In 2013, the science journal Nature was forced to retract a 19-year-old paper whose results could not be replicated. But Nature would have a hard time matching Science's track record: In 2012 it retracted five papers.
The paper about which I am concerned -- by Mary Pendery and her colleagues, entitled "Controlled Drinking by Alcoholics? New Findings and a Reevaluation of a Major Affirmative Study" -- appeared in Science on July 9, 1982.*
This was an odd study from the start. A follow-up on a study that reported more successful outcomes for 20 alcoholic patients at a San Diego VA hospital who were treated with controlled-drinking therapy (CD) than those who received standard abstinence therapy, Pendery et al. sought to disprove these advantages. But theirs was really an ideological battle to show that there was no possibility that alcoholics could control their drinking. Thus, Pendery et al. never bothered to follow up the abstinence treatment patients, so that no comparative conclusions between the two groups could be made based on the Science study. Instead, Pendery and her colleagues highlighted relapses by the CD subjects. Several subsequent inquiries, however, revealed that all of these relapses had been reported in the original research by husband-and-wife researchers Mark and Linda Sobell. The point was that CD patients had fewer and less severe relapses than did the patients who received abstinence-only treatment.
But the important lesson gleaned from the attacks and counterattacks around controlled-drinking research was inescapable -- non-abstinence treatment for alcoholics would never be tolerated in America, and in fact it virtually entirely ceased in this country.
Nonetheless, over the next decades a new public health and treatment paradigm called "harm reduction" (HR) became prominent worldwide -- if less so in the U.S. HR focuses on less-harmful drinking and drug use among those who can't or won't abstain. And this approach clashed in just the same way that the Sobells' CD research did with traditional AA and abstinence-based treatment in America, as described by drug policy reform advocate Ethan Nadelmann:
Where the 12-step thing has the most to own up to is its role in impeding harm reduction interventions to stem the spread of HIV/AIDS. Why was it that Australia and England and the Netherlands were able to stop the spread, and keep the number for injecting drug users under 5-10 percent, and the U.S. was not? It's that notion that abstinence is the only permissible approach, that we are not going to "enable" a junkie by giving him a clean needle. There has to be a kind of owning up to that role in hundreds of thousands of people dying unnecessarily, even as people in recovery play a greater and greater role in drug policy reform.
This accountability also must occur in the case of alcoholism treatment. According to the Drug and Alcohol Findings Effectiveness Bank description of yet another study confirming the benefits of brief interventions for alcoholics:
Commonly presumed unsuitable for dependent drinkers, the evidence is stacking up that brief advice after screening can lead even these drinkers to cut back. This study of heavy drinking Taiwanese hospital patients provides one of the most convincing demonstrations yet that brief intervention can work in this setting, and the drinking reductions were particularly steep among dependent patients.
In other words, it is possible -- with relatively modest investments of time and effort -- to assist alcoholics in moderating their drinking. This is not to say that all -- or most -- can become social drinkers. But, recall, HR is about how both drug addicts and alcoholics can make beneficial changes in their use and in their lives that may culminate in full recovery, either abstinent or non-abstinent. Yet, in the field of alcoholism in America, even more than with drug addiction, such HR approaches haven't been permitted.
In Nadelmann's words, there must be "a kind of owning up to that role in hundreds of thousands of people dying unnecessarily" in alcohol as well as in drug treatment. After all, in America, those who fail at AA and abstinence are simply left to experience their own negative consequences with no attempt to protect them or to help them make incremental improvements in their drinking and their lives. Remember George McGovern's daughter, Terry, who froze to death in the street. Terry McGovern is an example of a human being who could easily be alive today if we tracked and helped someone like her even though she had difficulty in mastering abstinence. And who shall pay for these unnecessary losses and how?
Even today, we are still not practicing HR as national policy for either drugs or alcohol in America. A first step towards doing so would be the retraction of the ideological, useless, indeed harmful alcoholism treatment study published by Pendery et al. in Science.
There is one last tragic irony about the Pendery et al. study. Since no data were provided by Pendery et al. about the abstinence subjects, perhaps Pendery felt that they all succeeded in avoiding relapse. In any case, some time subsequently, Pendery started a relationship with one such patient at the San Diego VA. As I described these events:
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.
And, so, the greatest victim of the myths of alcoholism treatment permitted -- propagated -- by the Science article was Mary Pendery herself.
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* Pendery, Mary L., Maltzman, Irving M., and West, L. Jolyon. "Controlled Drinking by
Alcoholics? New Findings and a Reevaluation of a Major Affirmative Study," Science 217 (9 July 1982), pp. 169-175.