must dedicate more efforts to correct existing regional and national imbalances and to bridge gaps between Member States in the area of social policy.

The European Council fails to commit towards change on issues related to equal opportunities and access to the labour market, fair working conditions, social protection including the elimination of precarious employment of young people, and the need to counterbalance the growth of profits by an improvement in remuneration levels. Economic reforms only make sense if they imply social progress for the working and middle classes, for young people and pensioners. Kompromisseja on rakennettu. Kompromissi on olemassa. Wim van de Camp, Rapporteur.

We hebben de afgelopen weken en dagen allemaal gemerkt dat het een politiek zwaar onderwerp is dat raakt aan de kern van de interne markt van de Europese Unie. In mijn dossier rij- en rusttijden gaat het om het verbeteren van de werkomstandigheden van de chauffeurs. Dan gaat het niet zozeer om de dagelijkse werk- en rusturen, dat is in een ander dossier geregeld. Daar komen we niet aan. Het gaat met name over de rusttijden 's nachts en in de weekenden. De belangrijkste vraag is waar een chauffeur die weekendrust doorbrengt. We hebben gezien dat er op dit moment langs vele Europese wegen illegaal geparkeerd wordt.

Daar zijn geen sanitaire voorzieningen. Daar is geen keuken. Dat proberen we op te lossen met dit dossier en het voorstel van de Europese Commissie. Wij worden in dat opzicht gestuurd en belemmerd door het Europese Hof in Luxemburg. Dat heeft bepaald dat de reguliere weekendrust niet meer in de cabine mag worden doorgebracht. Daarvoor hebben wij geprobeerd een oplossing te zoeken door dat te verbieden, maar wel met een fatsoenlijke overgangstermijn. Een ander element in dit dossier is wanneer de chauffeur naar huis gaat. Wij willen geen nomadenchauffeurs die langer dan vier weken van huis zijn.

Zij moeten op tijd naar huis en hun werkgever moet dat garanderen, maximaal in een termijn van vier weken. Resteert de korte weekendrust: die kan op de beveiligde en goed uitgeruste parkeerplaatsen worden doorgebracht.

Kontrolliertes Trinken in der Schweiz zwischen Anspruch und Wirklichkeit

Een bijzonder onderdeel van dit dossier zijn de buschauffeurs. U weet het, mevrouw de Voorzitter, passagiers zijn geen containers. Voor de buschauffeurs hebben wij iets meer flexibiliteit nodig. Voorzitter, een belangrijk onderdeel in dit dossier en de andere twee is de handhaving.

Daarnaast speelt inderdaad het probleem van de postbusbedrijven, een fenomeen dat wij koste wat kost moeten aanpakken en bestrijden. Voorzitter, tot slot nog iets over cabotage en detachering. Wij moeten ervoor oppassen dat we met te strenge wetgeving de flexibiliteit van de interne markt aanpakken respectievelijk belemmeren. Ismail Ertug, Berichterstatter. Es geht nicht immer ums Geld. Aber trotzdem gibt es auch dort einen Mangel an Fahrern.

Also kann es nicht allein am Geld liegen. Das hat damit zu tun, dass die Konditionen schlecht sind, dass die Bedingungen schlecht sind. Wir haben die Situation, dass wir nun letztes Jahr im Juli hier im Parlament abgestimmt haben und alle drei Dossiers abgelehnt worden sind. Ja, aber deswegen ist es ja auch ein Kompromiss.

Deswegen war das auch gut so, dass wir letztendlich nach dem 3. Die haben wir eingebracht. Wir haben Hunderttausende von Fahrern, die darauf warten. Summa summarum ist das Ganze ein guter Ansatz, der es letztendlich verdient, auch erfolgreich beschieden zu werden. Wollen wir das, uns wegducken und dieses Paket sterben lassen?

Das ist verantwortungslos. Das ist undemokratisch bis ins Mark! Karmenu Vella, Member of the Commission. The Mobility Package remains of course a political priority for the Commission, and for Commissioner Bulc in particular. However, she must participate in the informal Transport Council, which is taking place in Bucharest. In May , when the Commission adopted the first part of the Mobility Package, it aimed first of all at improving working conditions in the road transport sector; secondly, at ensuring fair competition and avoiding internal market fragmentation through uncoordinated national rules; and, thirdly, at reducing the administrative burden for operators and allowing more efficient and targeted controls through further digitalisation.

