Our attitudes toward alcoholism are doing more harm than good

Stanton Peele
Morristown, New Jersey

Most Americans assume that abstinence is the alcoholic's only hope. And in July 1982, a paper published in the prestigious journal Science was widely received as proof of this indelible truth. Mary Pendery, head of alcoholism treatment at the Veterans Administration Medical Center, in San Diego, interviewed a group of alcoholics who had participated in an experimental program at Patton State Hospital, in California. Twenty alcoholics had been taught, using behavioral-modification techniques, to drink moderately. Virtually all of them, Pendery and her co-workers discovered, had bouts of drunkenness within six months. In the ten years since their treatment, four of them had died—from what Pendery claimed to be alcohol-related causes.

John Sloan, McSorley's Saturday Night, 1929

Newspapers, magazines, and radio and television programs took up the researchers' findings and dwelled on the deaths, sometimes in graphic detail. The CBS weekly newsmagazine, 60 Minutes, interviewed several of the alcoholics, who described their drinking relapses and denounced the psychologists who had supervised their treatment, Linda and Mark Sobell, then students at the University of California at Riverside.

The news stories were fueled by accusations of fraud, veiled and explicit, which the authors of the Science article had leveled at the Sobells. These accusations had been expunged from their paper by the editors of Science, but the researchers repeated them to the press. They hoped to eradicate the influence of the Sobells' study, which, they claimed, had spawned a whole series of investigations into what is often called controlled-drinking therapy—treatments in which some patients are encouraged to become restrained, social drinkers rather than teetotalers. What concerned Pendery and her colleagues, and many of the reporters who gave the story so much attention, was the horrifying possibility that alcoholics were being treated by a method guaranteed to lead them back down the garden path to alcoholism.

Yet it hardly seems necessary today to discourage controlled-drinking therapy. In the United States, at least, the idea has already been beaten dead. Practically no treatment centers in this country now pursue it as an official policy. Not only do the rank and file of health professionals reject this sort of therapy out of hand, but even the small group of behavioral researchers who developed controlled-drinking programs in the first place say it is not appropriate for the severe alcoholic. What is more, there is little interest among alcoholics themselves in treatment aimed at moderating their drinking. Regardless of the merits or demerits of the Sobells' study, 79 percent of Americans accept the view that alcoholism is a disease and that it calls for medical treatment, according to a 1983 Gallup poll. For this reason, they are likely to assume that strict abstinence is the only possible happy ending.

Few Americans realize that this view of alcoholism and abstinence is not shared worldwide. Controlled-drinking programs are widely accepted throughout Europe. Britain's National Council on Alcoholism, for example, believes that "controlling one's drinking pattern . . . may be an alternative which many people prefer, and are able to achieve and sustain, and for this reason they deserve our support and guidance." And when two Scottish researchers distributed a questionnaire to treatment facilities in the United Kingdom in 1979, they learned that in 93 percent of these programs, moderation is considered a reasonable goal. This casts the American repugnance toward controlled drinking in a more culturally relative light.

As social scientists have known for decades, attitudes toward alcohol come in as many shapes as bottles; and attitudes, more than scientific evidence, have formed Americans' rigid notion of the proper treatment of alcoholics. An investigation of three Greek villages by Richard Blum, now at Stanford University, found that the villagers did not view alcoholism as a problem, or even as a potential problem. Moderate drinking is a Greek family custom, closely knit into the community's social fabric, and spirits are seen as a harmless acåompaniment of good times. Greek society encourages neither the extreme of abstinence nor the extreme of drunkenness: drinking is not a moral issue, and the abuse of it is rare. This comfortable attitude is palpable in the atmosphere of Greek clubs in America, where families gather to listen to music and to dance.

There are other notable pockets in the United States in which alcoholism is unusual, particularly among Italians, Jews, and Chinese Americans. In all of these ethnic groups, young people are introduced to alcohol, in the form of wine or other mild spirits, early in life and as part of rituals, religious holidays, and celebrations. Drinking takes place among both sexes and all ages and is strongly regulated by social custom. It seems that these people's perceptions of alcohol, and their very experience of its effects, are less intense than most Americans'. Fewer than one out of a hundred American Jews is alcoholic, for example, while the national average is one in twelve.