Audrey Kishline wrote a book called Moderate Drinking . Last week in the US she was found guilty of causing death by dangerous driving - while three times over the limit. So is the only answer to give up booze completely? We report on the debate splitting America

Anthony Browne and Edward Helmore

Sunday July 16, 2000

The crash ended two innocent lives and many of the dreams of the rebel crusade. As Audrey Kishline careered the wrong way down the Washington interstate highway, three times over the legal alcohol limit, the irony could hardly have been greater.

The outspoken founder of Moderation Management had made a living delivering a message of hope for alcoholics: that they needn't abstain from drink totally - they can simply learn to cut it down to sensible levels. Her book, Moderate Drinking: The New Option for Problem Drinkers , caused outrage and incredulity in the US, where the belief that abstention is the only solution is held with almost religious fervour.

But at the tail-end of a binge-drinking episode last March, 43-year-old Kishline drove her pick-up truck head-on into a car, killing Danny Davis, a 38-year-old electrician, and his daughter, LaSchell, who had just celebrated her twelfth birthday. When she woke up in a hospital accident and emergency unit, Kishline said, she could barely remember getting into her truck.

Last week, as she pleaded guilty to two counts of 'vehicular homicide', Kishline denounced the very organization she had founded.

Moderation Management, she declared, involves a lot of 'alcoholics covering up their problem'. In a statement of profound remorse made on the way to prison, Kishline said: 'When I failed at moderation, and then failed at abstinence, I was too full of embarrassment and shame to seek help. In self-pity I gave up and believed my nightly drinking at home could hurt no one but myself.'

The US has for long been riven by a battle over alcohol treatment which, with un-comfortable echoes of Mc-Carthyism, has claimed many high-profile casualties. Mark and Linda Sobell, two earlier advocates of 'controlled drinking', were eventually hounded out of the US for their beliefs more than a decade ago.

Many doctors have lost their jobs over the issue, with the latest being the head of the celebrated Smithers rehabilitation clinic - the US answer to Britain's Priory Hospital. Last week Dr Alex DeLuca was forced to resign after deciding to include Moderation Management as part of its services. 'I was only suggesting that you could engage people in a kinder, gentler manner rather than telling them that they had to sign up for a goal of achieving abstinence from the beginning,' he said after he left.

But Kishline's downfall has managed to inflame the debate, and has been met with almost tangible glee from her former adversaries. To millions of adherents of Alcoholics Anonymous, which advocates total abstinence, Kishline's long denial was at the core of a disease she had failed to accept before tragedy struck. 'The moral here is fairly clear: moderation for alcoholics is a very dicey idea, and Kishline will no doubt go down in history as the best evidence against her own theory, the woman who single-handedly, spectacularly, caused it to crash and burn,' wrote one member of Alcoholics Anonymous.

'This dreadful tragedy might have been avoided if Ms Kishline had come to this realisation earlier,' said Stacia Murphy, president of the National Council on Alcoholism and Drug Dependence in New York. 'Unfortunately, the disease of alcoholism, which is characterised by denial, prevented this from occurring. While this does not excuse Ms Kishline's actions, it provides a harsh lesson for all of society.'

But Moderation Management, stung from being denounced by its imprisoned founder, has far from conceded defeat. It has never claimed to be a programme for severely substance-dependent people, but insists moderate drinking is a 'reasonable and attainable recovery goal for problem drinkers'.

To MM supporters, Kishline's example is not a failure of the belief that alcoholics can learn to drink socially. Rather it was the failure of AA's total abstinence approach. The crash occurred after she had given up on controlled drinking, and joined the AA programme.

'Isn't it ironic that her most extreme case of intoxication came after she quit Moderation Management?' said Stanton Peele, an MM board member. 'AA didn't have the answers for her, either'.

The US debate is now spilling over into Britain. In the US, with its history of prohibition, the treatment of alcohol problems has focused almost exclusively on total abstinence.

In the UK doctors treat alcoholism not as a disease but as a behavioural problem, and have been more likely to advocate moderation, with abstinence as the last resort. There is fairly widespread agreement here that anyone whose alcohol dependency is severe will have little choice but to give up, while those with very mild dependency will be able to control it. It's in the middle ground that the battle is raging.

Kishline's tragedy is certainly a setback for Professor Nick Heather of Newcastle University, a leading advocate of controlled drinking, who advised her when she set up Moderation Management in 1993. 'It will provide a lot of support for those who believe alcoholism is a pre-determined disease,' he said.

'We need to let people know that there is another possibility before their dependence has reached a level where abstinence becomes necessary.

'People don't know that, and the Kishline incident may put us back. But there are literally hundreds of studies that show it is possible to maintain a pattern of harm-free drinking after some degree of dependence,' said Heather.

'The trouble is, the abstinence brigade don't believe those who say they can control their drinking: they are usually lying - or deceiving themselves - about the amount they drink.'

