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

(Editor's note:  Please see the July 1998 issue of 
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                       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 

     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 

     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 
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' 

     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 

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  years for deaths by 
'moderation drinker.'  Seattle Times. 
Koch, A.  (2000, June 20).  "Moderate drinking" author had 
decided to abstain.  Seattle Times. 
Maltzman, I. and Rotgers, F.  (2000, December).  Drinking:  
Abstinence vs moderation.  Counselor:  The magazine for 
addiction professionals, 1, 33-38. 
Peele, S.  (2000, November).  After the crash.  REASON.  
Penta, M.  (2000, June 27).  Fatal accident forces debate 
over movement for problem drinkers.  Associated Press. 
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 
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.  
Steele, D.R.  (2000).  A fatal collision.  Liberty 
Magazine, August, 10-11.  

- - - 

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).