From the beginning, we knew that this was going to be a marathon rather than a sprint. The stakes are very high on these proposals. That is why a long maturation period was unavoidable for these proposals to sink in and be improved. The road sector needs a breakthrough now. The hauliers and the drivers need a fair and stable framework for the next years.

The sector cannot wait any longer. A swift agreement in Parliament will show that this House is committed to address the pressing challenges this sector faces. The intense work of the Parliament has allowed us to reach rather uncontroversial solutions on important issues, such as the fight against letterbox companies; enhanced cooperation between national authorities; the better use of digital tools, such as tachographs, electronic freight documents and the notification of posting declarations; and proportionate rules for light commercial vehicles.

Progress on these issues allowed Parliament to focus the last discussions on the main outstanding issues, namely the rules on cabotage, the driving and rest times, and last, but certainly not least, the lex specialis on the application of the posting rules in road transport. At this stage, the Commission maintains a general reserve, but it will continue to support discussions with a view to reaching an agreement on these priority files.

We can support all amendments which maintain the balance between the freedom to provide transport services, improve working conditions and reduce administrative burdens. Let me now make a few considerations on particular points. I will start with the lex specialis on posting of workers. When the general Posting of Workers Directive was revised, there was a clear commitment to adopt specific rules for road transport. The so—called split model for the posting of directives, while being different from the approach proposed by the Commission, strikes a good balance between the protection of the social rights of drivers and the freedom for operators to provide cross-border transport services.

It is supported by the rapporteur and contained in the general approach adopted by Council. Moreover, we support posting requirements for the road transport sector that are as simple as possible to apply and to control with the use of digital tools. I turn now to the rules on driving and rest times. This is a sensitive subject, which has a direct impact on working conditions and road safety. At the same time, drivers also need to be granted suitable, safe and secure resting facilities. Therefore, ensuring the availability of such facilities is crucial.

The Commission supports and actively promotes the development of safe and secure parking areas, including through financial support from the EU budget. I can assure you that the Commission will intensify its efforts, including through EU funding under the next Connecting Europe Facility. For passenger transport, the sector has received a clear message over the last weeks. Certain driving and rest time rules are not adapted to the activity of a coach or bus driver.

The message has been heard, and we are ready to start immediately a comprehensive assessment on specific rules for these drivers, if this House so requests. For sure, our objective will remain the same: improving the working conditions of drivers and road safety. Let me finish on the rules on access to the profession and to the market. On cabotage, I am pleased that the rapporteur maintains the concept of an unlimited number of operations over a certain period of time, which was proposed by the Commission.

Cabotage, the cooling—off period and the regular return of the truck to the Member State of establishment have been the subject of intense debates. We have to reach a balance here. The obligation for the trucks to return to the Member State of establishment should be assessed together with the additional establishment criteria, and also the new rule requiring drivers to return home on a regular basis. I look forward to the debate. Please carefully reflect on the links between the different areas of the Mobility Package. I would appeal to all to be constructive and to focus on solutions that work for the road haulage sector and its workers, and of course, for the European Union economy.

This vote will be crucial for the work ahead of us. Por supuesto que es importante defender a los trabajadores y garantizar su seguridad. Most a Parlamenten a sor. No queremos que el conductor sea el culpable. Las empresas y administraciones deben, en su cargo, facilitar toda la tarea posible de control, porque en la era del 5G es aberrante tener a los conductores parados en la carretera para controlar pilas de documentos en papel. He saved the image of the European Parliament last night with his decision, because you cannot legislate in the manner that was proposed until yesterday night.

The European Parliament would be seen in that case as a subsidiary of qualified majority of the Council, or even as a subsidiary of the Commission. Politics also means compromise, always, and Trump did it a year ago, as we remember. Since the plenary voted against this compromise I think we lost any opportunity in this Parliament to get a real compromise, a professional and responsible compromise.

And not only until next week, but also until the end of this legislature. How does our House look in the context of the Mobility Package I? The responsible committee cannot submit a report on two of the three dossiers. Even if we continue next month in the same manner, merely outvoting proposals by one or two votes as on Monday in other parts of this House, then what does it mean for citizens in the run-up to the elections?

