Why and by Whom the American Alcoholism Treatment Industry is Under Siege - A New Attack on Alcoholism on Alcoholism

Written by Stanton Peele

A Whole Different Perspective

Wallace's and My Different Backgrounds and Perspectives

That alcoholism treatment is under siege is obvious. In the last paragraph of the third part of his "Waging the War for Wellness" series, Wallace (1987c: 27) issued a clarion call to alcoholism professionals: "We must recognize and resist the various tactics and strategies of the Anti-traditionalist lobby to divide us. We must stand shoulder to shoulder in solidarity. Otherwise, alone and divided we will be weak and easy targets for those who do not want to pay for alcoholism services [emphasis added]." Throughout his rebuttal of my article, Wallace (1989: 270) adopted a tone of injured innocence: "Despite Peele's efforts to discredit me by unjustly accusing me of intolerance and wishes to persecute, my convictions about the necessity for competent science to guide clinical practice remain intact." Wallace paints me as the persecutor. Yet the point of view he espouses is by far the dominant one in the United States. At the same time, as Miller and Hester (1986a: 122) indicated: "The list of elements that are typically included in alcoholism treatment in the United States . . . all lack adequate scientific evidence of effectiveness."

Whenever investigators question any tenets of the American treatment system, they are liable to be vilified. One well-known case was the Rand research. In 1976, Wallace participated in the NCA's press conference assailing the first Rand report: "I find the Rand conclusions of no practical beneficial consequences for treatment and rehabilitation." Others, like Samuel Guze, felt differently (Armor, Polich & Stambul 1978: 220-221): "Alcoholism and Treatment, a Rand report . . . is interesting, provocative, and important. The authors are obviously well-informed, competent, and sophisticated. They appear to recognize and appreciate the complex issues that their report covers .... What the data do demonstrate is that remission is possible for many alcoholics and that many of these are able to drink normally for extended periods. These points deserve emphasis, because they offer encouragement to patients, to their families, and to relevant professionals."

More than a decade later, Wallace (1987b: 24) was still attacking this report and its four-year follow-up and anyone who took them to indicate moderation of drinking problems was a real possibility, "Considering the scientific inadequacies of the first Rand report and the actual data from the second...." Others feel differently, including Mendelson and Mello (1985: 346-347), editors of the Journal of Studies on Alcohol and themselves preeminent alcoholism researchers: "Despite the gradually accumulating data base [on controlled-drinking outcomes], the 1976 publication of . . . the Rand Report was responded to with outrage by many self-appointed spokesmen for the alcoholism treatment community .... When this data base was followed again after four years, there were no significant differences in relapse rates between alcohol abstainers and non-problem drinkers .... [The Rand study] was evaluated with the most sophisticated procedures available ...." Whatever Mendelson and Mello's opinions, virtually no one in the United States (although not around the world) practices controlled-drinking therapy for alcoholics, and the practical applications of the Rand reports and of much other research, such as the techniques cited by Miller and Hester (1986a), are negligible. That is the power of the current alcoholism treatment establishment, which NIAAA director Gordis (1987) noted when he said, "Contemporary treatment for alcoholism owes its existence more to historical processes than to science ...."

My own work in the alcoholism field includes a number of critical summaries of views of alcoholism and other drug addictions and their treatment and prevention. Wallace (1989) referred to one of these articles, "The Implications and Limitations of Genetic Models of Alcoholism and Other Addictions" (Peele 1986), that cast doubt on genetic claims about alcoholism. Recently, another of my articles (Peele 1987a) received the 1989 Mark Keller Award for the best article in the Journal of Studies on Alcohol for the years 1987-1988. I also address addiction and alcoholism professionals at conferences, such as the 1988 [DHHS] Secretary's National Conference on Alcohol Abuse and Alcoholism, where I debated with James Milam whether or not alcoholism is a disease. In this sense, some important venues have answered Wallace's (1989: 259) question—"Can Stanton Peele's Opinions Be Taken Seriously?"—in the affirmative.

Nonetheless, my role in the alcoholism field is that of an outsider. When I name research professionals (mainly physicians)—such as Enoch Gordis, Donald Goodwin, Samuel Guze, Jack Mendelson, Nancy Mello, George Vaillant, John Helzer, Lee Robins, Forest Tennant, Robin Murray, and Griffith Edwards—to support my positions, and when I asked in my original article in this journal (Peele 1988) whether Wallace considered these mainstream figures to be anti-traditionalists, I was being ironic. I meant through this device to illustrate how poorly conventional wisdom does at explaining the results and views of the most prominent of alcoholism researchers. For example, the Goodwin, Crane and Guze(1971) article that described remission among former convicts who continued to drink could never be published today in the aftermath of the furor created around the Rand reports.

I described alcoholism treatment in Great Britain in my original article as a way of showing that the supposed biological basis of alcoholism and of its medical treatment does not travel well across the Atlantic. I do not understand Wallace's (1989) reasoning in his response to my quotes of Robin Murray's negative findings on genetic causation as well as his statement that British psychiatry finds that the disease approach to alcoholism does more harm than good. Wallace seemed to be saying that this is a slap at British and American researchers who study biological sources of alcoholism. My point was that the defection of almost the whole of a nation from the disease model does not support Wallace's (1989: 269) view that "in the future, I think that the type of arguments mounted by Peele against biological factors in alcoholism and in favor of controlled drinking will be dismissed readily as prescientific or even as ascientific."

In a major speech (Newman 1989), Wallace indicated where he thinks alcoholism treatment based on modern neuroscientific discoveries is headed. In the first place, he does not find them inconsistent with AA and "spiritual" recovery: "I think behavior affects neurochemistry. When you get in AA you get in touch with your good molecules." Here is how Wallace describes the future: "Treatment is going to be transformed over the next ten years. There will be a lot more so-called New Age initiatives, including body massage, meditation, and attention to diet."

That the British are going in the opposite direction from this country is clear in the description put forward in the pro-disease trade publication, the U.S. Journal of Drug and Alcohol Dependence (Zimmerman 1988: 7):

The ten men and women who live at the Thomybauk recovery home in Edinburgh have all had trouble with alcohol, but don't call them alcoholics or suggest that they have a disease.

They're problem drinkers. They developed a dependence on alcohol. They aren't being treated for alcoholism but are trying to learn to deal with personal problems in a way that avoids getting drunk. If they want to try to drink again and control it, their counselors at Thomybauk wouldn't object.

Thomybauk would be considered a novel, if not dangerous, course of treatment for alcoholism in the United States, where the traditional disease concept of alcoholism makes total abstinence the widely accepted goal of treatment. In England and Scotland, and Mach of the rest of the world, it's the other way around [emphasis added]. The majority of medical and psychiatric practitioners frown on the idea that persons who have once lost control of their drinking must, above all, avoid a "first drink" if they expect to sustain their recovery. In the eyes of these doctors, it is insisting on abstinence that may jeopardize alcoholic recovery. They prefer to work with a concept of alcohol dependence which has varying degrees of severity and may leave the door open for a return to social drinking by some patients.