Addictive Behaviors, Vol. 17, pp. 83-93, 1992 Printed in the USA. All rights reserved.

0306-4603/92 $5.00 + .OO Copyright 0 1992 Pergamon Press plc

WHY IS EVERYBODY ALWAYS PICKIN’ ON ME? A RESPONSE TO COMMENTS

STANTON PEELE

Stanton Peele is the latest in a long and worthy line of American contrarians unwill- ing to accept the status quo, especially when it is the product of wishful thinking, not empirical research. In this book, Peele challenges us to examine our most fervently held beliefs on the causes and cures of the addictive disorders - and urges us to mod- ify them, when the impelling logic of the data demands.

Peter Nathan, comment on jacket of Diseasing ofAmerica (Peele, 1989)

Not everyone said such good things about me and Diseasing ofAmerica as did Nathan. John Wallace’s review in Sober Times was entitled, “Reviewer Completely Refutes Author’s Views and Opinions.” It began:

Stanton Peele’s new book, Diseasing of America: Addiction Treatment Out of Con- trol, is intemperate, incautious, hyperbolic, resentful, distorted, illogical, misleading, inaccurate, angry, insensitive, dogmatic, without compassion, unfair, imprudent, and often wrong. In short, it is the literary equivalent of the dry drunk.

Apparently worried that Sober Times readers might not have understood his meaning, and might rush out and buy my book, Wallace concluded his review with a definitive proscription:

Stanton Peele’s book is not a controversial book. It is simply a bad book. Don’t buy it. (Wallace, 1990)

I have not been Wallace’s only target. Wallace (1987a, p. 21) harshly criticized a group of psychologists in the alcoholism field, beginning with Alan Marlatt: “Sadly, while interest in alcoholism was definitely on the rise, prejudice, hostility, and igno- rance did not disappear. Consider the thoughts of G. Alan Marlatt . . .:

From this viewpoint, alcohol for the abstinent alcoholic symbolizes the forbidden fruit, and a lapse from abstinence is tantamount to a fall from grace in the eyes of God. Clearly, one bite of the forbidden fruit is sufficient to be expelled from paradise. Anyone who suggests controlled drinking is branded an agent of the devil, tempting the naive alcoholic back into the sin of drinking. . . . (Marlatt, 1983, p. 1107)”

Requests for reprints should be sent to Stanton Peele, 27 W. Lake Blvd., Morristown, NJ 07960.

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Wallace (1987a) also criticized Nathan, first for having invited Marlatt to write his article for American Psychologist. Second, Wallace (1987a, p. 24) attacked Nathan for being a day late and a dollar short in rejecting controlled-drinking (CD) therapy:

Dr. Peter Nathan ( 1985) is very clear that he now believes that abstinence is the treat- ment goal of choice for “chronic” alcoholics, despite his belief that “the two Rand Reports, then, lent strong support to the idea, the legitimacy, of controlled drinking treatment. . .” (p. 17 1). To Dr. Nathan, craving, loss of control, and, in fact, the dis- ease concept are simply metaphors. In effect, according to him, alcoholics crave alco- hol and lose control of their drinking because they . . . “believe that craving and loss of control are inevitable components of alcoholism, rather than simply [being due to] the pharmacologic impact of alcohol. . . . The metaphoric sense in which we now view the whole concept of craving and loss of control, in fact, the disease model of alcoholism, is justified by this history.” (Nathan, 1985, pp. 17 1 - 172)

Wallace takes Nathan to task for saying that alcoholic behavior is steeped in expec- tation and not biology. He also takes issue with Nathan’s intimation that some problem drinkers (non-“chronic” alcoholics) can resume moderate drinking, and presumably may be counseled in that direction. Thus, Nathan encountered opposition from disease theory advocates like Wallace for not accepting the disease theory even as Nathan, like Wallace, concentrated on pointing out how few alcoholics were shown to moderate their drinking in CD therapy studies. Nathan, like Wallace, chose to downplay the often equally small numbers of completely abstinent individuals revealed in clinical and out- come studies, and the lack of any clinical trials that find abstinence to be superior to CD therapy for alcoholics of any description.