Tout le monde veut une Europe sociale, allons-y! Dobbiamo infatti consentire alle imprese di poter competere sulla stessa base; dobbiamo combattere il fenomeno delle delocalizzazioni, incentivare i sistemi fiscali e salariali non equi. Non possiamo sottrarci: quindi proviamoci fino alla fine, ci rivediamo la settimana prossima in commissione TRAN. Proviamo a dare regole e diritti sociali ai nostri autotrasportatori. Die Zeit ist zu kurz, dass wir uns jetzt hier in Lippenbekenntnissen verlieren.

Das ist traurig! Denn wo stehen wir denn? Und was erreichen wir jetzt damit? Was ist daraus geworden? Zum einen sind das die diametral entgegenstehenden Extremsituationen von den Sozialisten und von der EVP hier im Haus, die eine Bewegung nicht zulassen. Das ist der Grund. Sie wissen genau, dass Sie inoffizielle Koordinatoren-Meetings abgehalten haben, ohne einen Teil der Fraktionskoordinatoren eingeladen zu haben. Das ist eine Frechheit und antidemokratisch. To jest niegodne. Ormai da mesi assistiamo a un continuo rimpallo tra la commissione TRAN e la plenaria e viceversa e oggi, tra l'altro, avremmo dovuto votare e invece siamo ancora, purtroppo, alla discussione.

Io penso che sia stato fatto un buon lavoro finora: sono stati raggiunti dei compromessi sul cabotaggio, sul distacco, sui tempi di guida e di riposo. To jest kompromis? Was soll nun diese Aktion? Sie waren doch dabei! Das ist doch die Wahrheit. This is what the procedure will enable. Secondly, I regret that the President has not taken the effort to respond to a joint letter from myself and colleagues from a number of EPP delegations proposing a concrete scenario and compromises. Yes, we have a large number of amendments, but those are intentional.

They are deliberately tabled so as to complicate the proceedings. So we have a set of compromises and the decision next week will be about whether we want an internal market — as imperfect as the proposal is — that can function, that will tackle a number of the issues, that will tackle social rights, or do we wish to see something that will lead to unilateral measures, which that we have faced already in the past and that will lead to fragmentation of the internal market, with your responsibility.

We know that, in the case of long—distance, cross-border professional drivers, those conditions are overwhelmingly unhealthy, unsafe and undignified, with access to many of their social rights being deprived by shady employment and letterbox companies. Many drivers are expected to rest in their cabs, with no access to basic hygiene facilities, such as toilets and showers.

So with that in mind, our party is wanting to see, as an absolute minimum, that we retain a two-week reference period that would not encourage an increase in nomadic driving. An extended weekly rest should be in a hotel. Effectively we just end up with a stitch—up. Hvorfor blev de efterladt? Doch nun zum Thema. Ihre Aussagen waren so gut wie identisch. Und in der Nacht sollen sie dann auch noch das Frachtgut bewachen — das alles zu einem Hungerlohn. Peter van Dalen ECR. Dat betekent wat mij betreft onder andere dat we ervoor moeten zorgen dat er voldoende goede, veilige parkeervoorzieningen zijn, maar ook dat we alles op alles zetten om een strijd rondom wie er het minst verdient — een race naar de bodem — om die strijd te voorkomen.

Want bij een eerlijke arbeid hoort een gelijk loon voor hetzelfde werk. De manier waarop we de eerlijkheid voor chauffeurs kunnen waarborgen, is met name door een goede handhaving. Helaas is het zo dat handhaving er in de praktijk, maar ook in de wetgeving, nog bekaaid van afkomt. Ik denk dat er nog te weinig inspecteurs zijn. We hebben nog te weinig goede databanken.

We moeten meer grensoverschrijdende controles houden en hebben zeker ook een handhaving nodig waarin niet wordt gediscrimineerd. Last but not least moeten we veelplegers en hun dubieuze bazen aanpakken. Und darum geht es jetzt. Es gibt viele Unternehmen, die ihre Fahrer gut behandeln, gute Konditionen, auch gute Fahrerkabinen, bieten, aber halt nicht alle. Darum geht es ja in diesem Fall. Claudia Schmidt PPE. Wir sollten hier doch eigentlich mehr sein als der kleinste gemeinsame Nenner unserer Wahlkreise zu Hause. Diese zutage getretene Scheinheiligkeit von der besorgten Linken bis zu den neuen Protektionisten in meiner eigenen Fraktion wird der Idee Europa mehr schaden als alles andere.

