Alan Marlatt and I were two psychologists who became involved in the famed early 1980s controversy around controlled drinking treatment for alcoholics. Alan has gone on to make landmark contributions to the addiction field. Others in the controversy encountered tragedy.
The Stanton Peele Addiction Website, August 12, 2009. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
Paths to Light and to Darkness in the Addiction Field
More than 25 years ago, I participated in a watershed moment in Psychology Today's, psychology's, and addiction treatment's history. Writing in the first issue of Psychology Today after it was purchased by the American Psychological Association, I reviewed the controversy in which alcoholism counselor Mary Pendery, psychologist Irving Maltzman, and psychiatrist L. Jolyon West published a refutation of a study by psychologists Mark and Linda Sobell which had reported that alcoholics fared better with controlled-drinking (CD) treatment than with standard hospital abstinence care.
Pendery et al.'s study vilifying the Sobells and their research appeared in 1982 in the most prestigious American scientific journal, Science. Yet subsequent investigations of the controversy pointed out that there was actually no new evidence to suggest that the controlled-drinking group had worse outcomes than the abstinence group - which the Pendery et al. follow-up did not include. For example, Pendery et al. reported that four CD patients had died in the aftermath of treatment. But, further investigation revealed, in that same period six of the abstinence group had died.
But this post is not to rehash that study, other than to talk about what has happened in the quarter century plus since then. And I take as my model for this time period Alan Marlatt, the psychologist who, in addition to myself, did the most to defend the Sobells by pointing out the complexities in the situation and the shortfalls of the Pendery investigation.
In good part, the Sobells' research and CD therapy were attacked because they contradicted the 12-steps and AA that dominated American alcoholism and addiction treatment. Pendery and other defenders of standard alcoholism approaches in the U.S. launched an all-out campaign attacking Psychology Today, the APA, Marlatt, a few other defenders of the Sobells, and myself. And for some time behaviorists and other psychologists who didn't buy into the AA-disease model were on the defensive.
But now, all of this appears somewhat differently. AA and the 12 steps still dominate the treatment landscape. But not so totally as they once did. It is true that CD therapy for alcoholics is virtually non-existent. However, in its place harm reduction (HR) has become a strong force in dealing with addicts and alcoholics. This rarely means teaching addicts to use substances in a controlled manner. But it does mean understanding and accepting that many people will continue using substances, even many in an addicted manner, but that it is important and worthwhile to minimize the harm they experience from this use.
Alan Marlatt has been at the forefront of American HR with regards to alcohol. I earlier wrote in my blog about his demonstration of the positive results of allowing street alcoholics to drink in so-called "wet housing," where not only did chronic alcoholics experience fewer hospitalizations and prison stints, but they also actually cut back their drinking.
Alan has also created the best-tested method for dealing with collegiate binge and problem drinkers. Called the Alcohol Skills Training Program , in a nutshell, it teaches college students how to drink. It doesn't introduce them to drinking, which they already do. But it teaches them how to drink safely. This includes both moderate drinking techniques, and also precautions when young people drink too much and become intoxicated (not driving being one of the obvious ones). Although this approach has been proven to be effective in reducing both drinking and drinking mishaps, it is controversial in the American milieu, where most of the program's clients are under the legal drinking age of 21.
Alan's second major initiative in the addiction field has been relapse prevention (RP). Primarily, this technique disputes the AA contention that a single slip returns a person to their alcoholic state. Instead, RP develops stop gap methods after a person has had a slip to prevent them from abandoning all the progress they have made and returning fully to their former addiction.
More recently, Alan has added meditation and the Buddhist concept of mindfulness to the addiction treatment tool chest. Briefly, Alan has found that teaching addicts, people with other clinical diagnoses, and prison inmates to meditate reduces their relapse and recidivism. Likewise, Alan is exploring mindfulness techniques as ways of preventing relapse by coping with urges to drink or to use (for example, by imagining an urge as a wave to be ridden through).
All of Alan's subsequent work could have been endangered due to his position on the Sobells-Pendery controversy. That it wasn't is, first of all, fortunate for science, psychology, and addicted individuals. And, of course, his subsequent career is a tribute to his persistence, enterprise, creativity, intellectual rigor and to the simple usefulness of his science. A toast to Alan is in order.
The authors of the Science article have had less of an impact on the addiction field. West and Maltzman, who were not addiction specialists, made almost no further contributions - although for some time Maltzman continued to lambast the Sobells and controlled drinking.
Mary Pendery encountered tragedy. On April 10, 1994, she was murdered by an alcoholic lover. After leaving the VA hospital alcoholism treatment program she headed in San Diego to move to a hospital in Wyoming, Pendery reconnected with a patient she had known at the San Diego VA. On a visit to Wyoming, he became extremely intoxicated, shot Pendery, and then committed suicide.