Wallace selected Nathan for attack because of Nathan’s prominence in the field, but he did not restrict his attacks to Nathan (and Marlatt); Wallace included Nick Heather, William Miller, Martha Sanchez-Craig and others in his sweeping indictment. Wallace (1987a, p. 22) quoted this passage from my work concerning alcoholism and CD therapy:

A.A. preaches a doctrine oftotal redemption, teetotaling forever. And many a former alcoholic believes that a single drink will send him on the short, slippery slope to alcoholic hell. It’s true that for some alcoholics who have been uncontrolled drinkers for many years and whose health has deteriorated, the option of moderation is no longer workable. However, the resolution never to have a drink again is not always a cure-all. The vast majority of alcoholics who try to abstain eventually return to the bottle or to another addiction. (Peele, 1985, p. 39)

Wallace (1987c, p. 23) traced the strategy of this “Anti-Traditionalist” group.

These forces of disunity tried first to divide the alcoholism field over the issue of con- trolled drinking, and then through various attacks upon sobriety, on the disease model of alcoholism, on recovered people, and on the concepts, principles, and activ- ities of Alcoholics Anonymous.

Wallace (1987b, p. 25) found that “the [controlled-drinking] issue is controversial only in the sense that cod liver oil would be ‘controversial’ in the treatment of smallpox . . . or copper bracelets in the treatment of arthritis.” He then recommended:

With regard to the controlled drinking issue, I feel that the alcoholism field has too long suffered these outrageous attacks by certain members of the “Anti-Tradition-

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alist” crowd. In the interests of our patients and their families, and in the interests of alcoholics who still suffer, we must begin to scrutinize more closely the activities of this group and to take steps to ensure they do no harm. (emphasis added)

THE COMMENTATORS’ BACKGROUNDS

Readers unfamiliar with the volatile nature of the CD issue may now appreciate why most clinicians choose to prescribe abstinence for all problem drinkers. The responses to my article in this issue are by a group of psychologists who have all been attacked by Wallace because of their views on CD therapy, their endorsement of mind over body in the etiology and treatment of alcoholism, or their critiques of standard treatment practices and reported outcomes. Most of this group know and are friendly with one another. I have maintained friendly relations with all these people, although - unlike them - I have not made my living primarily within the alcoholism field.

Nick Heather is an outsider to this group in that he is not American born and has never worked in North America. Like me, Heather is not a behaviorist. Like me, Heather has never received a grant from the NIAAA. Unlike me, Heather does hold an institutional position in the field, in Australia, where he is director of the National Drug and Alcohol Research Centre. I have never received a grant from or held a job in the addiction or alcoholism field. I am far more likely to be invited by Canadian govern- ment institutions to discuss alcoholism and addiction than by the NIAAA: my only NIAAA-invited speech was at the Secretary’s Conference on Alcohol Abuse and Alco- holism in San Diego in 1988.

The primary institutional recognition I have received was the 1989 Mark Keller Award for the article in the Journal of Studies on Alcohol that best “demonstrates schol- arship as evidenced by research competence, and through its communicative style and broadly relevant implications contributes to innovative and provocative thinking as judged by the Award Committee.” Peter Nathan was director of the Center, which pub- lishes JSA, when my Keller Award article appeared as one of a series of two articles I wrote on theories of alcoholism and addiction (Peele, 1986b, 1987b), although JSA is independent of Nathan’s office.

Altogether, I have little to gain or lose from my critiques of institutional figures, and I can tell the truth as I understand it. I will not apologize for rattling skeletons in insti- tutional closets, challenging comfortable assumptions, and refusing to indulge in mutual back slapping - even with those who usually respect intellectual standards and collegiality.

