Causes, Patterns And Paths To Recovery Based On 45 Years Of Studies
First Edition later printing, Copyright 1983
Harvard University Press Publishing, Cambridge, Massachusetts
Alcoholism is a disorder of great destructive power. The damage it causes falls not only on the alcoholics themselves but on their families and friends as well.
To me, alcoholism became a fascinating disease. It seemed perfectly clear that ... by turning to recovering alcoholics [A.A. members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of A.A., I was working for the most exciting alcohol program in the world.
But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy. ...
... After initial discharge, only five patients in the Clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. ...
Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.
The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 283-285.
George E. Vaillant is/was Professor of Psychiatry, Dartmouth Medical
School and Director of the Study of Adult Development, Harvard
University Medical Services. He first wrote about a 45 year
(beginning in the late 1930;s) longitudinal study (not a slice in time
looking retrospectively, but a continuation study starting with three
groups of people before any developed alcoholism)) and published his
findings in a book entitled, The Natural History of Alcoholism. He
later wrote a follow up to that book. Here is one excerpt from his
book.
What we learn about the etiology of alcoholism must affect our
treatment. We must stop tying to treat alcoholism as if it were
merely a symptom of underlying distress. We must learn to mistrust
recent retrospective studies like Tyndel's which after reviewing the
charts of 1000 patients admitted to the medical unit of Toronto's
Addiction Research Foundation decreed that 100% of alcoholic patients
in an uncommonly large series of investigated cases lead to the
conclusion that the development of the disease process of alcoholism
is inconceivable without underlying psychopathology. Instead we must
learn to heed an old Japanese proverb: First the man takes a drink,
then the drink takes a drink, then the drink takes the man.
We must spot the fallacious etiological implication in Kissen's
otherwise correct statement: 'It is a truism that most alcoholics
cannot cope. They cannot deal with the normal frustrations and
irritations of the external world.' They were not always so helpless.
When, after analyzing the MMPI of alcoholics Hampton wrote: 'The more
maladjusted the individual is on the average, the more need he seems
to show for alcohol as a crutch.' He was 180 degrees off course. A
more accurate statement of the data and Kissen's generalizations might
be: 'The more an individual abuses alcohol, the more maladjusted and
crippled he will appear.'
pp. 105
Disease or Defense? click here to view
Review of the Natural History of Alcoholism,
by George E. Vaillant
Review by Stanton Peele
Foreword (1996) - Stanton's review of George Vaillant's The Natural History of Alcoholism revealed that the emperor was naked, and that the book was intellectually dishonest. Vaillant systematically created summaries that disputed his own data, while citing cases selectively to try to support what he perceived to be the safe positions to take. As a result of Stanton's review, Dr. Vaillant has for over a dozen years systematically attacked Stanton in speeches and workshops he gives around the nation, trying to square the circle by compulsively reinterpreting his (Vaillant's) data to show that alcoholics never resume controlled drinking.
New York Times Book Review, June 26, 1983, p. 10