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High-priced feud over letting drunks drink

Joanne Laucius The Ottawa Citizen - 7/16/2000
'Controlled drinking does not work,' the Smithers Foundation said in a full-page New York Times ad denouncing the practices of the clinic.

A feud at a New York celebrity rehab centre has reignited a simmering debate -- is drinking a disease or a choice?

Dr. Alex DeLuca, director of the one-time hardline abstinence-or-out-of-here Smithers Addiction Treatment and Research Centre, landed in hot water last week when he suggested patients should be able to choose from a range of options -- including drinking in moderation.

While 12-step abstinence programs work for some, they don't work for everyone, Dr. DeLuca told New York Magazine. "I'm not going to tell them: 'Come back after you have suffered some more and are ready to do it our way'," he said. "I can't operate that way as a physician."

It was a bombshell to the world of addictions treatment, "as if the inmates have taken over the asylum," said New York Magazine. The "inmates," apparently, love the new approach. "They're so relieved it's not the nightmare they thought it would be," said Dr. DeLuca.

But for many, including the board of the Christopher D. Smithers Foundation, Dr. DeLuca's statement was heresy. The foundation's benefactor was philanthropist and recovering alcoholic R. Brinkley Smithers, who funded the clinic 30 years ago. Since then, high-profile patients have included Daryl Strawberry, Truman Capote and Joan Kennedy. The foundation, which is no longer linked to the clinic, moved quickly this week to distance itself from the kinder, gentler have-one-but-take-it-easy Smithers Clinic.

Calling Dr. DeLuca's statements "an abomination, an insult and a disgrace to the memory of R. Brinkley Smithers," the foundation took out full-page advertisements in both the New York Times and the New York Post. "Alcoholism is a disease. Booze has no place in its treatment. Controlled drinking does not work," declared the ads.

St. Luke's-Roosevelt Hospital Center, which runs the clinic, said in a statement that the Smithers Center "has a long and proud tradition of treating alcoholism by advocating total abstinence. While we recognize there may be other alternatives in the treatment of this difficult disease, no change in our own program policy was ever approved."

Dr. DeLuca, who has resigned, has not commented. But he apparently joins other addictions experts who have questioned the abstinence model and the definition of heavy drinking as a disease. The belief that drinking is a choice has added a moral dimension to the debate. If people who drink are making a choice, then heavy drinking is a weakness, not an illness.

Health campaigners started calling alcohol an addictive drug so they would be be taken seriously, says author Andrew Barr. "In order to sustain the idea that America is suffering from a drug crisis that demands greater investment in anti-drug agencies and harder anti-drug laws, campaigners have lumped together all substances that can conceivably be called drugs," he wrote in his controversial 1999 book Drink: A Social History of America.

Mr. Barr traced the idea that alcoholism was a disease back to the 1800s. It was popularized only after 1935 with the creation of Alcoholics Anonymous, whose founders William Wilson and Dr. Robert Smith wanted to persuade potential recruits that they are powerless over alcohol, shifting the blame from the drinker to the drink. Brewers and distillers liked the idea because it didn't blame them. Doctors liked the idea because hospitals would accept patients suffering from a disease.

Those who advocate moderation instead of abstinence say heavy drinking is more of a social and economic problem than alcoholism. There are four times as many "problem drinkers" in the U.S. than alcoholics, according to some health experts, and they're costing the health system more than alcoholics. However, problem drinkers don't have withdrawal symptoms if they quit drinking and can't identify with the all-or-nothing abstinence solution. I'm not an alcoholic, they say. I just drink a little too much.

Others have problems with AA's spiritual focus, demanding reliance on a "higher power."

Mr. Barr says attending AA works no better than no treatment at all. "It has even been suggested that attending AA is less effective than allowing the abusive drinker to get over his problem on his own," he said.

"Research conducted by psychologists in Britain has shown that hospitalized alcoholics who believe that alcoholism is a disease are more likely to drink excessively after having a single drink than those who do not subscribe to the disease theory."

The growing popularity of the moderation solution has economic pressures behind it. Insurers and employers are questioning the cost of residential 12-step programs. It was becoming hard to justify the costs when so many drop out.

Ironically, the Smithers Clinic debate comes only three months after the founder of the best-known moderation program pleaded guilty to killing a 38-year-old man and his 12-year-old daughter while driving the wrong way on an interstate highway in Washington state.




Alexander DeLuca, M.D., FASAM.
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