HEATHER’S, THE SOBELLS’, AND MILLER’S COMMENTS

Heather’s background may help to explain why he feels free to agree with me. The Sobells (who for some years have worked in Canada) agree with my position vis-a-vis the American bureaucracy, as represented by the NIAAA, but disassociate Nathan from that establishment. They are indebted - quite properly - to Nathan for his defending them from the vicious anti-CD attacks on their work and their integrity by Mary Pen- dery, Irving Maltzman, and Wallace (who continues to harangue Nathan for failing to agree that the Sobells committed fraud). However, their point that they invited Nathan and McCrady (1987) to submit an article in support of abstinence goals does not explain the gusto with which Nathan has begun attacking CD therapy. Substantively, the Sobells have continued to track the large number of studies which reveal CD outcomes,

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including most recently an American study (Finney & Moos, 199 1) which aIErms that drinking moderation is a substantial outcome of alcoholism treatment, and one which increases the longer people are tracked after treatment (see Peele, 1987b).

Miller, based on his experience and research, repeats his emphasis on CD as a therapy mainly appropriate for less severe alcohol dependence. I am reminded in this context of how fundamentally cuhural and social context influences people’s perceptions of these realities (Peele, 1990). Miller (1986, p. 118) described how he had not fully real- ized how much his views were colored by the American scene, where he is viewed as a radical:

The clearest demonstration of this for me was in observing audience responses as I presented my research on controlled drinking treatments. In the U.S., such talks are invariably met with resistance ranging from skepticism to overt hostility. European audiences . . . by contrast, addressed pragmatic and methodological issues. . . . In Britain I was astonished to find my ideas regarded as “a bit old-fashioned,” particu- larly my defense of total abstinence as “the only realistic alternative for the addicted alcoholic.”

In this light, I am happy to see that Miller emphasizes that the relationship between dependence and the likelihood of moderation versus abstinence remission is a proba- bilistic and not a fundamental one. He also points out that self-labeling is an important and independent determinant of CD outcomes. Finally, he affirms my point that no clinical comparison has yet found abstinence treatment to be superior to CD therapy, for any group of alcoholics. Where Miller is off base is in describing me as using polar- izing techniques. I must remind readers that in my article I discussed the premature rejection of CD therapy for problem drinking and alcoholism in the U.S.; I didn’t advo- cate that the abstinence goal be excluded from treatment and research.

McCRADY’S COMMENT

Miller’s misstatement is taken further by McCrady. That her and Nathan’s position is untenable is most clearly indicated by McCrady’s misinterpretation of my position. I do not attack, as she states, “Nathan and other behavioral researchers who have focused on abstinence.” I am interested in abstinence and know it works for some. I am interested in moderation training for the same reason. My article is about Nathan’s con- tribution to the campaign to reject moderation training in American alcoholism treat- ment, including claims that such treatment is not only inefficacious, but unethical. Throughout my paper I accept and al&m that abstinence is a legitimate goal for ther- apists to pursue with alcoholics.

As for the substance of the argument, McCrady says that I offer “a scholarly overview . . . of research relevant to the issues of controlled drinking.” Indeed, in her conclusion, she goes so far as to label my article “very provocative and thoughtful” but says I “con- taminate” it with “attacks on Peter Nathan and the Center of Alcohol Studies.” I differ from McCrady in believing that an examination of the economic bases of the Rutgers Center of Alcohol Studies, which solicits both federal grants and private contributions from the disease lobby, is an important example for understanding the climate sur- rounding CD therapy in the U.S.

McCrady’s response to my “scholarly overview” causes me to wonder anew about her and Nathan’s position vis-a-vis CD therapy. She has “little quarrel with [my] review

Response to comments 87

of the literature, or with [my] specific conclusions,” and agrees with me that “there is no question that some people with drinking problems become moderate drinkers, some become abstainers, and many more continue to have problems.” This being the case, why is there no impetus at Rutgers, or in any other American clinical research program with which I am currently familiar, to explore the possible usefulness of moderation outcomes with some of those problem drinkers/alcoholics who do not achieve abstinence?

McCrady does not address the issue I raise that for some clinical problem drinkers moderation is the easier to achieve or otherwise superior outcome. My “scholarly over- view” included the work of three British groups (ENLawrence, Slade, & Dewey, 1986; Heather, Winton, & Rollnick, 1982; Orford & Keddie, 1986) who all found that per- sonal beliefs and values determine which alcoholics achieve remission through mod- eration or through abstinence. The four-year Rand study (Polich et al., 1981) found that, while more severe alcoholics were more likely to abstain than to moderate their drinking, younger single alcoholics at all levels of severity were more likely to relapse if they attempted to abstain rather than to control their drinking.

