The Financier of the Modern Alcoholism Movement

The modern alcoholism movement is the dominant approach to drinking problems in America, including the view that alcoholism is the essential drinking problem and that it is a treatable disease. This view is not shared worldwide, and has been questioned in the United States as well. For example, a problems approach views drinking dysfunction in terms of the negative behavioral and social consequences that stem from a variety of types of excessive drinking.

The dominance of the disease view in America is due in good part to one man — R. Brinkley Smithers. Through his personal contributions and those of the Christopher D. Smithers Foundation he commanded, Smithers influenced the course of the major national groups concerned with alcohol problems in the United States. Smithers provided the principal funding for the Rutgers Center of Alcohol Studies at pivotal points in its history. He was also the principal benefactor and a major officer of the National Council on Alcoholism ("and Drug Dependence" was added to the title in 1990) — the NCA(DD). Smithers and the NCA in turn helped to create the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Research Society on Alcoholism, and the American Society of Addiction Medicine.

Smithers donated over $40 million to alcoholism programs, $13.5 million through the Smithers Foundation and $28 million of his personal funds (1, p. 9; 1a). He was heir to Christopher D. Smithers, a founder of IBM. At age 47, in 1954, after a hard-drinking career, Smithers quit drinking at a private hospital in New York (2, p. 15). At the same time, the NCA, the brainchild of Marty Mann, was encountering severe economic problems (3, p. 10). Smithers immediately became a benefactor and officer of the NCA, to which the Foundation ultimately gave $3.5 million and Smithers personally gave $5.2 million (1, p. 9). Smithers was president or chairman of the NCA from 1958-1965, and a board member from 1954 until his death in 1994 (3, pp. 29, 37). The NCA expanded dramatically in size and influence under Smithers's guidance and beneficence: "With Brink 'on board,' NCADD added a dozen staff members and expanded the board of directors to 60 volunteers...." (4, p. 10).

The NIAAA was created in 1970 by the Hughes Act, named for Senator Harold Hughes, an NCA board member and Smithers associate (5, p. 143). Smithers played a critical personal role in this process, "including making some well timed phone calls to get then-President Richard Nixon to change his mind and sign the original legislation creating the NIAAA" (6, p. 1). The NIAAA "began contracting with the NCA for assistance. As a result, in 1976 NCADD's budget peaked at $3.4 million, nearly five times what it had been before the passage of the Hughes Act. Government funds accounted for more than 75% of it" (4, p. 14). However, "in 1977, the board voted to rely on private funds in the future and once again Brink was there to ease the transition" (4, p. 16). Although separated from the chief federal agency dealing with alcohol problems, the NCA maintained an important role in federal government decision-making about alcoholism, at one point "assuring the surviving [sic] of the Alcoholism Study Section of the Alcohol and Drug Abuse and Mental Health Administration when it was threatened with demise through integration with other study sections" (4, p. 28).

The NCA was also central in the creation of American Society of Addiction Medicine, the key America medical group concerned with alcoholism and addiction, which was initially a component of the NCA (4, p. 9). Likewise, the Research Society on Alcoholism, a group committed to biological research on alcoholism, was "formed under NCA auspices" (4, p. 19). Enoch Gordis, currently director of the NIAAA, declared, "NIAAA, the American Society of Addiction Medicine, and the Research Society on Alcoholism, all owe their founding in whole or in part to the efforts of NCADD" (4, p. 25).

Smithers rarely funded individual researchers. However, those he funded often figured significantly in American alcoholism developments, although not because of specific research they conducted. The first such grant to an individual occurred when "In 1957 he agreed to finance a major research project by Dr. E.M. Jellinek, later published under the title The Disease Concept of Alcoholism" (2, p. 16; see 1, p. 9). Another early grantee of the Foundation was Dr. Ernest P. Noble, funded in 1966 "to clarify, through genetic and behavioral measures, the inter-relationship of the biogenic amines and the alcohol metabolism" (1, p. 11).

Noble became director of the NIAAA. During his tenure, the Rand Corporation — based on an NIAAA-funded study — concluded that many alcoholics eliminate alcohol dependence while continuing to drink. On the morning of the release of the Rand report, the NCA convened a press conference to attack Rand's results. Meanwhile, despite three strongly worded letters commissioned by the NIAAA from major figures in the mental health field (e.g., Dr. Gerald Klerman wrote Noble, "I would strongly urge you and the NIAAA and ADAMHA to stand firm wherever possible"), Noble issued a press release questioning the Rand results and strongly urging "that abstinence must continue as the appropriate goal in the treatment of alcoholism" (7, pp. 215-234; 8, pp. 1340-1341).

Smithers' relationship with the Rutgers Center was crucial and long-lived. In 1962, grants from Smithers personally and from the Smithers foundation were used to match Department of Health Education and Welfare funds in order to move the Center from Yale to Rutgers (1, p. 11). At Rutgers, the Center was housed in Christopher Smithers Hall, named for Brinkley's father. However, some time after this, because of interest shown by the Center in controlled drinking therapy, Smithers "proceeded to cut the ... [Center] out of his will" (9, p, 193; 10, p. 57).

But Peter Nathan, who became the Center's director in 1983, was able to re-establish the Smithers-Center link. In 1986, Smithers made a personal gift of $6.7 million addressing prevention and job impacts of alcoholism to Cornell and Rutgers Universities ($3.54 of which went to Rutgers) (1, p. 15; 10, p. 58). The Cornell grant established a Smithers institute for prevention and workplace problems, with Harrison Trice "the central figure in alcoholism research at Cornell" at the time (Cornell and Rutgers Universities press release, April 23, 1986).

Rutgers and Cornell took this money knowing that Smithers could be a demanding donor. Smithers had a long-standing dispute with the St. Luke's-Roosevelt Hospital Center, to which he had originally pledged $10 million in 1971, and which used the funds to create the Smithers Alcoholism and Treatment Center. Smithers refused for some time to provide the second $5 million based on his dissatisfaction with the Roosevelt program. Smithers "disagreed with the way the center's program was run by Dr. LeClair Bissell, a psychiatrist and also a recovered alcoholic. Their dispute appeared focused on whom the center should treat, Mr. Smithers saying he was interested in helping people 'from my walk of life' and employed alcoholics. He also insisted that 'Rich people have more problems than poor people.' Dr. Bissell, however, argued that 'it was good for a variety of people to be in treatment together.'" (It is interesting that Smithers himself spent a good deal of time in sanataria for well-off drinkers prior to his recovery.) Bissell resigned in 1979 and eventually Smithers made good on the rest of his gift (1b).