Nathan and Wallace At It Again!

The American Psychological Association's Practice Directorate sent a mailing to all clinical practitioners in the APA (dated January, 1999) entitled "Alcohol-related Disorders: Psychotherapy's Role in Effective Treatment" — this document is labeled "just the facts." The directorate members "gratefully acknowledge the assistance of Peter E. Nathan, Ph.D.; John Wallace, Ph.D.; and Joan Zweben, Ph.D." in the document's preparation (Joan Zweben wrote me, "I was part of the writing" of this document).

Rather than providing facts, the document represents a remarkably outdated testimonial to AA and standard treatment and ignores research on advances in psychological treatment. In fact, the document is antipsychological, antipsychologist, and antiscientific.

To cite one example, the mailing claims that, "Using individual or group psychotherapy, psychologists can help people address psychological issues involved in their drinking. . . . They can also provide referrals to self-help groups such as Alcoholics Anonymous, a crucial part of any recovery program."

There is a world of misinformation in this small excerpt. According to their 1995 meta-analysis of controlled research on alcoholism treatments, Miller and his colleagues found the cumulative evidence of the effectiveness of "psychotherapy" to be highly negative (Miller and Hester, in their earlier summary of evidence of alcoholism treatment effectiveness, listed "group therapy" and "individual counseling" under "treatment methods currently employed as standard practice in alcoholism programs" for which there was no evidence of effectiveness.) In their 1995 analysis, Miller et al. list Alcoholics Anonymous as the treatment modality with the most negative cumulative evidence score among treatment modalities with too few studies to evaluate conclusively.

The directorate's mailing does not mention at all the treatments the Miller team found to be most effective, including brief interventions and motivational enhancement. While recommending support groups, the directorate's mailing suggests only AA , Al-Anon, and Alateen, as though alternative groups such as Rational Recovery, SMART Recovery, and other non-12-step approaches didn't exist. Nor is there any discussion in the directorate mailing of Alan Marlatt and his colleagues' thoroughgoing research on the benefits of a harm reduction approach of secondary prevention for college students with incipient drinking problems.

Finally, the directorate's broadside indicates, "reducing alcohol consumption doesn't work." Yet reduced consumption is the primary benefit of the Marlatt team's program and of brief interventions, as well as a choice allowed to individuals in motivational enhancement. The NIAAA's recent Project MATCH trial of treatment with a highly dependent alcoholic population touted the success of its outcomes; these results were that on average alcoholics reduced drinking from 25 to 6 days per month and the amount they consumed on drinking days from 15 to 3 drinks.

That such a document should be presented by this official source as the standard for practice for psychologists in 1999 is shocking. As one sign of how misdirected and outdated this material is, John Wallace's treatment center, Edgehill-Newport, closed a number of years ago based on the refusal of third-party payors to support its program any longer. (Apparently Peter Nathan and John Wallace were able to agree in the preparation of this document on points such as the futility of reducing drinking, showing that the two have patched up their differences since Wallace attacked Nathan as part of a group of "nontraditionalist" psychologists in the alcohol field along with Nick Heather, Alan Marlatt, Bill Miller, Martha Sanchez-Craig, and myself.)

Stanton Peele