The research tells us something more than that moderation may be a stable or unsta- ble outcome, which is the reason McCrady repeats for rejecting controlled drinking in treatment; this research tells us which clinical problem drinkers are more likely to suc- ceed at moderation relative to abstinence. In administering a student alcohol assistance program at Rutgers, if McCrady recognized and allowed some students to pursue mod- eration, she would be practicing CD therapy. Or has McCrady confidently rejected the evidence that eliminating moderation outcomes for college students will diminish the overall positive impact of the array of treatment options? Indeed, according to Fillmore (cited in Skinner, 1990, p. 1055), between 55% and 80% of men and 73% and 83% of women with drinking problems in youth will outgrow them on their own, in the large majority of cases, without abstaining. That McCrady does not discuss these issues is a sign of our times and of the professional safety - but not necessarily the clinical safety - of always urging abstinence.

McCrady describes the “abstinence-oriented researchers [who] have convincingly demonstrated that alcoholism is a group of problems with differing etiologies, patterns and courses, that treatment can be implemented in different settings utilizing different techniques, and that self-directed change is also possible.” But these researchers, according to McCrady, would not go so far as to entertain the idea that some can or should moderate their drinking. Apparently, this is something McCrady highly values in alcoholism researchers and clinicians. In her response to the same Marlatt (1983) article that set Wallace off she writes:

I question why training alcoholics in controlling drinking is so attractive. People who earn an alcoholism diagnosis have worked hard for it - they have consumed enor- mous quantities of ethanol and have created terrible pain in their lives because of their alcohol consumption. Instead of trying to help alcoholics drink, therapists might better view such a desire to drink as an “irrational belief.” (McCrady, 1985, p. 370)

As McCrady indicates in her comment on my paper, most alcoholics disregard her clarion call to abstain. Of this group, some overcome their drinking problems without quitting drinking. When McCrady refers to Tuchfeld as “abstinence-oriented,” I’m not sure how she means to deal with the 11 of the 5 1 former alcoholics Tuchfeld ( 198 1)

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reported who continued to drink. Likewise, identifying Skinner as “abstinence-ori- ented” depends on how you mean this phrase. According to Skinner ( 1990, pp. 1054- 1057):

A small but highly visible minority - approximately 5% of the adult population - show major symptoms of alcohol dependence. [In addition] . . . there is a sizable group of about 20% of the population, particularly young men, who are drinking at risk levels and have encountered some problems related to their alcohol use. . . .

[In a randomized controlled study in Great Britain of over 900 excessive drinkers who visited the health care system conducted by Wallace, Cutler, & Haines, 1988, these problem drinkers were] advised to not drink more than 18 U of alcohol per week, women not more than 9 U. If there was evidence of alcohol dependence, the patient was advised to abstain. Each patient was given a drinking diary with the fol- lowing prescription on the front cover: “Cut down your drinking!” . . . One year after initial assessment, the men and the women receiving treatment showed a significant reduction in alcohol consumption compared with controls.

Obviously, one issue that reappears here is whether clients are problem drinkers or alcoholics, a distinction Miller in his comment warned us can be difficult to make. For example, programs limited to “early-stage” problem drinkers seem always to net some people with positive signs of alcohol dependence (Heather, 1986; Sanchez-Craig & Lei, 1986). Is there any question that some of the problem drinkers Skinner described would be accepted for alcoholism treatment in the United States, in which case they would almost certainly be instructed to abstain? Yet, according to Skinner, this group com- prises 80% of the problem drinkers in North America. Would McCrady advise the prob- lem drinkers in the British study Skinner cited that they must abstain, and that any further desire to drink represents irrational beliefs on their part?

Meanwhile, McCrady’s attempt to shift the ground to position me as some kind of oppressive force in the alcoholism field is funny, given my lack of institutional involve- ment and power. McCrady even disingenuously reviews moderation-training research with alcoholics that was at one time sponsored by the NIAAA, as though this is a tack the NIAAA is actively exploring. Only in her conclusion does she finally agree that “Peele is correct in stating that there are powerful forces driving science in the United States away from moderation training.” How would she say these forces influenced her own career? Indeed, I would very much like to know her views on the central topic of my article - why does she think Peter Nathan disowned the controlled-drinking ther- apy he once practiced?