Ik denk dat we kunnen zeggen dat buiten deze zaal niemand snapt wat we hier nou aan het doen zijn. Dat knaagt aan het vertrouwen in de besluitvorming uit Brussel. Maar de chauffeurs laten niet met zich sollen. Dus of we nu vandaag of in april over hun werkroosters, hun lonen en arbeidsvoorwaarden stemmen, chauffeurs verdienen een eerlijke betaling en ze verdienen voldoende rust. Dat was mijn inzet, dat is mijn inzet en dat blijft mijn inzet, want vrachtwagenchauffeurs en buschauffeurs worden nu tegen elkaar uitgespeeld in een race naar de laagste lonen en naar de slechtste arbeidsvoorwaarden.

We moeten de uitbuiting van chauffeurs langs de snelweg in mijn land stoppen. We moeten de brievenbusfirma's sluiten en we moeten de chauffeurs de zekerheid geven van fatsoenlijke rij- en rusttijden. Kolegos, kompromiso mums nepavyko pasiekti. Peter Lundgren ECR.

It was a bad proposal to start with. Instead of sanctioning some national measures going against the single market, the Commission seemed to elevate the very same restrictive practices to EU level. This proposal fails several basic tests of any piece of EU legislation. Firstly, it goes against the principles of the single market, stifles competition, discriminates against a large number of Member States, throws environmental consideration into the dustbin, and in no way does it pursue the best interests of all Member States and citizens.

If we took a step back from simplistic slogans, we could see that in the pursuit of protectionist interests we decrease the competitiveness of our industries, create monopolies and raise greenhouse gases and prices for consumers. At the same time, we split Europe into two. We should definitely leave this package for the new mandate.

Dass wir heute unter Zeitdruck stehen, liegt vor allen Dingen an der Kommission, denn Juncker und Timmermans haben zwei Jahre lang die Kommissarin ausgegrenzt. Ein Gesetz ohne Kontrolle — da braucht man kein Gesetz. Gott sei Dank hat der Rat gesagt: Nein, das muss schon sein. Also das muss schnell passieren. Deshalb brauchen wir den Tachographen so schnell, wie es geht, am liebsten schon Antanas Guoga PPE. We would all love German wages. This will put people out of business — hard working people who want better wages. Help us get better wages; take time. Take time and help us. All the elements of the negotiations are on the table now and it is time to vote.

It will provide a level playing field for companies by having uniform rules, improved working conditions for drivers and enhanced control possibilities. It addresses many of the known problems in the sector today and, what is more, absence of new European rules will likely lead to a further deterioration of the situation in road haulage with wage and social dumping, fragmentation and protectionism all rising. Let me give you examples. For companies the package will bring: a stable and predictable legal framework avoiding uncoordinated national rules, which risk fragmenting the single market; clear lists of documents to be provided and carried in trucks; clear establishment criteria eradicating the growing phenomenon of letterbox companies; a new cooling-off period to avoid the so-called systematic cabotage practices; the professionalisation of van operations with light commercial vehicles, which will be submitted to similar rules in international transport; and an agreed increased use of digital tools, reducing the administrative burden, for example for posting declarations.

For drivers the package will also bring important benefits: posting rules will apply to them with minimum wage and employment conditions of the host country; the regular return home or to another private place after a maximum of four weeks will be guaranteed; the conditions for regular weekly rests and obligations of employers to pay accommodation will be clarified; and better resting conditions will be ensured to avoid fatigue and prevent endangering road safety. The package will finally provide for better enforcement with much earlier deployment of smart tachographs with geo-localisation to control posting and driving time; with reinforced administrative cooperation between national authorities; with the use of electronic freight documents to check cabotage rules; and with the use of digital tools to facilitate roadside checks.

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Actually, we note that many among those important measures are in principle, largely consensual within your house. On all other outstanding points we strongly recommend support for the reports of the rapporteurs, which are striking the right balance. The state of the road market in the Union, the working conditions of our drivers and the environment in which our companies are operating are far too serious matters to be left at an unsatisfactory status quo for an as yet unknown period of time.

