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VOLUME 6, ISSUE 1 PSYCHNEWS INTERNATIONAL May 2001
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SECTION I: THE FIFTH COLUMN
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Note: The Fifth Column is a regular PsychNews column,
managed by Jeffrey A. Schaler, Ph.D.
Opinions and comments are invited. Please send them to
the PsychNews Int'l mailbox: psychnews@psychologie.de
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(Editor's note: Please see the July 1998 issue of
Psychnews International at
http://mentalhelp.net/pni/pni32.htm)
AUDREY KISHLINE'S "ACCIDENT":
CAN CONTROLLED-DRINKING PROGRAMS KILL?
Jeffrey A. Schaler
In March 2000, Audrey Kishline, founder of "Moderation
Management", a controlled-drinking oriented, self-help
program alternative to Alcoholics Anonymous, drove her
pickup truck the wrong way down Interstate 90 near Seattle,
Washington, USA, killing Richard Davis, 38, and LaSchell,
his 12-year-old daughter, in a head-on collision. Kishline
was driving drunk. She pled guilty to two counts of
vehicular homicide in August 2000 and was sentenced to
four-and-a-half years in prison in Washington. The
incident sparked significant controversy around the world
regarding the efficacy of controlled-drinking programs (see
references): People who believe in the myth of the disease
model of alcoholism tend to consider controlled-drinking
programs "dangerous." Kishline's behavior allegedly proved
their point: "Alcoholics" cannot drink responsibly.
I helped Kishline launch MM years ago and subsequently
severed all relations with her and her organization.
Recently I was asked by an editor at Counselor: The
Magazine for Addiction Professionals to respond to the
following question: "Is it possible for people who suffer
from alcohol abuse or alcoholism to choose moderation over
abstinence as a correct mode of treatment for themselves;
and how can a treatment provider effectively determine the
competence of a person who abuses alcohol to self-select
treatment?" This article constitutes my reply.
In a word, the answer to the first part of this
question is "yes". However, the question overlooks two
important facts: (1) There is no such thing as
alcoholism. (2) Since alcoholism is not a literal disease
it is not literally treatable. What passes as treatment
for alcoholism is moral management masquerading as
medicine. Of course, it is possible for people who drink
too much to choose moderation over abstinence. Everyone
has the ability to control himself or herself. One either
controls oneself or is controlled by others: The relevant
issue here is whether heavy drinkers will choose to control
themselves or not. Will they choose to resist the
temptation to drink in excess, and risk harming themselves
or others by drinking too much? No one knows. A treatment
provider cannot effectively determine the competence to
select treatment of a person who abuses alcohol.
To be sure, if someone chooses to remain abstinent he
or she will not get into trouble with alcohol. And
similarly, a person who henceforth always drinks in
moderation will also not get into trouble with alcohol.
Refusing to be abstinent is no more a disease or sign of
impaired volition than refusing to moderate one's drinking
is.
Controlled-drinking advocates assert their program is
for "problem drinkers", not "alcoholics", that is, people
with the putative disease called "alcoholism". The
distinction between "problem drinkers" and "alcoholics" is
a false one fabricated by self-appointed experts in the
addiction field: Problem drinkers are called that because
they create problems when they drink, either for themselves
or others. Alcoholics are people who do the same. There
is no objective physiological test that can be administered
to determine the alleged difference between the two.
Obviously some people have a worse drinking problem than
others, and we may choose to call those with the worst
drinking problems "alcoholics", those with less severe
drinking problems, "problem drinkers". But the exact line
between them would be impossible to determine precisely,
and is arbitrary in any case. We have no evidence that
different methods work better with those having the most
severe problems than with those having less severe
problems.
The bottom line is this: Drinking is a choice. It is
a behavior. It is a metaphorical disease and it is never
involuntary. What many people, especially those in the
"addiction-is-not-a-disease-we-support-the-idea-of-
controlled-drinking camp" avoid acknowledging is that since
addiction is not a literal disease it can only be treated
in a metaphorical sense, for instance by talking
persuasively to the person called an addict. Anyone who
claims that addiction is a metaphorical disease, yet is
literally treatable, is addicted to nonsense.
I'm neither for nor against abstinence or moderate-
drinking approaches to helping people labeled alcoholic or
addict. I think people should have the freedom to worship
as they see fit, and those who want to go to Alcoholics
Anonymous (AA) and/or MM, for example, are no exception.
No "one way" is right for everyone. An abstinence-oriented
approach may be best for some people, just as a moderate-
drinking approach may be best for others. Some people feel
more comfortable with Christianity, others prefer Judaism.
The population of people labeled alcoholic, alcohol
abuser, and addict is a heterogeneous not a homogeneous
one. No two people are identical. Everyone is different.
Research shows that moderate drinking and abstinence-
oriented approaches are equally effective (or ineffective,
depending on how one looks at the evidence) in reducing the
problems associated with heavy drinking. It also shows
that metaphorical treatment, that is, conversation, is as
effective as a "dose of advice."