The topic McCrady discusses that I know the most about is how much money I have made from my views on alcoholism. When I succeeded in publishing an article in Psy- chology Today (Peele, 1983b) analyzing the Pendery, Maltzman, and West (1982) attack on controlled-drinking research by the Sobells, I immediately was threatened with a cancellation of a major speaking engagement. In fact, I lost most of my public speaking opportunities for several years thereafter (Peele, 1986). Each such engagement pays me as much as or more than Psychology Today did.

The Rutgers Center with Nathan as its director and McCrady as its acting director certainly did not ask me to teach or speak. Yet, apparently to show how open the Rut- gers Center is in its education programs, McCrady cites the one time in the summer of 1982 when I spoke at the Rutgers Summer School Alumni Institute. Neither my key- note address nor my workshop was on controlled drinking (my talks were “Addictive

Response to comments 89

Relationships and Therapy,” and “Sex, Power, and the Alcohol Experience”). The invi- tation focused on my book Love and Addiction (Peele, 1975) and did not invite my iconoclastic positions on alcoholism, which I spoke about anyway. The Rutgers Center has never invited me to speak since.

Contrary to McCrady’s impressions, maintaining the value of moderation goals in alcoholism has not been highly profitable; neither has publicizing data that many peo- ple use illicit drugs in a controlled manner (Peele, 1986a). But I think I will profit ulti- mately from sticking to my guns. Although most of my income comes from sources outside conventional research, teaching, and lecturing channels, I continue to influence the field. I fully expect that my views will be accepted eventually, as have my ideas that relationships can be addictive (Peele, 1975) and that self-cure of addictions often occurs (Peele, 1983a). Acceptance of my ideas, and not money, has always been my major goal.

NATHAN’S RESPONSE

Although Nathan now announces that I regularly don’t do my homework, he wrote a highly complimentary blurb for my 1989 book, Diseasing of America, highlighting my commitment to truth. In 1990, Nathan and McCrady invited me to write a com- mentary on AA for the Annual Review of Addictions Research and Treatment. Pro- motions for this review have claimed that it is an “informed debate by commentators and reviewers who are each a leading authority.” Nathan was also the gatekeeper for two controversial articles on addiction I did for American Psychologist (Peele, 198 1, 1984), the latter of which discussed controlled drinking at length and foreshadowed the arguments I made in my paper in this Journal (Miller, 1985, included the article in a reader for his students). I expect that he encountered criticism at the time for publishing my article. In his current response, however, he calls my review “a potpourri of mis- statements, misunderstandings, exaggerations, and mistakes of fact and history” which he breezily dismisses.

Nathan does not respond to my queries about the propriety of the director of an aca- demic center soliciting funding from a private donor with a strong public position on key topics being debated in the alcoholism field. I would like to understand more about how such fund-raising is conducted within a state university which also receives large federal grants. I would very much like to learn from Nathan what took place in order to get R. Brinkley Smithers to reconsider his contributions to the Rutgers Center, after writing the Center out of his will, and whether Nathan finds any conflict in wooing pri- vate donors who wish their contributions to support a particular point of view, like the disease theory of alcoholism.

And Nathan, like McCrady, does not address the issues raised by my review of the literature on CD therapy, including recent findings that CD outcomes become more common over alcoholics’ lifetimes (Finney & Moos, 199 1; Nordstrom & Berglund, 1987).

Finally, reviewing his writings about CD therapy, Nathan claims that his views on controlled drinking have remained constant, that he didn’t advocate CD therapy ear- lier, and that he is not now an outspoken CD critic. However, I believe Nathan has shifted considerably between his 1979 articles urging caution about CD therapy, although still finding it valuable, his 1980 description of how he attempted to start a CD clinic, his 1982 description of a private practice which he restricted to CD, and his neg-

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ative discussions’of CD therapy in Nathan (1985, 1986) and Nathan and McCrady (1987).