The situation in the road transport sector is extremely critical and needs to be addressed. We have only compromises on the cabotage, the file of Ismail Ertug. Why are we now in a difficult situation in this plenary? Ismail Ertug, Rapporteur. I can assure all my colleagues within this House that I will use the next days once again to find a solution. I invite all my colleagues to come together and to be open to my proposals. Once again, we have found proper compromises which may not be acceptable for some colleagues, but we will try once again. It was a birthday celebration for an industrialist, who, together with invited guests, partied 2 for three whole days at a manorial estate.

Day two was launched with a Mormon brunch, which the men attended in beards and hats with the ladies appearing in country costume. Later in the day a gentleman's broth 3 was served in tobacco leaves whilst the ladies enjoyed a soup garnished 4 with Laura-Ashley roses - those with the luscious petals - flown in specially from England. In fact, as Balzer emphasises, he remembers each and every one of his events right down to the decoration and the order of the menu — and there have been many throughout the years.

What's the nicest thing about his role as host? The Goose Bump Guarantor is a literal translation and is only just on the edge of being acceptable. I have been noticing a shift of emphasis in English with goose bumps being reserved more and more for the reaction to cold or horror whilst 'the hair on the back of one's neck standing up' is being used more often to describe the feeling implicitly referred to in this article. Maybe it would be best to find another title altogether — maybe 'The Earl of Entertainment' or something like that.

I have used italics for particularly colloquial terms such as might be used in a magazine article, especially in an article of this sort that wants to sound up-beat and 'with it' 3. Changed to 'broth' avoid the repetition of 'soup' in close succession and because it somehow sounds more masculine. My assumption is that the soup was garnished with roses rather than being made of them — can you eat roses? Google und Co. Einige tragen ihn als file auf ihrem Memory Stick mit sich herum oder er steht im digitalen Buchregal, an das keiner mit Hammer und Bagger ran kann.

Und selbst wenn sich die Wut der Hacker irgendwann auf die Literatur richten sollte, so kann niemand vermeiden, dass der ein oder andere vielleicht noch seinen unangetasteten Memory Stick oder seinen External Drive irgendwo rumfliegen hat, auf dem The Transnational schlummert, bis ihn wieder jemand entdeckt. Die Worte der Autoren des Transnational sind konserviert.

Die Moderne schenkt ihr die Grundlage und ihr schenkt ihr dieses Leben. Since the creation and development of a network of autonomous systems in the form of the Internet, humanity has changed faster and more radically than ever before in the course of history. We know things today that our parent's generation never even dared dream of. We live in hash-tag Twitter societies in which people not only transmit information in mere seconds, but can also disseminate it around the world. I often catch myself thinking back nostalgically to the days when people still wrote more letters than emails and simply drove over to see their friends rather than texting them.

Every innovation relating to the further expansion of high-tech' social media seems to be accompanied by the increasing scorification of the human collective, which goes hand-in-hand with the rape of the private sphere to which we give our willing consent. According to German Sociologist Harald Welzer, our modern societies are not only heading towards a new totalitarianism, but are also in the throes of an, as yet peaceful, revolution in the prevailing form of rule in which social platforms and corporations, such as Google and Co.

As a student of totalitarianism, Welzer knows that, in order to be better able to control people in the longer term, the first things to be dispensed with under any dictatorship are the private sphere along with all things secret and hidden. Google and their ilk have already been working towards this abolition privacy for many years, and already control not just the mountains of data within the Internet but also, with our acquiescence, our private lives.

We empower them to create new standards and values — to dictate to us what is normal and appropriate, what is cool or uncool, what is beautiful and what is ugly — what is desirable and what is not. Yet, over the past few weeks and months I have had to relativise the way I view this new digital world to some extent.

For it strikes me that, as dangerous as it may be on the one hand, the retention of online data counteracts a radically different development — the destruction not only of data, but also of our collective memory — the erasure of the historical record. The upshot is that burning books no longer poses the same threat to today's self-proclaimed advanced civilisations as it once did.

During the past month I've relocated to Potsdam, a beautiful town with more UNESCO World Heritage Sites than you can shake a stick at, which somehow manages to seamlessly connect the eighteenth and twenty-first centuries. Just how well it does so becomes obvious when one takes a leisurely bike ride passed the Sanssouci Palace gardens every morning whilst simultaneously keeping abreast of how ISIS is systematically annihilating the common heritage of humanity in other, but not too distant, parts of the world. Yet, the very fact that such a heinous act of cultural vandalism inevitably leaves a trace in the digital world ensures the ultimate survival of, at least, images of the sites in question, even if the physical remains are reduced to dust and rubble.

