Why and by Whom the American Alcohol Treatment Industry Is Under Siege

Abstract

Conventional disease-based inpatient alcoholism treatment is under attack in the United States and internationally because it accomplishes little beyond simple counseling and is less effective than other life-skill-oriented therapies. Nonetheless, disease-model adherents retain a stranglehold on American alcoholism treatment and attack all "nontraditionalists" who question their approaches. One such attack by Wallace (1989) is discussed. In addition, Wallace's claim that his treatment program at Edgehill Newport as well as other private treatment centers have remission rates ten times as high as those found for typical hospital treatments is examined critically. Finally, the group of researchers who question at least some elements of the standard wisdom about alcoholism and addiction is found to include nearly every major research figure in the field.

Treating alcohol problems: a study of programme effectiveness and cost effectiveness according to length and delivery of treatment

“…It was in this context that the Institute of M edicine of the US National Academ y of Science undertook their 4-year investigation (Institute of Medicine, 1990), stimulated by a view that the alcohol ® eld ª needed to prove itselfº (Saunders, 1991) in terms of treatment ef® cacy, relevance to m odern health service provision and cost-effectiveness. Peele (1990) and Miller & Sanchez-C raig (1996) have critically exam ined claims for high success rates for alcoholism with programm es making claims of abstinence rates of 60± 90%. W hile it is clear that treatm ent is more effective than no treatment (McLellan et al, 1996), and that patients who receive treatm ent in well-designed treatm ent studies are signi® cantly improved in a variety of problem severity areas at follow-up (M cLellan et al, 1996;Project M atch Research Group, 1997) the nature and amount of change is typically more modest.…”

The evolution of an evidence‐based programme for problem drinking: treatment components

“…Throughout the 1980s, the alcoholism treatments most widely available in the British Independent Healthcare sector and in North America were remarkably similar to those used several decades earlier (Cook, 1988;Fingarette, 1988;Peele, 1990). These treatments either lacked research support or were contraindicated by their research evidence (Fingarette, 1988).…”

“…The review and evaluation of the treatment were driven by the aims of avoiding therapist bias and allegiance effects (Kendall, 1998), and to ensure external objective scrutiny (Peele, 1990). These aims were achieved by the use of independent experts to review and advise on treatment programme change and to oversee the treatment evaluation of the project.…”

Alcoholics Anonymous and the Counseling Profession: Philosophies in Conflict

“…Because of this self-selection it becomes impossible to know whether it is AA efficacy or member motivation that is being measured (Bebbington, 1976). Although AA's explanation of alcoholism as a disease is supported Additional problems involved in the scientific research of AA by the American Medical Association, its validity continues to be include member anonymity, lack of control groups, and the confounddebated in the literature (Erickson, 1992;Miller, 1991;Peele, 1990, ing effects of other treatment programs. These difficulties have led 1992).…”