Can some alcoholics learn to drink in moderation?
The answer, at least in this country, may be more political than scientific.

Morristown, New Jersey

In the July 9, 1982, issue of Science, an article by Mary Pendery, Irving Maltzman, and L. Jolyon West claimed that controlled drinking is not a viable treatment for alcoholism. The article was an attack on an earlier study that had found that controlled drinking was superior to abstinence for alcoholics. Pendery, Maltzman, and West were highly critical of Mark and Linda Sobell, the authors of the earlier study; Maltzman accused them of fraud.

The Science article received a great deal of news coverage, which created the impression that controlled drinking could not possibly succeed with alcoholics and that there was no basis for claiming that it could. It seemed that the disease theory of alcoholism—that an alcoholic has an inbred and irreversible predisposition toward excessive consumption of alcohol—was beyond question.

What the news reports failed to show was that scores of studies, done before and after the Sobells' work, have found that alcoholics can drink in a controlled manner. Actually, the controversy between Pendery et al. and the Sobells represents a larger dispute—one between those espousing the disease theory and those who favor a research approach that leads to far more complex notions about the nature of alcoholism.

The charges raised by the Pendery group were investigated by the Addiction Research Foundation of Ontario, which exonerated the Sobells in a 1982 report that has received scant attention. Other investigations are in progress, but whatever their results, it is clear that the controlled-drinking approach is a dead issue in the United States. The question is whether its demise was based on reasoned evidence and scientific scrutiny, or on superficial reporting arising from popular conceptions about alcoholism and alcoholics.

The Sobell controversy began in 1970, when Mark and Linda Sobell—then students at the University of California—designed a study to compare what happened to alcoholics treated in two different ways. The Sobells assigned 20 patients at Patton State Hospital in California to a behavior-modification program designed to produce moderate drinking. Another 20 received standard hospital treatment aimed at total abstinence. The Sobells' published results—including one- and two-year follow-ups—indicated that patients in the controlled-drinking group functioned better than those instructed to abstain.

In 1973, Pendery, an alcoholism counselor in San Diego, and Maltzman, a psychologist at UCLA, began their own investigation of the former patients in the Sobell study. The Sobells refused to release the names of the subjects. This set off a prolonged legal battle, during which another research team, headed by psychologist Glenn Caddy, performed a three year follow-up of the original study, confirming its results. The Pendery group believes that Caddy's work, which was supported by the Sobells, added nothing to the debate.

Eventually, Pendery and Maltzman obtained a list of the patients. They did not find it easy to get funding, however, and for several years Pendery paid for most of the research herself. It was only in 1979 that she was able to enlist the help of West, head of the Department of Psychiatry at the UCLA Medical School. West helped to find some financial support, and became the third author of the Science article.

The published article was actually a revision of an earlier draft, which the editors of Science had felt might be libelous. Nevertheless, the draft had been widely circulated and had formed the basis for many of the early press reports on the dispute. The draft also led to the appointment of an investigating committee by the Addiction Research Foundation, which now employs the Sobells.

Pendery and her colleagues refused to participate in the committee's deliberations, making its report inconclusive. Pendery, on the advice of her lawyers, declined—because, she said, the committee did not have the subpoena powers or right of cross-examination it needed to fulfill its mandate. More basically, Pendery said, this body could not possibly hope 'to judge the Sobells' state of mind 10 years ago,' and discover whether they had intentionally misrepresented their results. Yet Pendery and Maltzman apparently did just that in their own investigation, which depended on patients' recollections of events up to nine years in the past.

The committee selected by the ARF consisted of four distinguished professionals, representing the fields of law, medicine, psychology, and university administration. None of them had a previous connection with the alcoholism controversy. In the continuing dispute, which in some ways resembles the endless litigation that Charles Dickens describes in Bleak House, this committee's report stands out as a reminder of the basic methods and goals of science.