Thieme E-Journals - Suchttherapie / Abstract

As long as mankind is able to read the digital record, nothing it contains can be lost forever. I love the idea that The Transnational — and your contributions to it — will always have a niche of their own within this nebulous universe of computers, servers, external drives, and social media: we shall persist — and you shall persist. Our words will remain. Much like some antibody, they are immune to destruction by outside forces because The Transnational is swimming through the vast ocean of data that is the Internet in the form of an e-book.

Some carry it around as a file on a memory stick. Others stow it away on some digital bookshelf. Either way it is safe from jackhammers and wrecking balls. And even if the hacker community should ever turn its destructive gaze on literature, somebody somewhere will always have a pristine copy of The Transnational on some form of removable media, just waiting to be rediscovered. They are chiselled into the very fabric of the Internet and will continue their 'careers' for as long as anyone cares to read them, listen to them, share them or comment on them.

So literature, one of man's earliest achievements, has found a way to survive. Modernity itself furnishes it with the means to do so, but it is you, the contributors, who give it life. In this edition, 38 authors come together to comment on life, to allow us a glimpse into their various mind sets, and to draw our attention to the things that move them as individuals and which may, or perhaps ought to, move others. Thus, they gift to us a piece of eternity.

We may agree or disagree with these utterances. We may formulate our own thoughts on the issues in question or we may expand upon existing ideas — we can do all of that, but no one can destroy them. They cannot be eradicated. We are in the process of creating our own cultural heritage in words, sentences, and opinions. My heartfelt thanks to all contributors. All the best to you all from Potsdam. Das Ende der Sprachlosigkeit. Und so warfen sich die Derangierten in die Arztkittel und vertauschten frech die Rollen.

Das war ihr Marsch durch die Institutionen. Felix Krull im Vergleich war da nur ein Hotellaufbursche.

  • It Shouldnt Happen to a Vet: The Classic Memoir of a 1930s Vet (Macmillan Collectors Library Book 89).
  • Fanny Kemble: A Performed Life.
  • The God Patent.
  • La Trappe Sociale (French Edition);

Was bedeutet das konkret? Hier wird im Schnellverfahren jeder bis in seine Existenz hinein mit ideologischen Fallbeilen guillotiniert. Hemmungslos verschlingt der falsche Leviathan die Demokratie samt freier Marktwirtschaft. Translation - English The loony left - what's it all about? The basic concept, en vogue since when the sons and daughters of the bored-oisie found their vocation in hooliganism, seems convincingly simple and goes like this: it's not the sick who need treatment but rather the society that ostensibly makes them ill.

And so the misfits promptly donned white coats and insolently switched roles. Since then a whole host of these patients have managed to penetrate to the highest echelons of power cleverly disguised as therapists: their own version of Dutschke's 'march through the institutions'. Felix Krull was a mere errand boy by comparison. So what does it all mean in practice? Ironically enough, this is all been done by those very people who have traditionally stood shoulder-to-shoulder with the most vocal advocates of paedophilia. But it's in the battle of terminology that the loony left is able to fight with such bravura.

It's their insidious euphemisms and masterly displays of outrage that have such a mesmerising effect and drag the disoriented masses into the maw of the all-encompassing, all-controlling, and all-knowing state, that very state now garrisoned by these same sons and daughters. After all, their illustrious careers derive precisely from their Samaritan-esque embodiment of the state, masquerading as the benefactors of the needy and healers of the helpless.

And so it is that this false state, with its counterfeit doctors, infiltrates every sphere of public and private life. All that remains to be done is to silence a few dissenters, to intimidate and browbeat all the non-believers, who bravely continue to cling to the principle of personal responsibility.

All hounded to their very souls in summary hearings and dispatched under the ideological guillotines, while, with wanton abandon, this treacherous Leviathan gobbles down democracy along with the free market economy. The loony left is the bloodhound snuffling out the "victims" in need of its aid. The more it learns how to distil "hardship and helplessness", "cold indifference and exploitation" from the tiniest of scratches, the more aid workers need to be recruited to provide succour to the "victims".

