|
Page 3 of 7
The Implications for Alcoholism Treatment and Research of Smear Tactics and Trial by Media
NCA and other critics of the Rand reports justified lurid accusations and resulting headlines on the grounds that simply learning of results like those reported by the Rand investigators could lead alcoholics to relapse and to death. As Dr. Luther A. Cloud, having "learned that some alcoholics have resumed drinking as a result of...the Rand study," felt compelled to indicate, "this could mean death or brain damage for these individuals" (Armor et al., 1978, p. 232). Thus, these critics believe there are good grounds to suppress such information. Several efforts were made to prevent the release of the first Rand report. The L.A. Times reported that Rand board member Thomas Pike "had tried unsuccessfully to get the Rand report killed" (Nelson, 1976, p, 17). Mary Pendery, chair of the California Advisory Board, announced at the NCA press conference that she had called the head of domestic programs at Rand in a last-minute attempt to delay the report so that it could be reanalyzed in line with the opinions of "top scientists" (NCA Press Conference, 1976 , p. 5).
Of course, the impact of different treatment strategies and goals is an empirical question, one which the Rand research was intended to investigate. Both of the Rand reports analyzed the results of patients' moderated drinking or abstinence for later relapse. Neither discovered one approach to be inherently superior for preventing relapse. The primary goal of the Sobells' study was to compare the success of controlled-drinking versus conventional abstinence treatment on patient outcomes. Its conclusion was that although relapse was not uncommon for either group, controlled-drinking therapy yielded significantly less relapse. The primary criticism of the Pendery et al. study by the ARF panel and others was its failure to present any comparative follow-up data for the hospital abstinence group in the Sobells' study, which meant it was never able to refute the Sobells' claim that controlled-drinking therapy led to better outcomes.
Pendery et al. reported that four controlled-drinking subjects had died in the ten years following treatment. In response to the ARF investigation, the Sobells discovered (simply by writing to California authorities) that six of the abstinence subjects had died in the period covered by the Pendery et al. report. Moreover, Sobell and Sobell (1984) found the first of the controlled-drinking deaths occurred more than six years after treatment and the last two ten years or more after. The latter two subjects, who died while intoxicated, had both recently been released from traditional abstinence programs. Overall, Sobell and Sobell (1984) noted, the death rate for controlled-drinking subjects in this study was less than that reported in typical studies of alcoholic patients.
Why then was such a fuss made about the tragic outcomes of controlled drinking treatment? Of course, any death is horrible, the more so when brought on by self-destructive behavior. Yet the Pendery et al. data could not cast light on the risks of controlled-drinking versus abstinence treatment. Nonetheless, deaths in the experimental treatment group were highlighted in media accounts of the case. The CBS Evening News, in its report on the Science article, showed a lake where one controlled-drinking subject drowned. 60 Minutes, in a segment strongly supporting the Pendery et al. argument (screened in March, 1983), filmed Harry Reasoner walking alongside the grave of one subject. Such scenes are, after all, how television dramatizes the news. Naturally, they pack a tremendous emotional punch. We might compare these circumstances to those in which David McClelland (1977) reported on results of a nonabstinence socialized power approach to treating alcoholism. McClelland noted with academic caution that five in the standard hospital treatment program used as a comparison died while none died in the socialized power treatment. Imagine the potential consequences if this finding had been reversed!
At the time of the 60 Minutes program on the Sobells' case, the ARF panel's report was already available. Mary Pendery and Irving Maltzman had declined to cooperate with the ARF investigation, they said, because it lacked subpoena powers (Maltby, 1983). This made it easy for 60 Minutes to ignore the report (which ran 124 pages in length). Reasoner's reason for discounting the report was that the panel had not interviewed the patients in the study. A later investigation conducted by the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) likewise exonerated the Sobells of intentional or serious wrongdoing. This investigation solicited materials from a subject, Raymond Miller, who had been central to the Pendery et al. and 60 Minutes investigations. The report found nothing inconsistent in this man's evidence with the Sobells' published data.
The ADAMHA report ("Report of the Steering Group," 1984) described how several times, Pendery and or Maltzman either volunteered or agreed to send additional materials to support their assertions (p. 11). "However, despite repeated requests from the investigators, neither Pendery nor Maltzman submitted any documents ... in support of their allegations" (p. 2). In two other cases, investigators were stymied in efforts to enlist the cooperation of the Science article authors. James Jensen, an investigator for the Subcommittee on Investigations and Oversights of the United States Congressional Committee on Science and Technology, also found no basis for any claims of fraud against the Sobells. Jensen mentioned that "in several conversations" he had been unable to convince Pendery to present her evidence (Maltby, 1983, p. 1). Lastly, two psychologists interested in alcoholism treatment and controlled drinking and known for their balanced positions had arranged with Pendery and Maltzman to examine the latters' evidence against the Sobells. Based on this understanding, William Miller (letter to Mary Pendery dated July 5, 1984) composed a detailed list of 14 questions he and a colleague planned to address, including such basic issues as the protocol the investigators used to conduct follow-up interviews with subjects, which has nowhere been reported. However, Miller (personal communication, October 8, 1984) informed me, "Maltzman has withdrawn the offer made to me by Mary Pendery to examine their data first-hand" because he claimed this would "compromise the class action [suit] by the patients against the Sobells."
In explaining why she had cooperated with the 60 Minutes program but no other investigation, Pendery announced, "It did a terribly thorough investigation .... I was aware you have to cooperate with some people because you lose credibility if you don't" (Maltby, 1983, p. 3). At the 1983 NCA conference at which Pendery made an "emotional address" against controlled drinking, critics of her work, and the APA and psychologists in general, a tape of the 60 Minutes program was continuously screened ("Controlled Drinking Gets Rough Review...," 1983). As exemplified by the wide distribution of the version of their article rejected by Science, the Pendery et al. use of the media has been highly successful. There would seem to be little reason for these authors to cooperate with elaborate institutional or scientific investigations that have not yet provided much support for their case. Instead, they have achieved their aims through the national media and presentations to alcoholism groups. Describing one such presentation, entitled "Controlled Drinking; A Pseudo-Controversy that Kills," Marlatt (1984) reported that Maltzman accused the Sobells of fraud and Pendery indicated that controlled drinking had caused the death of several alcoholics. In her 1983 speech before the NCA, Pendery announced the overriding purpose of her campaign was to secure "a correction in the textbook literature "eliminating mention of the Sobells' research and other studies supporting controlled drinking ("Controlled drinking...," 1983, p. 1).
|
