Mary Pendery, whose article in Science showed that controlled-drinking subjects in an alcoholism study suffered many relapses, was killed by an alcoholic she felt was safely remitted due to his abstinence therapy at the same facility where the CD treatment took place. Her tragic mistake -- which caused her and this alcoholic their lives -- offers a beacon for the future.
The Stanton Peele Addiction Website, May 30, 2011. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
How the Disease Theory of Alcoholism Killed Mary Pendery, and Harm Reduction Could Have Saved Her
Recently, an old friend of Mary Pendery's contacted me via e-mail. I was surprised to see Mary's ghost resurface this way. This friend was not able to provide me with any new facts about Mary's sad demise. So what follows are the facts as I know them (I welcome the help of anyone who can fill in the blanks) and conclusions that are solely my own.
This is my Memorial Day tribute to poor Mary's memory.
Let me start from the end.
On April 10, 1994, Mary Pendery was murdered by an alcoholic lover. Pendery left the alcoholism treatment program at the VA Hospital in San Diego which she headed to move to a VA hospital in Sheridan, Wyoming in 1992. In January 1994, Mary recontacted George Sie Rega, whom she had first known while he was being treated at the San Diego VA. Mary apparently was rekindling an old flame. By the time Sie Rega joined Mary in Wyoming in April 1994, he was deep in alcoholic relapse. Extremely intoxicated (his BAL was >.30), Sie Rega shot Mary dead and then turned his weapon on himself.
I'm not sure why Mary vacated her post in San Diego. I became acquainted with Mary (whom I never met nor knew personally) in 1982, when she -- along with co-authors Irving Maltzman, a distinguished UCLA perceptual psychologist, and L. Jolyon West, a distinguished psychiatrist at UCLA's medical school -- published an article in the prestigious journal Science claiming 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 (CD) therapy was superior to abstinence therapy 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 most common criticism of Pendery et al.'s research was that it identified various relapse events among the CD subjects, but in fact made no effort to uncover similar episodes for abstinence subjects. In other words, it imagined that the abstinence-treated subjects did better, without demonstrating this.
Yet, in fact, the original study merely proposed that the CD subjects had fewer and less severe relapse incidents. As one example of how the whole research process was distorted, Pendery et al. noted that four of the 20 CD subjects had died in the eight years following treatment. But by simply searching California public records, the Sobells pointed out that six out of 20 abstinence-treated subjects had died in that period, four from what were judged to be alcohol-related causes. Only by fantasizing that those treated with standard AA bromides about never drinking again were immaculately successful could anyone imagine the Pendery et al. research had any meaning or was at all helpful.
Despite the obvious deficiencies in the Pendery et al. research (what was Science thinking?), I feel strongly that Mary should not have died in vain, and I have tried to make sense of her senseless death as a way of doing so.
Her death was senseless because I believe that fundamental, ordinary principles of harm reduction would have prevented it. That is, recognizing that people use a substance in the aftermath of treatment or following periods of abstinence, and planning on preventing such slips from becoming full-out relapses, might well have nipped Sie Rega's murderous rampage in the bud.
I believe, on the other hand, that the Disease Theory killed Mary, in these ways:
(1) The Disease Theory imagines that addiction is simply some genetic or other byproduct of an alcoholic's biological make-up. Harm reduction (HR) and cognitive-behavioral therapy (CBT), on the other hand, see alcoholic drinking as a response people utilize as part of their personal ecology to ward off unwanted emotional reactions and to protect themselves against distressing events or aspects of their environments.
Without knowing the dead lovers, I expect that Mary could be a challenging woman. Sie Rega may well have been a man who was anxious about such challenges, for which he had frequently sought refuge in a bottle in his past. In a phrase, Mary might have been too much for Sie Rega to handle, at least without better preparation. (This is not to blame Mary for her own death beause she was an assertive woman.)
(2) Alcoholics Anonymous and the Disease Theory teach people that curtailing a drinking episode is impossible -- a la "one drink, one drunk." HR and CBT instead instruct people that they are able to get off the relapse train at any point in the process, no matter what has transpired before, and moreover offers them tools and gives them practice in doing so. For example, even after he began drinking, Sie Rega might have learned that he needed to find an isolated setting, and avoid interacting with others, introducing safeguards into his life to make sure he did just that (as well as making sure he had no access to guns). Getting all-out drunk was bad, of course; but killing himself and his lover was morally and therapeutically unforgivable -- literally.
But applying such brakes or constraints is considered impossible within the Disease Theory and AA paradigm, where loss of control is the watchword. To even discuss curtailing a relapse episode in progress is to violate their precepts. There is no profit in AA to trying to head off relapse at the pass -- AA members must confess that they have relapsed and start counting their sobriety over whether they have one drink, five drinks, 20 drinks, or -- in a strange way -- if they murder someone! Everything they have learned in treatment or their group points them towards going full speed ahead into their addictive relapse, which Sie Rega apparently did in spades.
(3) Unfortunately, I think Mary herself may have become caught up in the Disease Theory mythology. Taking her own research seriously, she might actually have thought the 12-step treatment at the VA was effective! (The Science article in fact included a strange caveat that everyone knew that the abstinence subjects had themselves fared badly.) Disarmed in this way, she might have become heedless around the signs that Sie Rega's emotional condition was deteriorating rapidly, and that he simply had no preparation in therapy, nor any personal tools, for halting or limiting his alcoholic descent. Her acceptance of the Disease Theory thus caused Mary to be blind-sided by Sie Rega's all-too-typical relapse progression.
As I said, we can use Mary's sad demise as an object lesson going forward in changing our attitudes towards addiction and our style of treating it. In other words, it is up to us to make sure that we learn the crucial lessons that Mary died to teach us!
Alternately, Mary's death may simply have been God's hand in action. May we all recite Kaddish in Mary's memory this holiday.