The monstrance of tolerance is extolled by the high priests of the loony left and borne aloft through the streets as a means of creating ever more victims. Only, now a sudden breeze blows in from the desert, bearing tidings of long ago. Standing outside the gates in the form of an impoverished child it laps up the nourishment and care lavished on it by the loony left that protects it and raises it as if it were the fruit of its own loins.

It's the innocently smiling child that came from afar and will one day deal it the death blow. Translation - English On dreary beach, by grey sea shore And not far off the town; The fog bears down on roof and floor, Through quiet night resounds the roar Drearily round the town. No forest rustles, birds don't cry Without a rest or pause in May; And just the goose with raucous cry Does cross on Autumn nights the sky, The grasses wave all day. Yet all my heart remains with you, O dreary seaside town; Enchanted youth for ever true Rests smiling still on you, on you, O dreary seaside town.

Willst du die Stummel nicht haben? Ich hoffe er wird dich ohrfeigen, wenn du mit den Litzen auf der Schulter nach Hause kommst. Translation - English It was just getting light as we reached the German border: to the left a broad river; on the right a forest whose depth one could even discern by its edges.

It became quiet in the goods wagon. The train advanced slowly along the patched up tracks, passing shot-up houses and splintered telegraph poles. The youngster 1 crouching next to me took off his glasses and carefully wiped them. And as we stopped at Nijmegen just as the dawn was breaking and someone said we'd soon be coming to the German border, he had nervously asked around if anyone would swap some thread for a couple of cigarette ends; and when no one had responded I had offered to rip off my collar patches — or flashes as I believe they were called — and turn them into dark green thread.

I took off my tunic and watched him as he carefully removed them with a piece of tin before picking them apart and then actually beginning to stitch the officer cadet braiding around his epaulettes. Now, as we pulled into Cleves, he interrupted his sewing and crouched next to me, Tom Thumb dagger in hand. How about you? Don't you want the cigarette butts? I hope he thumps your ear when you turn up at the house with those braids on your shoulders.

However it is clear from the further context that it is the person's inexperience and unperturbed idealism that stands in stark contrast to the narrator's more jaded frame of mind, so I have used 'youngster' in the English rendition to emphasise this difference. I have therefore taken the liberty of varying it slightly when it seemed appropriate to do so. This is a matter of taste and is the sort of thing that I would ordinarily discuss with a living author or alternatively with the commissioning editor.

I think 'Tom Thumb's dagger' rolls off the tongue with slightly more ease. Ich pflegte ihn, doch es gelang mir nicht, ihn zu retten. Gestern habe ich ihn begraben. Denn wir sind alte Rivalen: der Tod und ich. Medizinisch gesehen handelte es ich um den letalen Ausgang einer akuten Infektionskrankheit: Typhus. Robin Guiscard starb. Translation - English A few days ago a person died in my house, here on the heath. I did not know him, had never met him before, and of his life's story I only gathered as much as he blurted out in his delirium, as he had already been sick when he came to me.

He lay in this room for nearly two weeks, fantasising, declining and fighting his way through pain and confused dreams to his laborious death. I nursed him but I could not save him. I buried him yesterday. He is lying under a hillock rising out of the plain covered in ferns, anenomes and meadow-grass. I dug the grave parallel with the track that cuts across the heath from East to West. In accordance with his wishes I positioned his head towards the sinking sun; he had said he wanted to lie facing the morning.

This was neither my first burial nor the first time I had seen a person die without being able to help him. For we are old rivals; death and I. From the medical perspective it was the fatal result of an acute contagion: typhus. The ability to survive this illness is individually highly variable. There are those who, having only just survived the primary infection, subsequently succumb to chronic complications like inflammations of the lungs, heart, or bone marrow; and others who harbour millions of typhus bacteria without themselves ever falling ill.

The 36 year old Robin Guiscard — whose name and age I gleaned from his documentation — was not one of these. Of feeble constitution, worn out and tired, his belongs in the category of the 12 to 15 percent of fatal cases, recognised statistically as death's minimum toll. Robin Guiscard died. He died in spite of my many attempts to preserve his life; despite quinine and antipyrin; regardless of spotless hygiene and all the diets; despite my genuflection 1 before the traditional remedies of the medical literature.

He died in the end, after having lain for days in an appalling struggle for his life, without protest, almost at peace with the way out that had opened up for him, almost happy; calm in fact. The use of the German word 'Devotion' conjures up a feeling of quasi religious reverence for the traditional medical literature.