Nathan quotes my own statement in which I recognized that he did not change his views simply because he was appointed as the Rutgers Center’s director. Rather, I said, the pressures he faced in this position exacerbated earlier shifts he had made in response to ambiguous data and an environment hostile toward CD therapy, a hostility with which he was quite familiar personally (Nathan, 1980). I acknowledged in this part of my paper that Nathan had had reservations about CD therapy earlier. Why did I iden- ttfy and attack Nathan's position now? What led me to write this article was the increas- ing visibility of Nathan’s anti-controlled-drinking stance. I read the passage in Monti et al’s ( 1989) text that ruled out CD therapy using Nathan ( 1986) as the ultimate word. I noted that at the annual meeting of the New Jersey Psychological Association in 1990, Nathan presented his views on CD therapy to a broad audience of nonspecialist psychologists.

In all of this, Nathan has certainly changed his emphasis from the time before he assumed the leadership of the Rutgers Center, when he personally provided CD therapy because,

given this richness of treatment resources for alcoholics, problem drinkers, and their families in central New Jersey, it is natural to ask whether any gaps in the range of services exist in this area. I think such a gap does exist - and I undertook to fill it. . . . (Nathan, 1982, p. 107)

In discussing Nathan’s (1982) description of his CD therapy with a relatively severely dependent client who lacked many “objective” CD indicators, I should say that it took a good deal of courage for him to perform this therapy and to write about it. Once he became director of the Rutgers Center, it probably became impossible for Nathan to carry out CD therapy, or certainly to publish descriptions of it. Clearly, it has become very difficult for any therapist to recognize that some clients will do better with a CD aim, or even to accept that few clients will successfully adopt a pure abstinence model without experiencing relapses or occasionally drinking moderately.

Unfortunately, Nathan has contributed to this fearful atmosphere. What has most upset me is Nathan’s increasing use of words such as “ethical” in his discussions of CD therapy, as though only irresponsible people might consider trying a nonabstinence approach with an alcoholic or accept that complete abstinence is unworkable. Nathan and McCrady ( 1987) have opined: “There are other alcoholics whose occupations make continued drinking, even in moderation, problematic,” in which category Nathan and McCrady (p. 118) mention airline pilots. The imagery of the pilot reminds me of the kind of emotional pitch John Wallace made in Time magazine: “The suggestion that an alcoholic may be able to return to social drinking safely is ‘a serious ethical problem, because at least 97% of alcoholics, if you let them drink, could die”’ (quoted in Peele, 1984, p. 1342). But the question remains, when does alcoholism therapy succeed better tf it aims for moderation, recognizes some posttreatment drinking will take place, or strives to control occasional drinking episodes, and when does it work best if it insists on complete abstinence? These are empirical and scientific questions, no matter how luridly the issues are cast.

Nathan and McCrady ( 1987, pp. 126- 127) accurately describe a treatment landscape in which, “The majority of training experiences available to alcoholism counselors assume a disease model of alcoholism, with abstinence as the only appropriate goal of treatment. Many alcoholism counselors have a personal background of recovery. . . . If

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these [behavioral] treatment and evaluation techniques could be taught within a frame- work which includes abstinence as the ultimate treatment goal,” then “behavior ther- apists and traditional alcoholism workers . . . [can] identify ways in which the two approaches can be integrated.”

Coalescence of psychological and disease views is taking place. In January 199 1, the New York State Psychological Association adopted “Guidelines for Psychologists in Assessing and Treating Substance Abuse.” This influential group emphasized as its first three points in the treatment of substance abuse that (according to Washton, 1991, p. 8):

Psychologists who elect to treat substance-abusing patients should be able to: ( 1) pro- vide abstinence-oriented counseling aimed at helping the patient to immediately stop all alcohol/drug use as a starting place for treatment . . .; (2) intervene in effective ways to counteract the patient’s denial and mobilize his/her motivation for recovery; (3) address the substance abuse problem as a primary disorder and not merely as a symptom of underlying psychological problems . . .

