Alexander DeLuca, M.D.
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The Abstinence vs. Harm Reduction Follies of Summer 2000
OR: Addiction Medicine Shoots Itself in the Foot, Again

Compiled by Alexander DeLuca, M.D., FASAM; Addiction, Pain, and Public Health website; 2001-01-27; Modified: 2006-07-09

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See also:

The Controlled Drinking Debates: Review of Four Decades of Acrimony - Brook Hersey, Psy.D., Rutgers, 2001
Abstinence, Moderation and Harm Reduction archives  ;  The DeLuca Collection
Abstinence, Moderation, Harm Reduction and the Great Debate - Journalism and Advocacy archives
Harm Reduction for Alcohol and Drug Use Disorders Weekly -
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If you are only going to read one article, read this one:
"The Controlled Drinking Debates: A Review of Four Decades of Acrimony - by Brook Hersey, Psy.D. , 2001.  This is a scholarly, yet very readable, review of the controlled drinking controversy from the 1960's to my firing in 2000. Provides an excellent historical context for better understanding the twisted events detailed below.

"[The] debate about whether abstinence is necessary for people with drinking problems has been going on for four decades. The paper that follows represents this writer's effort to better understand the controversy's heat and longevity, by tracing it from J.P. Davies' 1962 paper through to [DeLuca's firing in 2000]. I will conclude my historical review with a discussion of some important issues that confront a contemporary observer of the controlled drinking debate."

and then read this one: "12 Steps Back" - by Maia Szalavitz in the Talk Back column of Brill's Content, January 2001.

The circle is completed. Maia writes about how her story in New York Magazine was altered by it's editors and about how several stories and issues were conflated together and exploited; by the media, the NCADD, the Smithers Foundation, and by St. Luke's/Roosevelt Hospital Center, each for it's own narrow and gutless reasons. This is the most thorough, almost-entirely-correct, accounting of what happened, and I feel vindicated by it.

The sad tale actually begins here... 
"Drink Your Medicine" - New York Magazine, 7/10/2000, (on the street a week earlier) Gotham column. Attributed to Maia Szalavitz with some sickening editing and an obscene graphic inserted by New York Magazine to trivialize and titillate and inflame. The graphic showed a cartoon of a patient in a hospital bed, pie-eyed and drinking from a bottle of booze, while a nurse looks the other way and whistles. This is where it all began. (Maia's actual article-as-submitted, while somewhat glib was not defamatory, and was significantly different from the article-as-hacked by New York Magazine's editors).

"Advocate of Moderation for Heavy Drinkers Learns Sobering Lesson" - New York Times 7/9/2000 - National Desk. Article about Audrey Kishline's fatal crash and then says that I changed the treatment program at Smithers into one based on a book by a drunken killer. Did the Times call me to fact check? Nope, just picked it up from New York Magazine article about me and threw it into the copy about Kishline. That's the Old Grey Lady for you. Guilt by media juxtaposition.

"Is Smithers using "moderation management" in inpatient treatment?" - by Alex DeLuca. This was an Ask-A-Doc question that I answered 7/9/00 after returning from a week of vacation. This is what I sent to the ADD_MED listserv via Terry Rustin, one of the very few in this entire nightmare who had the intelligence and grace to actually ask me what was going on. I was fired the following day.

"Smithers Rehab Chief quits over 'Just a Sip' Policy" - New York Post, 7/11/2000. A lazy hack job of the New York Times article which reported the sickening hack job of the New York Magazine article by Maia. Dramamine anyone?

"Addiction Center's Director Quits in Treatment Debate" - New York Times, 7/11/2000, Metro section. Roosevelt Hospital officials quoted making the false statement that I had resigned (I had been fired for cause) and attributes defamatory and silly beliefs to me. This article also associates me by juxtaposition with the tragedy of Audrey Kishline who they portray as a drunken killer. Nice company. Interestingly enough, the quotes of me in this article are quite accurate. OK, the New York Times has weighed in twice. Now it's a FACT.

"DeLuca's letter of resignation" - turns out I'd already been fired 'for cause.'.

NYC Moderation Management web page - (circa Spring 2000) including announcement of the  scheduled weekly meeting at Smithers outpatient department after clinic hours. Permitting this meeting to take place in the Smithers site, in Roosevelt Hospital, after hours when the space was not otherwise being used, was the entire reality of the relationship between Smithers Treatment Center and Moderation Management.

"From 10 Days to Shutdown - Abstinence Uber Alles!!" - a psychotic little rant by someone called "Neil Scott" from something called "The Alliance for Recovery." Who are these people, and what investigation of my work have they made that justifies their gleeful celebration of my loss of employment and separation from a place I put my heart and soul into for a decade? This is undoubtedly a front organization for the Axis of Evil - the NCADD and / or the Smithers Foundation. Neil, get some self respect; the way you make your living is pathetic.

"Director of rehab center quits in dispute over alcohol treatment" - 7/11/2000 - Very interesting. This is the Associated Press with a sort of 'final synthesis' of the articles in New York Magazine, the NYTimes, and the NYPost. Check this out, an un-edited paragraph from the article: "DeLuca's decision to include Moderation Management as a treatment option at Smithers was first reported in last week's New York magazine. He told the magazine: "I humbly submit that this is the way alcoholics should be treated." The quote in context reads: "In medicine, if treatment doesn't work, you change it. I humbly submit that this is the way alcoholics should be treated." Deliberate quoting out of context with intent to malign. Thanks Associated Press.

