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Dawson (1996) analyzed 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) data mentioned above, designed and sponsored by the NIAAA and conducted face-to-face by the U.S. Census Bureau.
Table 6. NLAES Data on Alcohol Dependent Subjects
| Outcome categories | Treated (n=1,233) | Untreated (n=3,309) |
| < 5 years since onset dependence |
| abuse/dependence |
70% |
53% |
| abstinent |
11% |
5% |
| drinking w/o abuse/dependence |
19% |
41% |
| 20+ years since onset dependence |
| abuse/dependence |
20% |
10% |
| abstinent |
55% |
30% |
| drinking w/o abuse/dependence |
24% |
60% |
These data seriously question most assumptions made in alcoholism treatment today, to wit:
- Only those whose alcohol abuse does not meet dependence criteria may continue/resume drinking without clinical problems. In fact, nonabusive/dependent drinking was by far the largest outcome category in this group of formerly dependent drinkers. (Indeed, MATCH itself was really a kind of controlled-drinking experiment, since it reported improvement in terms of reduction in days drinking—on average from 25 days/month to 6 days/month—with corresponding reduction in consumption on drinking days.)
- Treatment is necessary for recovery. Treated alcoholdependent subjects in fact had lower remission rates than untreated dependent subjects, and this disparity grew with the passage of years. Treatment mainly served to turn people towards abstinence versus drinking without clinical problems as an escape from dependence.
Those who only know alcoholics in clinical settings (and then only during treatment or briefly afterwards) seem to be missing the larger picture of alcoholism, including the large majority who remain untreated. Among other things, addiction and alcoholism are not progressive diseases, but patterns into and out of which people regularly cycle. Within this framework—in at least some cases—treatment has the counterproductive effect of stalling people in the addictive swing of the cycle and of preventing their ultimate emergence from addiction.
These data strongly affirm similar inperson data from the Vietnam study as reported by Lee Robins, John Helzer, and their colleagues (1980) over 15 years earlier (this is the same research group—Helzer, Robins et al., 1985— who claimed that resumption of moderate drinking by alcoholics is impossible). These researchers reported the following challenges to conventional wisdom about heroin and drug treatment based on their research:
Is addiction to heroin more or less permanent without prolonged treatment?
Of all the men addicted in Vietnam [defined as prolonged heavy use and severe withdrawal symptoms lasting more than two days], only 12% have relapsed to addiction at any time since their return. . . . Of those men who were addicted in the first year back, half were treated and half were not. . . . Of those treated, 47 percent were addicted in the second period; of those not treated, 17 percent were addicted . . . .
Does recovery from addiction require abstinence?
Perhaps an even more surprising finding than the high proportion of men who recovered from addiction after Vietnam was the number who went back to heroin without becoming readdicted . . . . Half of the men who had been addicted in Vietnam used heroin on their return home, but only oneeighth became readdicted to heroin. Even when heroin was used frequently . . . , only onehalf became readdicted.
These government-funded studies (the Vietnam research was funded by the Defense Department) seem to contradict the impetus of a massive government propaganda effort. Shouldn't the U.S. government get its story straight?
"Who Gets Treated" Revisited
We have seen that more socially deprived people are to be found in alcohol and substance abuse treatment. But the NLAES and Vietnam Vet studies also showed (as has other research) that treated alcoholics/addicts are, on average, more severely addicted. This means that those who received treatment in the NLAES and Vietnam study fared worse because they had worse addictions. But this can't account for the entire phenomenon of natural remission and of superior outcomes for untreated over treated addicts/alcoholics. First, keep in mind, all subjects in the Vietnam study were classified as addicted based on prolonged heavy use and the appearance of substantial withdrawal, while everyone in NLAES was classified "alcohol dependent" according to DSM-IV. In other words, those who recovered at such a good rate without treatment—better than untreated addicts and alcoholics—were in fact genuine addicts and alcoholics, at least as determined by standard diagnostic tools.
More importantly, the relatively poor performance of the treated addicts and alcoholics in these studies seemingly belies the optimistic claims for treatment, most notably those of NIAAA director Gordis and other MATCH research personnel. In NLAES, 7 in 10 treated alcoholics were still abusing alcohol or alcohol dependent within five years of treatment. Recall, then, the elimination of more than 60 percent of prospective patient/subjects for Project MATCH due to "residential instability; legal or probation problems, etc. " In other words, by advantageous selection and other special features, MATCH created results wholly unlike those actually found for alcoholism treatment in the U.S.
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