This official position adopted by a powerful state psychological association offers a standard disease treatment program’s list of bromides, the cornerstones of which are abstinence and denial. Apparently, the reconciliation of psychological and disease approaches has occurred very much on disease-oriented grounds, which is exactly the situation I warned against in my 1984 American Psychologist article. Yet I see an entirely different approach to assessing and treating addictions of all kinds arising from social and psychological conceptions of substance abuse, an approach I have called “The Life Process Program for Outgrowing Destructive Habits” (Peele & Brodsky, 199 l), and which we based on self-curers and therapy drop-outs as well as those who maintain therapeutic regimens.

When a psychologist of Nathan’s stature - someone who has nurtured my views and those of others opposed to the disease model - assumed the leadership of the most prominent clinical research center for alcoholism in the U.S., perhaps I expected that he might work to broaden prevailing attitudes toward treatment, as Nathan (1980, 1982) personally attempted to do. This did not happen. The failure of psychology to offer alternative treatment options in the U.S. is not just a matter for academic debate. It takes its toll in human suffering. As a leading exponent of nondisease views and of the harm the standard approaches often cause, I hear regularly from those who feel they have been hurt by oppressive, stigmatizing - yes, exclusively abstinence-oriented - alcoholism treatment.

In trying to bridge both sides of the alcoholism-as-disease conflict, psychologists like Nathan and McCrady have given up too much. They may be less likely to invite attacks from Wallace in the future. But their concessions to the disease model will someday be regarded as wrongheaded capitulations to ignorance and persecution. I believe that we must always harm ourselves as individuals, as a profession, and as a society when we turn our backs on the complexities of reality in favor of convenient dogmas.

REFERENCES

Elal-Lawrence, G., Slade, P. D., & Dewey, M. E. (1986). Predictors of outcome type in treated problem drink- ers. Journal ofStudies on Alcohol, 47,4 l-47.

Finney, J. W.. & Moos, R. H. (1991). The long-term course of treated alcoholism: I. Mortality, relapse and remission rates and comparisons with community controls. Journal of Studies on Alcohol, 52,44-54.

92 STANTON PEELE

Heather, N. (1986). Change without therapists: The use of self-help manuals by problem drinkers. In W. R. Miller & N. K. Heather (Eds.), Treating addictive behaviors: Processes ofchange (pp. 33 l-359). New. York: Plenum.

Heather, N., Winton, M., & Rollnick, S. (1982). An empirical test of “a cultural delusion of alcoholics.” Psy- chological Reports, 50,379-382.

Marlatt, G. A. (1983). The controlleddrinking controversy: A commentary. American Psychologist, 38, 1097-1110.

McCrady, B. S. (1985). Comments on the controlled drinking controversy. American Psychologist, 40,370- 371.

Miller, W. R. (Ed.). (1985). Alcoholism: Theory, research, and treatment. Lexington, MA: Gunn, 1985. Miller, W. R. (1986). Haunted by the Zehgeist: Reflections on contrasting treatment goals and concepts of

alcoholism in Europe and the United States. In T. F. Babor (Ed.), Alcoholandcuhure: Comparativeper- spectives from Europe and America (pp. 110-129). New York: Annals of the New York Academy of Sciences.

Monti, P. M., Abramq D. B., Kadden, R. M., & Cooney, N. L. (1989). Treating alcohol dependence. New York: Guilford.

Nathan, P. E. (1980). Ideal mental health services for alcoholics and problem drinkers: An exercise in prag- matics. In P. 0. Davidson & S. M. Davidson @Is.), Behavioral medicine: Changing health lifestyles (pp. 279-298). New York: Brunner/Mazel.

Nathan, P. E. (1982). Louise: The real and the ideal. In W. M. Hay and P. E. Nathan @Is.), Clinical case studies in the behavioral treatment of alcoholism (pp. 107-125). New York: Plenum.

Nathan, P. E. (1985). Alcoholism: A cognitive social learning approach. Journal ofSubstance Abuse Treat- ment, 2, 169-173.

Nathan, P. E. (1986). Outcome of treatment for alcoholism: Current data. Annals ofBehavioralMedicine, 8, 40-46.

