London and California · 1962–1984
A psychiatrist, two psychologists and a report from RAND said some alcoholics went back to drinking without trouble, and the argument turned bitter.
“Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it evidently hasn’t done so yet.”
In 1962 D. L. Davies, dean of the Institute of Psychiatry at London’s Maudsley Hospital, reported on 93 patients the hospital had treated for alcohol addiction. Seven of them, he reported, drawing partly on a social worker’s visits to their homes, had been drinking without trouble for seven to eleven years. He still advised that “All patients should be told to aim at total abstinence.” The Quarterly Journal of Studies on Alcohol printed eighteen responses. The reaction stayed “limited to professional circles and ‘dismissive’ rather than outraged,” as Mike Ashton put it in his 2021 history of the controversy for the Society for the Study of Addiction.
At Patton State Hospital in California in 1970 and 1971, the psychologists Mark and Linda Sobell gave 70 men a goal: 30 were to stop drinking and 40 to drink in a controlled way. Some had a new behavioral treatment, which, as Ashton describes it, let them drink “in a mocked-up bar,” showed them videos of themselves drunk, and gave them electric shocks for drinking at all or past the limits, depending on their goal. In 1973 the Sobells reported that “some ‘alcoholics’ can acquire and maintain controlled drinking behaviors.”
In June 1976 a report by the RAND Corporation for the federal alcoholism institute found about 70 percent of treated alcoholics “in remission” six and eighteen months later, counting both abstainers and those drinking “within a range specified as normal.” On the morning it came out, the National Council on Alcoholism, which Marty M. had founded, held a press conference in New York calling it “dangerous, misleading, and not scientific.” RAND’s four-year follow-up, in 1980, found about half the men in remission, but remissions “were generally intermittent rather than stable over long periods of time.”
In 1982 Mary Pendery, Irving Maltzman and L. Jolyon West reported in Science on the Sobells’ twenty men who had been trained to drink in a controlled way, followed through 1981. Only one, they found, had kept it up, and four had died of alcohol-related causes. Maltzman called the study fraud, and in March 1983 60 Minutes showed the four men’s graves. The Sobells answered that ten to eleven years after treatment, 20 percent of their men had died against 30 percent of those treated the usual way. Inquiries in Toronto and in Washington, and by their profession, found no fraud.
In 1939 the Big Book said no one had found a way to make a normal drinker out of an alcoholic. In 1962 a London psychiatrist reported seven men, out of ninety-three, who seemed to be drinking normally.
In California, two psychologists taught some hospital patients to drink in a controlled way, in a mocked-up bar. In 1976 a report from RAND said some treated alcoholics were drinking normally, and on the morning it came out, the National Council on Alcoholism called it dangerous.
In 1982 a team went looking for the California men. Only one, they said, was still drinking safely, and four were dead. The psychologists were accused of fraud. Inquiries found none, and the argument went on.
In the studies
The four studies that found some alcoholics drinking without trouble, in the order they were published: who was studied, the figure each turned on, what it found, and who answered.
From the studies’ abstracts and reports, RAND’s own papers, and Mike Ashton’s history of the controversy for the Society for the Study of Addiction (2021). The bars show shares of the men each study followed.
7 of 93 patients drinking without trouble
“…the evidence suggests that only a minority may recover completely.”
AnsweredEighteen responses in the same journal. Griffith Edwards traced the men again (published in 1985), and in 1994 called Davies’s account “substantially inaccurate.”
“Normal Drinking in Recovered Alcohol Addicts,” Quarterly Journal of Studies on Alcohol, 1962; the quotation is from his reply to the responses, 1963.
40 of 70 men given a controlled-drinking goal
“…some ‘alcoholics’ can acquire and maintain controlled drinking behaviors.”
AnsweredIn 1982 Pendery, Maltzman and West found that of the twenty men trained in controlled drinking, “only one” had kept it up through 1981, and four had died.
Behavior Therapy, 1973, with follow-ups in Behaviour Research and Therapy, 1973 and 1976; Science, July 9, 1982.
22% drinking normally at 18 months
Long-term abstainers, 24%Drinking normally, 22%
“…it appears that some alcoholics do return to normal drinking.”
AnsweredThe National Council on Alcoholism, at a press conference in New York the morning the report came out: “dangerous, misleading, and not scientific.”
Alcoholism and Treatment, R-1739-NIAAA, 1976; the 18-month figures from RAND paper P-5997, 1977.
46% in remission at four years
Not drinking, 28%Without problems, 18%
“…remissions were generally intermittent rather than stable over long periods of time.”
It also foundOlder, more dependent men were less likely to relapse after abstaining; for younger, less dependent men it was the other way round.
The Course of Alcoholism: Four Years After Treatment, R-2433-NIAAA, 1980, a study of 922 men; the shares as Ashton gives them.
Never most
Each study found some former patients drinking without trouble, and none found most of them. What that minority meant for everyone else was the argument.
For a closer look
How AA’s own literature used controlled drinking, what the treatment at Patton involved, and the charge of fraud.
AA’s own books used controlled drinking as a test. “We do not like to brand any individual as an alcoholic, but you can quickly diagnose yourself,” the Big Book said in 1939. “Step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try it more than once.” The Twelve Steps and Twelve Traditions (1953) has members tell the doubter, “Why don’t you try some more controlled drinking, bearing in mind meanwhile what we have told you about alcoholism?”
Marty M. put the hope plainly to a Senate subcommittee in 1969: “What they want is to become normal drinkers. It is hard for them to recognize that is the one thing they can never do.” After RAND’s report came out, the Grapevine asked in January 1977, “Is Public Controversy Ever Justified?” It reported that “Many other AA members, identifying themselves as such, wrote angry letters to newspapers and magazines.”
The Sobells’ behavioral treatment ran seventeen sessions. The men were assigned at random to it or to the hospital’s usual treatment, and the treated groups “differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules.” An earlier pilot study, with 13 men, had used a bar and “painful electric fingershock.”
The two-year follow-up reached 69 of the 70 men and found that those trained in controlled drinking “functioned significantly better than their respective control subjects on a variety of measures.” A third-year follow-up by other researchers, in 1978, was billed as an “independent double-blind follow-up”; in the first year, Ashton notes, the interviewer had known which group each man was in, and the second year used the same method.
Pendery, Maltzman and West found that “most subjects trained to do controlled drinking failed from the outset to drink safely.” Of the twenty, eight went on drinking heavily, six gave up and stopped drinking, four died of alcohol-related causes, and one couldn’t be found. When 60 Minutes showed the graves, it “failed to mention the six men who had died after undergoing the standard abstinence-based treatment,” as an encyclopedia of alcohol later put it.
A committee of the Addiction Research Foundation in Toronto cleared the Sobells of fraud in 1982; an investigator for a committee of Congress and a panel of federal health officials followed, the panel in 1984. The American Psychological Association’s ethics committee told them that “There was no convincing evidence that your admittedly erroneous estimates of the frequency of follow-up contacts significantly affected the conclusions drawn from this research.”