Commenters on my "How the Disease Theory Killed Mary Pendery" really came down hard on me, saying -- well -- I'm killing alcoholics. Their shared view: if you drink again, damn you, you deserve to die (along with anyone you're dating). None mentions harm reduction, though.

 

The Stanton Peele Addiction Website, June 4, 2011. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.

When AAers Strike!

This post is a response to How the Disease Theory of Alcoholism Killed Mary Pendery, and Harm Reduction Could Have Saved Her

 

I've been dealing with angry, demented comments from AA members for a long time -- just imagine what their response was to my 1983 article, "Through a Glass Darkly," in Psychology Today decimating the Mary Pendery et al. study in Science claiming to have proven the value of 12-step, abstinence-fixation treatment. It was brutal!

AAers know no boundaries, since (a) they're sure they're right, (b) Ann Landers and Dr. Drew agree with them, (c) they get to claim that anybody who disagrees with them is killing alcoholics.

Of course, that's why I pointed out in "How the Disease Theory of Alcoholism Killed Mary Pendery" that death lurks on their side -- after all, more of the abstinence-only patients in the the study Pendery et al. attacked died following treatment than relapse-prevention patients.

So how do they deal with the fact that a man who was judged a great success in the San Diege VA abstinence-program got really drunk and killed America's most famous (at the time) abstinence huckster, and then himself?

Here's how Anonymous, in a comment titled "Preposterous," responded: "2 people are dead because an alcoholic drank again: conclusion: alcoholics ought not drink! Duh!"

Notice the cocksure confidence, the put-down. But, here's the irony -- the patient and therapist agreed with Anonymous -- abstinence is the only possible solution, after which all hope must be abandoned. They gave their lives in the service of their myopia -- it's almost as though Anonymous is saying -- "too bad two people had to die to prove that's what happens when you don't abstain after going through treatment."

What about Anonymous' view of harm reduction? Well, he or she makes no mention of it. In another area, this omission might be surprising, since the second half of the title of my blogpost was, "Harm Reduction Could Have Saved Her." But this is the alcoholism field, after all.

The entire idea that, since most alcoholics won't abstain forever following treatment -- most not even for a very long time -- means therapy must develop a fallback position, fell on deaf ears in Anonymous' case, I fear.

How about Ned Wicker's inevitable comment: "Alcoholism is a disease?" For Ned, my ignorance is apparent since, "Alcohol dependence is a disease because some get it and others don't and it's characterised by an inability not to drink. Alcohol killed Mary and it's very sad that you can't see that."

This comment is a little confusing, since it says that some people cannot avoid drinking, which is a bit of what I pointed out with the man who killed Mary Pendery.  So it's not clear what it is that I don't see (other than not blaming that on some disease). My post is about reckoning on the many failures to abstain -- which was true in the abstinence treatment condition in the study Science critiqued, with results Pendery and her co-authors acknowledged to be disastrous -- and developing therapy techniques to prevent such commonplace events from exploding to life-threatening proportions.

Which is what happened to Pendery herself.  Isn't that irony so collosal, so self-evident that the commenters might tone down their self-congratulatory arrogance on behalf of the disease theory and the 12 steps just a notch? (Did I mention, Ned doesn't refer to harm reduction in his truculent comment?)

Then, Colin S. jumps into the debate. First, Colin makes clear, "anyone working within addiction clearly understands that there are no 'cures' there is only treatment which is reliant on not using." So what we have learned from decades of brain research is that alcoholics can't and shouldn't drink, even though the government's own alcoholism research shows that the overwhelming majorty do. Amazing how little brain science has added to AA's original 1935 view (and, in fact, how little it has added to the 19th century's temperance perspective) don't you think?

All right, I know you are waiting for Colin's other shoe to fall on my neck.  Here goes:

As a way forward for treating addictions the main post is destructive as it is limiting in its perspective and oppertunities to facilitate recovery. Not everybody benefits from one particular type of treatment and to limit the oppertunities available by "slating" others may leave you with the knowledge that you have contributed to another relapse or worse.

I don't know the term "slating" -- and I left Colin's antic spelling of "opportunity" stand as is. But is he criticizing me for having a "limiting" perspective that fails to recognize that "Not everybody benefits from one particular type of treatment" and that we need a greater range of options?

Moreover, Colin throws in that hoary accusation that my bringing all of this up has "contributed to another relapse or worse." Damn, and I was commenting on how existing treatment bromides -- ones that Colin endorses with such an ironclad commitment that he can't even contemplate "anyone working within addiction" thinking anything else -- killed two people. It seems that, according to Colin, that's the way it goes.

I made a brief response to Colin: "Colin, Do you know what harm reduction is?" I asked this because -- surprise -- Colin doesn't mention the idea.

So, perhaps I should end with a description of harm reduction, in case Colin, Ned or Anonymous should read this.

Harm reduction represents methods for minimizing the damage that comes through continued substance use for problem and addicted drinkers and other users, so as to give them room to improve their lives -- perhaps ultimately to cease substance abuse, or substance use. But even if that isn't in the cards for them, human beings who continue to be addicted deserve to live the best lives they possibly can. And treatment should help them in achieving any and all of these results.

Don't you agree, Colin?

P.S. The first comment by an AAer addressed to me to prove me wrong is titled: "Mean spirited, angry old man."  This is analyzed perfectly by Ilse Thompson : "If you have ever had the temerity to criticize 12 step philosophy in a public arena, you’ll know that you will be swarmed with recovery evangelicals who pity you for being so angry and resentful."  Ilse explains how anger is taught to AA members to be a sign of the disease in order to keep women in line.

Thanks, Anonymous, for being a perfect illustration of AA's attack mode -- are you allowed to reveal if you're a woman?