Harvard Medical School Gives General McCaffrey Zinberg Award
Morristown, New Jersey
Harvard University's Department of Psychiatry and Division of Addictions, in conjunction with the American Academy of Health Care Providers in the Addictive Disorders, has organized a conference for March 1997 entitled, "Treating the Addictions: What Works." This conference will present its annual achievement award (named for Norman Zinberg) to two individuals, General Barry R. McCaffrey, Clinton's drug czar, and former senator George McGovern. In addition, the first winner of the Zinberg Award, Harvard psychiatrist George E. Vaillant, will be honored.
These awards, particularly that to General McCaffrey, offered in the name of drug policy reformer and iconoclast Norman Zinberg, are so perverse as to be reprehensible. McCaffrey has led the Clinton administration's efforts, first to defeat, now to subvert the California and Arizona state referendums liberalizing the use of marijuana for medical purposes. Both States passed the referendums by overwhelming majorities.
Why would a medical institution such as Harvard award McCaffrey's reactionary attitude towards this medical advance? Is Harvard currying favor with the government? Moreover, McCaffrey's opposition is emblematic of the larger administration and American recalcitrance towards enlightened medical approaches to drugs. The marijuana case example pales next to the much more serious one of needle exchange. In a recent issue of Britain's prestigious journal, Addiction, Gerry Stimson (1996), drug researcher at the University of London's Department of Psychiatry, editorialized on the UK's remarkable success in preventing the spread of HIV infection.
Unlike many nations, Britain was able to prevent the epidemic spread of HIV once it was detected among injecting drug users (IDUs) through a series of preventive policies joined under the rubric of harm minimization, the most critical of these being needle exchange or clean needle programs. One commentator (Wodak, 1996) on this tremendous British accomplishment compared it with the nation with the worst record in this regard, the U.S.
The case for the effectiveness of policies and programmes in the United Kingdom becomes even stronger when "negative control" countries are considered. The United States is probably the best example of a negative control country with only 76 needle exchange programmes in 55 cities by October 1994 [purchase or use of hypodermic syringes by nonmedical personnel violates U.S. law], despite prevalence levels of HIV-1 of around 50% in IDUs in the northeast for over a decade.... Enthusiasm for prohibition survives as a form of national denial, tragically ensuring the continuation of the shooting galleries which perpetuate the epidemic. IDU's remain an underclass.... (p. 1091)
Compared with Britain, American drug policy under Czar McCaffrey is murderous.
Moreover, in what respect can former Senator George McGovern increase the medical understanding of addiction? His book about his daughter expressed a simplistic and outdated view of the problem. As distinguished as his career has been, Mr. McGovern has not demonstrated any special insights into alcoholism. And as much as one can sympathize with him for the death of his alcoholic daughter due to exposure while intoxicated, she is not a good demonstration of effective treatment.
Terry McGovern had been in and out of alcohol programs throughout her life. One of the speakers at the conference, Reid Hester, will be presenting data he and colleagues gathered showing that the programs demonstrated to work best in the U.S. are not the disease-based ones that dominate treatment, and to which Terry McGovern was inevitably exposed (the title of Hester's talk is "What works best is what we do least"). The better programs seek to teach people life skills and to enhance internal motivations to change, rather than convincing them they are lifelong alcoholics whose condition is incurable and who will relapse should they free themselves from treatment (cf. Miller et al., 1995).
Finally, previous Zinberg award-winner George Vaillant's most prominent work was his 1983 book, The Natural History of Alcoholism, which offered the following dismal results of Vaillant's assessment of his hospital and AA-based treatment for alcoholism:
It seemed perfectly clear that ... by disregarding "motivation," by turning to recovering alcoholics rather than to Ph.D.'s for lessons..., and by inexorably moving patients from dependence upon the general hospital into the treatment system of AA, I was working for the most exciting alcohol program in the world.... [Trying "to prove our efficacy," Vaillant instead found:] After initial discharge, only 5 patients in the clinic sample [out of 100] never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment [after eight years] were no better than the natural [untreated] history of the disease. (pp. 283-284)
In other words, alcoholics were as likely to overcome alcoholism on their own as through undergoing Vaillant's program.
Harvard's awards to these people under the guise that it is rewarding "what works" only proves America's peculiar attitudes and practices towards drugs and alcohol.
Miller, W.R., Brown, J.M., Simpson, T.L., Handmaker, N.S.,Bien, T.H., Luckie, L.F., Montgomery, H.A., Hester, R.K., and Tonigan, J.S. (1995). What works?: A methodological analysis of the alcohol treatment outcome literature. In R.K. Hester and W.R. Miller (Eds.), Handbook of Alcoholism Treatment Approaches (2nd Ed., pp. 1244).
Stimson, G.V. (1996). Has the United Kingdom averted an epidemic of HIV-1 infection among drug injectors? Addiction, 91, 1085-1088.
Vaillant, G.E. (1983). The Natural History of Alcoholism. Cambridge: Harvard University.
Wodak, A. (1996). A stupendous public health achievement. Addiction, 91, 1090-1092.