Why Controlled Drinking Never Dies
In response to howls of outrage that some professionals (few enough) continue to talk about controlled drinking, Stanton points out that the result that many people reduce their drinking healthfully is an ever-present research finding, even among the most unlikely anti-controlled-drinking sources.
The Stanton Peele Addiction Website, 8 August 2000
A staunch defender of the disease theory of alcoholism and the absolute requirement of abstinence (a recovering alcoholic and psychiatrist named Floyd Garrett) pointed out, in relation to Audrey Kishline’s car crash, quotes from two notable alcoholism professionals, Nicholas Pace (a long-time critic of controlled drinking, from the Rand Reports on, with whom I once had a television debate) and the irrepressible George E. Vaillant:
Dr. Garrett wrote:
The article below was published in 1995. In hindsight we must appreciate Dr. Pace’s prophetic powers:
Added Pace: “As far as I’m concerned, [Kishline] has a big problem with alcohol. I’d like to see what happens to her in five years. She and her group are doomed to failure.”
Dr. Vaillant’s analysis coincides precisely with mine:
Said George Vaillant M.D., professor of psychiatry at Harvard Medical School and author of The Natural History of Alcoholism: “People who keep coming up with new ways of doing this do so in direct proportion to the degree they’re not immediately involved in treatment of large numbers of alcoholics. It’s like trying to cure cancer with prayer.”
I like to reflect on the arrogance of abstinence theorists. That Audrey Kishline had decided to abstain prior to going blotto with alcohol might not explain that fact, but that a person or organization makes claims about AK’s horrible drunken splurge without mentioning that she was attending AA and had recently shifted to an abstinence goal is, unequivocally, a sign of intellectual dishonesty. In my review of George Vaillant’s book, The Natural History of Alcoholism, I noted that, although GV reported that about two thirds of alcohol abusers who resolved a problem did so without going to AA, he only described cases of people who either entered AA, or else failed to resolve an alcohol problem. In other words, he used his cases to undercut — misrepresent — the reality of his data. Furthermore, I was later able to leverage from Vaillant data comparing self-abstainers and AA abstainers, and the latter were more likely to relapse! (George has never forgiven me for revealing this fact in his data, and he never gives a lecture now without attacking me.) That George — like the NCADD — now uses AK as proof of his position that only AA and abstinence work without the inconvenience of mentioning some complicating factors, like that she had joined AA is, I’m afraid, a mark of the man.
And, on to the remarkable Mary Pendery. MP made a career over claiming that people taught moderation techniques relapsed a lot — although she declined to follow-up the abstinence-treatment group in the Sobells’ study (who, she acknowledged, had horrible outcomes). MP became so enamored with her insight that controlled drinking was bad and abstinence was good that she dated a man who had completed her abstinence program some time before. But her miscalculation was so severe that it killed her — her lover George Sie Rega relapsed hard and shot her dead. We often talk about the death-encouraging nature of alcoholism; how about the death-causing arrogance of the therapist who cannot recognize that her claims that abstinence work so well are unfounded, and are disintegrating in front of her eyes in a man she is having a love affair with? Is this detachment from reality worth analyzing — is it encouraged by recovery nuts who believe abstinence resolutions and therapies cure all?
The entire enterprise of “proving” by individual citation is a mark of witch-hunting and McCarthyism. And the goal of proving AA and current treatment — abstinence fixated as these are — are all we need to confront alcoholism serves two functions: (1) reassurance of those who have chosen that path for themselves that it was the only way, and that their former years of drunkenness, self-destruction, and hurt of others was a mark of denial expressed by putative attempts at controlled drinking that were futile in the face of a biological imperative to drunkenness they harbor inside them, (2) a neotemperance idea that the chemical involved in alcohol is the cause of all that alcoholics do to themselves and others.
What we fail forever to accomplish with the abstinence approach is (1) to attract the overwhelming majority of people into ameliorative programs in the first place (including the many who describe years of alcoholism that they bottled up when they finally accepted AA, but only after untold carnage in their own lives and for those around them), (2) to prove that even those well-intended enough to enter treatment and AA seriously will show noteworthy periods of abstinence — or even do better than those (as they did not in Vaillant) who tried it on their own, (3) to note and encourage any improvement alcoholics display over all-out dissolute and uncontrolled drinking, (4) to have anything in place — other than admonitions of hell and brimstone versus the proffer of AA and abstinence — for the vast number of currently active alcoholics and problem drinkers. This number, by all accounts, has risen since the 1960s and 1970s (when we drank as much as or more than we do today), and seems paradoxically to be growing among the young.
