Survivors of the Alcoholism Wars

Once controlled drinking hid—then came harm reduction, and the world opened

Posted Apr 04, 2014

In the 1970s-1980s, there were the controlled-drinking wars. The National Council on Alcoholism organized a major press conference to confront the so-called Rand Reports, 18-month and four-year follow-ups of alcoholics at national treatment centers. The Rand investigators found that a distinct number of treated alcoholics became moderate drinkers, even though they were not taught to control their drinking. The reports were blamed for (in anticipation) causing massive deaths among alcoholics who would believe that safe drinking was possible.

Then came the Mary Pendery-Irving Maltzman critique of controlled-drinking therapy research by Mark and Linda Sobell, behavioral psychologists who believed alcoholics could be taught to be moderate drinkers. The Sobells came to within an inch of their professional lives. (Mary Pendery was later shot to death by a recovering alcoholic she was dating.) Controlled drinking therapy became a dead letter in the American treatment armory. Its demise was announced by Peter Nathan and Barbara McCrady, behaviorists who headed the famed Rutgers Center of Alcohol Studies.

Let's just say I was involved in these fights. In particular, John Wallace, a psychologist and recovering alcoholic who ran the Edgehill Newport alcoholism program wrote and published in journals broadsides entirely devoted to deriding controlled drinking advocates, and then me and my views specifically. The dispute kept me busy.

Dial forward to the present.

Immense national studies conducted by the National Institute on Alcohol Abuse and Alcoholism now find that same minority of treated alcoholics as in the Rand studies moderate. However, three-quarters of alcoholics overall achieve stable recovery, and a majority aren't abstinent. We didn't know about all of these people, since most don't enter treatment, and so many of those who remain untreated don't abstain. (NESARC found that only a quarter of alcoholics receive treatment.)

It's unlikely that the National Council on Alcoholism and Drug Dependence (an AA-based organization) will picket the NIAAA.

Then came harm reduction. 

In the late 1980s and continuing through the 1990s, harm reduction was introduced as a concept by Ethan Nadelmann and others as a part of the public health-legalization debate about drugs. Harm reduction originally focused on providing clean needles to injecting heroin addicts—itself a matter of considerable debate. Obviously, with the legalization of marijuana in several states, and in terms of the international presence of clean needle programs, the legalization/harm reduction debate has progressed to a different plateau in the United States and around the world. (At the same time, we should bear in mind, needle exchange is still not federal policy in the U.S., and abstinence-only policies are resurging in the UK and elsewhere in Europe.)

So, I googled John Wallace, and found that he is in the same part of the world that I am:

Dr. John Wallace is the Director of the Maxwell Institute of St. Vincent's Westchester, a program that is partially funded by the Community Fund of Bronxville, Eastchester and Tuckahoe. Questions about alcohol and other drug addictions can be addressed to him by calling 914-337-6033.

John is still pursuing his same tried-and-true approach to alcoholism. Here are his recommendations for alcoholics over the holidays:

Secondly, recovering people can choose to step up their programs of recovery. If they are members of AA, NA, or Al-Anon, they can increase their meetings to daily meetings or twice-daily meetings if necessary. They can call other recovering people on a daily basis and increase their meetings with their sponsors in their 12-step programs. A number of AA groups hold AA "marathons" in which meetings, food, coffee, and fellowship are available all day long. The Hastings "Lighten-up" AA group, for example, has meetings throughout Christmas Day and evening starting with a breakfast at 9:00 AM at Saint Matthew Lutheran Church in Hastings-on-Hudson. On New Year's Eve at the Aldersgate United Methodist Church, The Dobbs Ferry Group is holding AA meetings every hour on the hour from 9:00 PM until 7:00 AM New Year's Day. People already enrolled in substance abuse-treatment programs can ask their therapists for extra sessions. Hopefully, all the people in early recovery will take advantage of the services available and everybody will make it safely through the holidays.

In Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program, Ilse Thompson and I refer to John's as the "white knuckle" approach to addiction—holding onto sobriety while the world swirls around you. It's not that we oppose abstinence—that's one option some people prefer and may need. But we feel that a substantial number of addicts can achieve a fuller life, one that doesn't revolve around their abstinence. (And what, we ask, about those addicted, or formerly addicted, to shopping, eating, sex, and love?)

This is our different approach to sobriety:

This fixation on abstinence requires that people who recover through the 12 steps decide that their lives revolve around an empty space. Not only is that undesirable, it’s unsustainable. You can’t commit your life to nothingness, only to health, your goals and plans, and your belief in yourself.

Instead, our focus is on purpose and values, as expressed by people like an old friend who recently told me how she had quit drinking for two years: "I just can't be drinking while I'm pursuing my musical caeer. I couldn't manage all of this (pointing around the bar where her group had arrived and was setting up) drinking the way I was." Oh, and she had quit smoking to preserve her voice.

I told her how much I admired her.

Stanton Peele has been at the cutting edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has developed the on-line Life Process Program for addiction and has written (with Ilse Thompson), Recover! Stop Thinking Like an Addict with The PERFECT Program.