Heather recognises Alcoholics Anonymous has helped a lot of people. But after the pleasantries, he is swift with his reservations - particularly about their Twelve Steps Programme, which he sees as being akin to a cult. 'I'm a rationalist in favour of scientific evidence, but it's mumbo jumbo,' he said.

The lobby group Alcohol Concern, which leans towards the controlled-drinking camp, was keen to play down the Kishline incident. Its assistant director, Sue Boon, said: 'This individual has realised that moderation wasn't for her. If you look at it on an individual level, one person finding a method doesn't work for them isn't such a big deal.'

The two sides take the debate seriously because they see it, not as the fine print of an academic argument, but literally as a matter of life and death. Each says the other gives out the wrong message, recklessly destroying lives.

Chris Cook, professor of psychiatry of alcohol misuse at the University of Kent, argues that the common perception that abstinence is the only solution for any type of alcohol problem deters many people from seeking help in the first place.

He said: 'Kishline has to be a setback for the controlled drinking argument. But the abstinence message can be very counter-productive. If you send a lot of people off to the AA, they'd think, "My God, I'm not as bad as them - do you think I am some kind of wino?", and then not come back for any help.'

Alcoholics Anonymous has a policy of never formally commenting on public debates. But John, a senior member in Britain, countered: 'Trying to make sensible drinkers out of alcoholics is condemning people to death - they may choke or even die in a car crash before they tackle the problem. One guy in Stirling hospital, who was being treated by a consultant who didn't believe in alcoholism, was trying to stick to under 14 units a week - but he saved up, drank 28 units in one day, and it was fatal.'

John hoped that people would learn from Kishline's tragedy: 'I hope that the message to anyone who is practising controlled drinking is that they walk away from controlled attempts and towards abstinence.'

Statistics

Since 1995, the Government's sensible drinking limits have been set at 4 units a day for men, and 3 units a day for women.

Thirty-eight per cent of men, and 20 per cent of women, exceed this at least once a week. For 16 to 24-year-olds, that rises to one in two men, and 41 per cent of women.

Alcohol is believed a factor in 25 per cent of accidents at work and 14 per cent of road accident deaths.

In 44 per cent of violent incidents, victims describe their assailant as 'drunk'. Alcohol is associated with up to 70 per cent of homicides, stabbings and beatings, and 50 per cent of fights or assaults in the home.

In the UK, more than 1 in 25 adults are dependent on alcohol.

Source: Alcohol Concern/Office for National Statistics

Case Studies:

No 1: Patrick, the abstainer - 'One drink was never enough'

'I had an appetite for things that were nice, and alcohol was. I was in the Royal Marines, and it was part and parcel of the job - I liked to work hard and play hard. By 1982, I was drinking a couple of bottles of spirits a day. I couldn't get out of bed without it, I couldn't go to work without it, and I had to keep myself topped up during the day. I knew I was alcoholic, but I just couldn't stop.

'I tried controlled drinking a couple of times, but it just didn't work, because one drink was never enough.

'I got a final warning from the service authorities, my marriage was in tatters and I just lost control of my life. I got in touch with Alcoholics Anonymous and they opened my eyes - I knew I wasn't alone.

'I abstained for six months, but then I decided I could have a drink because I thought I could handle it. But I ended up having nine bottles of vodka over three days - it almost killed me.

'But I haven't had a drink since - and that was 10 years ago. There is no middle ground. There is no such thing as controlled drinking.'

No 2: Clint, the controlled drinker - 'Now I drink 8 pints a week'

'I was a club manager, and it was just part of my life. I used to drink 8am till 2am six days a week - drinking more than 20 pints of draught lager a day, but I didn't think that I was an alcoholic.

'I was so bad I used to get hallucinations, seeing lizards and spiders coming out of my skin, or people with animal heads. It was very frightening. It affected my family life, and I got divorced. I attempted to take my own life.

'I was in hospital for six weeks for an overdose, then a psychiatric ward for a month. After that I didn't drink for ten months.

'But I didn't think I was proving anything to myself - I wanted to control the drink rather than have it control me, to prove that I could just have a drink. I had a pint on Boxing Day, and it tasted terrible - I had to educate myself into the taste of beer again.

'Now I drink 8 pints of beer a week, in this club where I go dancing three nights a week. I've never gone over that limit for nine years now, nor been tempted. I now have a wonderful life and a wonderful wife, and I would never go back to the old situation again. I'm enjoying life too much.'

How do I know if I am an alcoholic?

• You suffer withdrawal symptoms: sweats, nausea, 'shakes' and less commonly delirium tremens (DTs).

• You need to drink more to get the same effect.

• You acquire drinking habits - the same drink in the same environment.

• Your drinking takes precedence over family and work.

• You drink to avoid withdrawal symptoms.

• You think about alcohol most of the time.

anthony.browne@observer.co.uk