In the popular science periodical put out by the New York Academy of Sciences and the newsletter of the addiction division of the American Psychological Association, Stanton turns Project MATCH and other NIAAA and mainstream research on their ears to show that alcoholism cannot be dealt with as a medical disease. Instead, such research shows, even highly dependent drinking is an interchange between drinker and environment, shifts considerably over time, allows for moderated drinking, does not particularly respond to treatment (and almost not at all to standard, overly-aggressive 12-step therapy that dominates the American treatment scene), and responds best to brief helping interactions in which the drinker is the principal actor.
In the APA Division 50 newsletter, the president of Division 50 states, "Project MATCH delivered what it was paid to do," while Richard Longabaugh, who commented on Stanton's paper, noted, "This response is undertaken with considerable apprehension as it has been my impression over the years that offering a view at variance with Dr. Peele's is rarely 'a day at the beach.'" Please note the remarkable points of concurrence between the views Stanton expresses and those expressed by William Miller in his David Archibald Lecture, (see Addiction, 93:163-172, 1998).

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The Sciences, March/April, 1998, pp. 17-21

The gospel of abstinence and twelve-step, studies show, is leading American alcoholics astray

The week before Christmas 1996, as people dashed to the liquor store for reinforcements and clinked their glasses at holiday parties, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) convened a press conference in Washington, D.C. The purpose was to herald the findings of Project MATCH, a government study devised to learn whether certain kinds of alcoholics respond best to specific forms of psychotherapeutic treatment. For example, twelve-step therapy and Alcoholics Anonymous (AA)—based in part on lifelong abstinence and personal surrender to a "higher power"—might work best for those seeking spiritual and religious meaning in their lives. Coping-skills therapy could help antisocial and emotionally disturbed alcoholics. And motivational therapy might best suit drinkers who show little desire for improvement, by spurring their desire to change.

Project MATCH had taken eight years to design and execute and had cost $27 million—the biggest and most expensive psychotherapy study ever mounted. It had encompassed thirty treatment sites and eighty therapists throughout the United States, along with dozens more of the country's most experienced investigators in alcoholism treatment, who had supervised and analyzed the study. The results of MATCH, much anticipated, promised to set firm guidelines for the therapy best suited to the particular needs of any given problem drinker.

Enoch Gordis, a physician and the director of NIAAA, stepped up to the microphone. "The good news is that treatment works," he announced. The therapies tested in Project MATCH all led to "excellent" overall results, he said.

But Project MATCH failed to find the links its organizers and most other alcoholism investigators had expected. The results showed virtually no differences in drinking reduction attributable to matching a patient's traits with a specific treatment. In fact, few clinical trials exist to show that the most popular American treatment for alcoholism, the twelve-step approach, is effective at all. Moreover, the results of both Project MATCH and a major 1996 NIAAA study showed that most people who had once struggled with alcohol abuse could later cut down on their drinking—a result that is anathema to the devotees of AA, to the U.S. medical establishment and to the American way of temperance.

Last December the MATCH collaborators published a further analysis of their study in the British journal Addiction, which basically repeated their earlier conclusions. Thus the group's official position remains the same as a year ago: All is well with alcoholism treatment in America. In that view, whatever therapy people are pushed toward—which in the United States effectively means a twelve-step program with the aim of total abstinence—they will be fine. Such an outlook, Gordis's overoptimistic interpretation notwithstanding, represents a public-relations triumph for the alcohol-treatment industry in America. But the blanket assurance that "treatment works" does precious little for most people who drink too much.

I'LL CALL HER ALICE (NOT HER REAL NAME). She is a woman I interviewed who tasted liquor for the first time in college and promptly went on party alert. She dropped out of school and drank heavily throughout her early twenties. Three to five times a week she got drunk, both alone and with a shifting cast of friends. During one nine-month binge and for several shorter stretches she drank virtually every night, polishing off nearly a pint of Scotch before she went to bed. Several times during her decade of drinking she was homeless.

Nevertheless, when she went home to visit her parents, sometimes for a couple of weeks, there was a major change in Alice's behavior. All she drank was wine over dinner with her father (her mother was a teetotaler). She did not want her parents to know how badly she was messing up her life; she controlled herself so she would not lose their love and support.

Alice had attended a few AA meetings, but she found the confessional atmosphere stultifying and oppressive. The turning point for her came when, at age twenty-nine, she got a job as a receptionist in a dentist's office. The dentist reminded her of her father, a pharmacist; he was a new authority figure she wanted to please. She began spending her spare time with her coworkers—people who did not abuse alcohol. Alice realized she wanted to be like them: steady and productive. She took classes to become a dental hygienist, and she began drinking in moderation, wine with dinner only. In short, Alice's new job and new friends helped jump-start her desire for a stable life.

Alice is in her forties now, married with children, and still drinking moderately. Her case may sound unique: an alcoholic who recovered without treatment and who continues to drink. In fact, her story is typical of former alcoholics in the United States, according to NIAAA research. Indeed, Project MATCH, while finding no difference in results based on the kind of treatment received, did find that personal motivation and the drinking behavior of peers made a significant difference in a patient's success.