For abstinence-over-all proponents, the constant suggestion of the possibility that some alcoholics may control their drinking is an outrage and an evil for which controlled-drinking advocates should be held accountable. The answer to the never-ending struggle (a Manichaean struggle between good and evil according to many) is for all to fall down and bow to abstinence — they MUST do so, for their own good and the good of all alcoholics. That this never happens, that it never can happen, that it is perhaps less likely today to happen, since harm reduction as a philosophy is gaining a toe-hold in treatment circles, is not the point for these abstinence advocates. They can never be discouraged. Partly, the reason for this — other than their own internal imperatives — is that they are largely thought correct in official circles, or at least in the public fronts presented by agencies like the NIAAA. Thus, the goal seems tantalizingly near — we need only to stamp out a few heretics, underdogs and aberrants that they are, including a small rag-tag organization like MM. What, after all, would it take to blow this small assemblage, hanging on by its nails anyhow, away (yes, the abstinence forces are, unapologetically, bullies — they know they are right, and to assail small groups of unpopular individuals is their right and obligation)?
But, then, there are the data. We can hardly perform a study comparing abstinence treatment with controlled drinking treatment — for any group of alcoholics — which fails to suggest that their outcomes are equivalent. Oh, we can toy with the definitions (for Vaillant, a successful abstainer might have up to a week of relapse, while even a day of drunkenness rules against a successful controlled drinking outcome), but such results constantly pop up. And therapy organized around producing complete abstinence — never does so (and when it does, as it did at John Wallace’s fabled program, he claimed, no one believes it and people are perfectly content to see the program shut down). The most remarkable example of this was in the abstinence-oriented Project MATCH research conducted under the auspices of an abstinence-fixated NIAAA and its head, Enoch Gordis. But what were the results — in the outpatient treatment alone component, only a fifth abstained for as long as a year after treatment; for the outpatient follow-up to hospital care, the year-long abstinence rate was a third. So, instead, controlled-drinking-hating Gordis and the NIAAA noted that, on average, alcoholics reduced drinking from 25 to 6 days a month, and from 15 to 3 drinks per occasion — how else could they justify the $27 million they spent to show that matching alcoholics with treatments would enhance outcomes, when it did not?
Such results will never disappear; they are real. They will always crop up; they cannot help but do so. The lackluster results from encouraging and measuring abstinence are the one thing history proves to us over again (rather than that alcoholism is a disease and that abstinence the only cure). And so, to lash out at heretics, as inconsequential and beleaguered a group as they appear to be, never gains the final abstinence uber alles conquest always just eluding abstinence adherents. It is so tantalizingly near; they must press on. The minor successes or failures of these controlled-drinking “forces” only serving to spur the rancor and vehemence of the dominant powers — who control all official treatment and research agencies in the U.S. already. Nonetheless, the just-released 10th Special Report to the U.S. Congress on Alcohol and Health noted:
Relatively little is known about developmental pathways that bring about change in a person’s diagnosis of alcoholism over the adult life course. However, research has shown that the progression of alcoholism is not uniform for all individuals, whether or not they are treated. That is, not all alcoholics remain actively alcoholic after the onset of the disorder. A general population study investigated stability and change in measures of alcohol abuse and dependence over 4 years among male drinkers (Hasin et al. 1990). Of those originally classified as alcohol dependent, 46 percent still reported indicators of dependence 4 years later, 15 percent had moved to the abuse only category, and 39 percent no longer reported any indicators of alcohol abuse or dependence. Of those originally classified as alcohol abusers, 24 percent remained in the abuse only category, 30 percent reported indicators of alcohol dependence with or without indicators of abuse, and 46 percent no longer reported any indicators of alcohol abuse or dependence.
Hasin, D.S., Grant, B., Endicott, J. (1990), Natural history of alcohol abuse: Implications for definitions of alcohol use disorders. American Journal of Psychiatry, 147(11):1537-1541.