Denial - of Reality and of Freedom - in Addiction Research and Treatment - Denial in Addiction Research and Treatment

Written by Stanton Peele

The Science article authors were led to their conclusions in good part by their interviews with former subjects, many of whom had now accepted abstinence treatment. Some former subjects in the Sobells' study organized an "Alcoholism Truth Committee" to support the Pendery et al. investigation (Peele, 1985). Raymond Miller, a key individual in this group, was prominently featured on 60 Minutes and was singled out for acknowledgement in the Pendery et al. Science article. Miller co-authored a book entitled Alcoholic Heaven in which he described his participation in the Science investigation, including enlisting the support of other experimental subjects and gaining cooperation from one spouse when he found the subject himself uncooperative.

This entire enterprise of recruiting former subjects to testify against a therapy or therapists has tremendous implications for the conduct and evaluation of therapy. In an era of activist malpractice claims against all sorts of treatment, the psychotherapist would seem to be particularly susceptible to claims of failure or discontent by former patients. As indicated, a group of former Patton State patients has sued the Sobells and the state of California. Obviously, controlled-drinking therapists are not the only potential objects for such claims, since continued alcoholism sometimes leading to death is a frequent outcome of all treatment for alcoholism (cf. Helzer et al., 1985). As Marlatt (1983) pointed out, nearly all the Sobells' patients also underwent standard alcoholism treatment, so should these treatment centers also be liable for any patient failures and deaths? Under other circumstances, people may be more forgiving of the failure of therapists to succeed with patients. For example, news articles describing the appointment of Dr. Forest Tennant as chief of drug testing for major league baseball mentioned among his credentials his treatment of Steve Howe. Howe has relapsed several times and was released by two baseball teams after his treatment for cocaine addiction.

The dangers in one school of therapy spearheading legal and personal assaults against another have not roused psychology or the alcoholism field to action. In part, this is because the competing claims are often so difficult to evaluate. Moreover, psychology has traditionally been reluctant to take stands on matters of individual treatment doctrine or to censor those who go too far in criticizing others. One colleague of Irving Maltzman's wrote me, for example, that he feared editors had unfairly discriminated against Dr. Maltzman by not allowing him to publish articles they felt slandered the Sobells or other parties involved in this dispute. I find the reluctance of psychologists actively to disapprove this type of calumny and smear tactic very troubling. For me, the fear, self-protection, and disregard for individual rights surrounding the attack on controlled drinking (paradoxically justified by the academician who wrote me in terms of intellectual freedom) very closely resemble the atmosphere of the McCarthy era.

Continuous reinvestigation of the Sobells' work, affidavits by their research assistants, and the basic consistency of their data with all new claims by subjects and others about relevant events have somewhat lessened the impact of the attacks on the integrity of these researchers. (We may wonder how well many researchers and clinicians would hold up under the kind of scrutiny that has been applied to the Sobells' work.) Nonetheless, the harassment and obfuscation the Sobells and the Rand investigators experienced have clearly discouraged objective research of the type their work represented. The Sobells may no longer labor under the suspicion—at least among most fellow researchers and scholars—that they have committed a heinous crime against science and humanity. However, the burden of national television shows and popular magazine reports about the harmfulness of controlled-drinking therapy and those who perform it will not be so easily removed. For the public, many professionals in the field, and some opportunistic academics and others concerned with alcoholism, it has been proven that those who would recommend controlled drinking for alcoholics must be inept or dishonest and should not be considered seriously as scientists and therapists.

The Latest Drug Menace

The attention of the media cannot long be held by relatively subtle questions like controlled-drinking treatment for alcoholics. Instead, with increasing intensity in recent years, our society has been addressing the question of cocaine abuse. The surge in concern over this substance parallels, but may be more intense than, that directed in turn towards marijuana, LSD, glue sniffing, PCP, Quaaludes, heroin, et al. Researchers and clinicians have appeared to be eager to join this bandwagon (certainly none wishes to be in the opposite camp of favoring cocaine use). Part of the analysis by pharmacologists, psychologists, and physicians has been of the special addictive properties of cocaine, thus reversing decades of work claiming that cocaine was to be distinguished from heroin in that cocaine lacked addictive, or physical-dependence producing, characteristics (cf. Peele, 1985.)

Consider the following description by Cohen (1985):

If we were to design deliberately a chemical that would lock people into perpetual usage, it would probably resemble the neuropsychological properties of cocaine [p. 153] .... The primary deterrent [to cocaine dependence] is the inability to sustain the practice because supplies become unavailable. The user is then driven to obtain additional cocaine without particular regard for social constraints. A variety of paranoid, manic and depressive psychotic states result with accidental, homicidal or suicidal potentials. (p. 151)

The imagery here is reminiscent of Reefer Madness and of the popular view of heroin—a view which the Vietnam research radically undermined (Robins et al., 1980 ). In fact, the epidemiological data on cocaine use are in line with similar data for other powerful mood-modifying substances. While 17% of 1985 college students used cocaine in the previous year, 7% in the previous month, .1% reported using it daily (Johnston et al., 1986). This compares, incidentally, with 57% of male college students and 34% of female who reported having a drinking bout (five drinks) at least once in the previous two weeks.

Siegel (1984) found the majority of long-term cocaine users were controlled users. Even those who abused the drug usually had intermittent episodes of excess and thus little resembled those who call cocaine hotlines or who are presented as typical cases in television documentaries. Clayton (1985) noted that, although large numbers of high school students and others were using cocaine, less than 5% of those in treatment reported it as their primary drug of abuse. Cocaine abusers abuse other drugs at the same time and share the characteristics of abusers of other drugs. For example, the best predictors of degree of cocaine use for high school students were marijuana use, truancy, and cigarette smoking. Similarly, although lurid stories of crack addicts are featured in the media, the very numbers of crack users in New York city and elsewhere strongly suggest there is a range of patterns of use of this form of the drug (Peele, 1987b).

Thus the federal cocaine trafficking trial in which several baseball players testified revealed primarily large numbers of users either whose use never got out of hand, or else who saw their use was detrimental to their game and desisted on their own (Peele, 1986). Yet the mood of the country today is not likely to support the idea that cocaine is a drug with widely variable effects and usage patterns. Even those whose research depicts such complexity slant their writing toward sensationalistic depictions of cocaine addiction and toward highlighting the inevitable dangers and damage from the drug. Fear of cocaine and other illicit drug use among the young, athletes, and others has created a hysterical atmosphere where almost any steps, from foreign invasion to invasion of privacy, can be justified.