Further Reading

Don't alcoholism counselors have to know something about counseling?

Dear Stanton,

I have recently been through a hellish few months trying to deal with an alcohol problem through an AA oriented treatment program. Their totalitarian attitude was most clearly displayed when every time I disagreed with anything they said I was told I was in "denial" or I am a victim of "distorted and addictive thinking". I also noticed that the counselors would say anything and use any example, no matter how simple minded or contradictory, to back up their view.

My opinion of these folks evolved from thinking they were well meaning, but aiming at the lowest and simplest common denominator to wondering if they were in a way truly malicious. Shouldn't treatment personnel involved in the field, backed up by a reputable M.D. alcohol expert, be conversant with several approaches and not pretend there is only one opinion?

I thought I was going crazy until I ran across your name and looked you up (thanks to a short article on MATCH in Science News). My self esteem has taken a beating, and was not too high to begin with or I probably would not have tried to take what they said seriously so long and hard. I almost feel like suing for malpractice, but know my voice is meaningless in a world where I am by definition in denial. I also almost feel like getting on a soap box, but still feel too ashamed and internally self-doubting.

Any suggestions?

Thank you for writing so coherently and logically on this subject so full of bizarre assumptions and voodoo science.

You make a point that I often have thought -- that maintaining ethical and intellectual standards is the best guarantee of effective treatment, and their rejection a sure sign you are in a bad place (like the usual treatment center). When you sit in a treatment or lecture setting and those leading the session say illogical things backed by cooked evidence and reject any challenges, then you know that, whatever it is called, you are in a totalitarian environment.

From my earliest exposure to the field, I have been shocked by the field's rejection of fundamental standards of fairness and intellectual integrity (see my 1986 article on-line, "Denial -- of Freedom and Reality -- in Addiction Research and Treatment.") What was even more shocking to me was how readily academic institutions that ran certification programs for alcoholism counselors, starting with the best-known and most prestigious, The Rutgers Center for Alcohol Studies Summer Program, endorsed this intellectually repressive, no-nothing atmosphere (the last I heard, Gail Milgram, who has headed the summer program for more than a decade, still rejects sessions on controlled-drinking treatments).

Barbara McCrady and John Morgenstern of the Center have conducted a research project on the actual conduct of treatment by grass-roots counselors, videotaping and analyzing these sessions. Morgenstern expresses shock at how poorly these sessions are conducted by people with no formal counseling training other than certification programs like the one run by his own institution (of which McCrady is former Director and current Clinical Director).

So your anger and sense that you are in a world turned upside down is right. The abuse to your self-esteem is unfortunate and you must instead remember that your standards are the correct ones. Now we've got to deal with your drinking problem! That is how you ended up there, isn't it? The point is to harness your anger and the recuperation of your self-esteem in getting your behavior where you want it to be. Let's show them that they can't push people with intellectual standards around!

Before you come out and speak against the irrationality of the treatment environment, you must (as you indicate) deal with your problems. I think in this regard of the founder of Moderation Management, Audrey Kishline, who after a period of inpatient treatment and unsuccessful drinking behavior has now created MM as an alternative self-help network. In this endeavor, build on what you know to be true, on your own intellectual strengths and standards, on your feelings that you have something to offer when some much untruth is being promoted.

Keep me informed, please,

Stanton Peele