Nathan, P. E., & McCrady, B. S. (1987). Bases for use of abstinence as a goal in the behavioral treatment of alcohol abusers. Drugs & Society, 1, 109- 13 1.

Nordstrom. G.. & Bemlund, M. (1987). A prospective study of successful long-term adjustment in alcohol dependence. Journal ofStudtes on.Alcohol,48,95-103..

Oxford. J.. & Keddie. A. (1986). Abstinence or controlled drinkina: A test of the denendence and oersuasion hypotheses. British Journal ofAddition. S&495-504. -

Peele, S. (with B&sky, A). (1975). Love and addiction. New York Taplinger. Peele, S. (198 I). Reductionism in the psychology ofthe eighties: Can biochemistry eliminate addiction, men-

tal illness, and pain? American Psychologist, 36,807-8 18. Peele, S. ( 1983a, September/October). Out of the habit trap: How people cure addictions on their own. Amer-

ican Health, 42-47. Peele, S. (1983b, April). Through a glass darkly: Can some alcoholics learn to drink in moderation? Psychol-

ogy Today, 38-42. Peele, S. (1984). The cultural context of psychological approaches to alcoholism: Can we control the effects

of alcohol? American Psvchologist. 39, 1337- 135 I. Peele, S. (1985, Januaty/February)~Change without pain: How to achieve moderation in an age of excess.

American Health, 36-39. Peele, S. (1986a). Denial-of reality and freedom-in addiction research and treatment. Bulletin oftheSoci-

ety OfPsychologists in the Addictive Behaviors, 5, 149- 166. Peele, S. (1986b). The implications and limitations of genetic models of alcoholism and other addictions.

Journal of Studies on Alcohol, 47,63-73. Peele, S. (1987a). The limitations of control-of-supply models for explaining and preventing alcoholism and

drug addiction. Journal of Studies on Alcohol, 48.6 l-77. Peele, S. (1987b). Why do controlled-drinking outcomes vary by country, era, and investigator?: Cultural

conceptions of relapse and remission in alcoholism. Drug and Alcohol Dependence, 20,173-201. Peele, S. (1989). Diseasing ofAmerica: Addiction treatment out of control. Lexington, MA: Lexington Books. Peele, S. ( 1990). Addiction as a cultural concept. Annals of the New York Academy of Sciences, 602,205-220. Peele, S., & B&sky, A., with Arnold, M. (1990). The truth about addiction and recovery: The Life Process

Program for outgrowing destructive habits. New York: Simon and Schuster. Pendery, M. L., Maltzman, I. M., & West, L. J. (1982). Controlled drinking by alcoholics?: New findings and

a reevaluation of a major affirmative study. Science, 217, 169- 175. Polich, J. M., Armor, D. J., & Braiker, H. B. (198 1). The course of alcoholism: Four years after treatment.

New York: Wiley. Sanchez-Craig, M., & Lei, H. (1986). Disadvantages of imposing the goal of abstinence on problem drinkers:

An empirical study. British Journal OfAddiction. 81, 505-5 12. Skinner, H. A. (1990). Spectrum of drinkers and intervention opportunities. Canadian Medical Association

Journal, 143.1054-1059. Tuchfeld, B. S. (1981). Spontaneous remission in alcoholics. Journal ofStudies on Alcohol. 42,626-641. Wallace, J. (1987a, January/February). Waging the war for wellness: I. The attack of the “anti-traditionalist”

lobby. Professional Counselor, 23-27.

Response to comments 93

Wallace, J. (1987b, April). Waging the war for wellness: 11. The attack upon the disease model. Professional Counselor, 13-27.

Wallace, J. (1987c, May/June). Waging the war for wellness: III. The forces of disunity. Projksional Coun- selor, 23-27.

Wallace, J. (1990, April). Reviewer completely refutes author’s views and opinions. Sober Times, 17. Wallace, P., Cutler, S., & Haines, A. (1988). Randomized controlled trial ofgeneral practitioner intervention

in patients with excessive alcohol consumption. British Medical Journal, 297,662-668. Washton, A. M. ( I99 1, May). Cross-training is long overdue. U.S. Journal ofDrug and Alcohol Dependence,

8.