In my opinion, addiction treatment professionals tend
to be dishonest: They say they care about their "patients"
but in actuality they care more about earning a living. I
don't think there's anything wrong with wanting to earn a
living. Since they're selling their products, they have an
interest in getting consumers to buy their products, so we
would do well to bear in mind the possibility that they may
be tempted to misrepresent their own and their competitors'
products.
My main concern is that people be allowed to do
whatever they want as long as they do not harm others in
the process. If people want to attend moderate-drinking
programs I think by all means they should be allowed to do
so. If they prefer abstinence-oriented programs they
should be allowed to attend those. What I object to is
government involvement in either program, voluntary or
court-ordered. I object to governmental involvement in
metaphorical treatment for addiction for the same reason I
object to state entanglement with religion. One should
have nothing to do with the other.
AA and disease-model proponents claim that teaching
alcoholics they can control their drinking causes people
like Audrey Kishline to kill themselves and others. MM and
controlled-drinking defenders point their finger to the
fact that Kishline had left MM and joined AA when she drank
to excess. Therefore, they say, AA is to blame for the
celebrated "abstinence violation effect." (The abstinence-
violation effect refers to the tendency for some people to
drink problematically when they believe abstinence is too
difficult a goal to achieve or maintain.) It is important
to remember that Kishline went to AA because she was
drinking heavily -- She drank heavily when she was in MM.
It is reasonable for MM supporters to point out that
Kishline had reverted to AA before she killed two people.
It's also reasonable to point out that she drank before she
reverted to AA. When all's said and done, this person went
to AA, she kept drinking excessively, she founded MM, she
kept drinking excessively, she reverted to AA, she kept
drinking excessively. Then while drunk she had an accident
and killed two people. It doesn't follow that either an
abstinence-oriented approach or a moderate-drinking
approach is necessarily at fault, but it does seem that
this person shouldn't have been setting herself up as an
authority on how to cure excessive drinking.
My academic and intellectual interest continues to be
focused on the relationship between liberty and
responsibility, and public, clinical, and legal policies
based in the idea that the person is a moral agent. This
is not the same thing as saying that heavy drinkers or drug
users are good or bad people. As psychiatrist Thomas Szasz
once remarked, behaviors have reasons, things are caused.
People can control their drinking because drinking is a
behavior. There's abundant research to support that idea
and I list some of it in my book entitled Addiction Is a
Choice (Open Court). My colleagues Bruce K. Alexander,
Ph.D. in British Columbia, Herbert Fingarette, Ph.D., in
California, and Patricia Erickson, Ph.D. in Toronto, among
others, have written about this extensively. Whether heavy
drinkers or drug users WILL control their drinking or not
is another matter. But this is not an issue of whether
they CAN control themselves or not. Each drinker alone is
solely responsible for the consequences of his or her
behaviors.
References:
Birkland, D. and Koch, A. (2000, June 17). Alcohol-
abstinence critic accused of DUI in fatal I-90 crash.
Seattle Times. http://www.seattletimes.com
DeMillo, A. (2000, June 30). 'Moderate drinking' author
pleads guilty. Seattle Times. http://www.seattletimes.com
DeMillo, A. (2000, August 12). 4 ½ years for deaths by
'moderation drinker.' Seattle Times.
http://www.seattletimes.com
Koch, A. (2000, June 20). "Moderate drinking" author had
decided to abstain. Seattle Times.
http://www.seattletimes.com
Maltzman, I. and Rotgers, F. (2000, December). Drinking:
Abstinence vs moderation. Counselor: The magazine for
addiction professionals, 1, 33-38.
http://www.counselormagazine.com
Peele, S. (2000, November). After the crash. REASON.
http://www.reason.com/0011/fe.sp.after.html
Penta, M. (2000, June 27). Fatal accident forces debate
over movement for problem drinkers. Associated Press.
http://www.ap.org
Schaler, J.A. (1994). Foreword. In A. Kishline Moderate
drinking: The new option for problem drinkers. Tucson,
Arizona: See Sharp Press.
Schaler, J.A. (2000). Addiction is a choice. Chicago,
Illinois. Open Court Publishers. (See especially the
chapter entitled "Moderation Management and Murder," pp.
107-114, reprinted at
http://www.enabling.org/ia/szasz/schaler/mmurder.htm)
Smolowe, J., Dodd, J., Berestein, L., and Champ, C. (2000,
July 17). Under the Influence: Audrey Kishline, who
steered clear of abstinence, drove drunk and killed two
people. PEOPLE Magazine, 63-65.
http://www.enabling.org/ia/szasz/schaler/inthenews/kishline
people.htm
Steele, D.R. (2000). A fatal collision. Liberty
Magazine, August, 10-11.
http://www.enabling.org/ia/szasz/schaler/inthenews/Liberty.
htm
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Jeffrey A. Schaler, Ph.D., a psychologist, teaches at
American University's School of Public Affairs in
Washington, DC and at Johns Hopkins University in
Baltimore, Md. He is the author, most recently, of
Addiction Is a Choice, published by Open Court (2000).
http://www.schaler.net
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