"Abstinence vs. Harm Reduction: a False Dichotomy" - by Alexander DeLuca. An article submitted to New York Times Op-Ed page circa 8/2000 and not published there, alas. One of the best things I've ever written.

"Through a Glass Darkly" - just for giggles, a link to an article that actually says something. Psychology Today, April 1983, pp. 38-42 from Stanton's website: . Ok, now back to the madness...

"Here's what Audrey Kishline told the Moderation Management group on January 20:" - a link to a web page that VERY THOROUGHLY documents and traces the event's stemming from Audrey's leaving MM to re-join AA on 1/20/2000. This article will open in a new window. Just close that window to return here.

"Setting the Record Straight on Substance Use Treatment" - by Andrew Tartarsky and Mark Sehl. A passionate article about the importance of diversity and rationality in substance abuse treatment. Very supportive of me. Thanks guys.

"Clouds Over Future of an Alcoholism Treatment Center" - New York Times, 1/28/1999. The trouble and ill will between SLRHC and Ms. Smithers-Fornacci goes back a long way.

"Is Abstinence the Only Way to Beat a Drinking Problem?" - Larry King Live - Aired July 10, 2000 - 9:00 p.m. ET. Don't bother reading it, it's the usual Treatment Industry Suits and Recovering Personalities. Not one M.D. The only Ph.D. was poor outnumbered Marc Kern. Pathetic.

"Letter from Jennifer N. of NYC MM to Sigurd Ackerman, M.D., President SLRHC" - Letter protesting the expulsion of the Moderation Management meeting that had been meeting after-hours on Smithers premises for some five months without incident.

"Learning to Say 'I've Had Enough'" - by Dr. Sally Satel, New York Times, Op-Ed page, 7/14/2000. A quiet and sane perspective from someone actually in the field of addiction medicine. I really like this piece and agree with it in tone and content. Also, it was nice to "meet" Sally on NPR (she was the guest, I called in) - I'm sure we'll run into each other at some conference or other.

"Sudden Exit as Clinic Chief Sends Addiction Specialist Reeling" - by Robin Finn, New York Times 'Public Profiles' column, about me. Not entirely flattering (she refers to me as an "addled, idled, addiction specialist"), but accurate enough. Also, really nice picture of me!

"Booze goes on the menu at Famed Celeb Rehab Clinic" - 7/6/2000, by Ikimulisa Sockwell-Mason and Jessica Graham, New York Post. Pure misinformation and disinformation, the text of the article is copied to ADD_MED. This vile little piece of trash, which actually implies that I permitted inpatients to drink, is then discussed by the very eminent and learned Doctors of the ADD_MED listserv, in an ignorant, fat-headed, jump on the bandwagon manner. Very Depressing. One writer bemoans 'the removal of the "moral" ("spiritual") element too.' Another message confidently states that 'financial matters' were behind it. (What?) So, enjoy the witty repartee if you can; personally, it makes me sick. 

Recommend you bring airline-sickness bag on this one. Exceptions to the general tone of  holier-than-thou, macho flavor, are Dr. Robin Room who tried to keep the discussion this side of delusional, and Dr. Terry Rustin, who actually wrote and asked me, (can you imagine?), what was going on. Which lead to my first public statement on the entire matter, which is the following document:

"Smithers, Moderation Management, and Trials of Controlled Drinking" - This is the last exchange between myself and a person using the "Ask-An-Addiction-Doctor" feature of what was the Smithers Treatment Center website (before it became I was fired the next day. 

"Smithers brouhaha" - Anne Geller and LeClair Bissell come to my defense on the ADD_MED listserv, 7/13/2000. Two sentences from this post:

Last line: "In your attacks on DeLuca you ... behaved like a bunch of religious fanatics with Satan in sight. Shame on you."   Thank you, Anne. Thank you LeClair. 

Favorite line: "
It is enormously depressing to us, both now in retirement, to witness the same mindless zealotry that so beset our field 30 years ago again raise its head to make us a laughing stock in the medical scientific community."

"Can Alcoholics Cut Back? - Abstinence camp blasts moderation" By MARY JANE FINE From: DAILY NEWS - News and Views | City Beat | Sunday, July 16, 2000. More of the same old tired Smithers Foundation version of reality that I somehow changed the program and thank god they fired me and so on. But why is there a picture of Charisse Strawberry, wife of Darryl Strawberry, in the article? Was that somehow my fault too? 

A recent history of Moderation Management" - by James Cannon circa 7/2000. His account of how Smithers, Moderation Management, and my firing came to pass. My favorite line: 

"I called the Times to price an advertisement like that. They told me $102,173.40. Adele could not have done more to advance the work of MM if she had donated an equal amount to our treasury."

"Wrongful Termination of Dr. DeLuca from Smithers Center" - Letter by R. Scott Greathead, Attorney for DeLuca, to K. Meyers, Attorney for SLRHC. Favorite section in this one: 

"... A treatment strategy that is designed to better engage and retain patients in Smithers' abstinence-oriented treatment groups, and for which the Hospital Center receives substantial Federal funding, does not amount to an unauthorized change in the program any more than publicly discussing it could possibly be 'harmful.'"  

"What we actually accomplished at Smithers, 1990 - 1998" - by Alex DeLuca. Document prepared for new incoming administration so they would know what we were about so as not to ruin us. So, do you think it worked?

"Current grant funding and grant submissions as of my termination from Smithers 7/10/2000" - the ideas and infrastructure, outlined in the previous document, bear real fruit. Hospital fires chief of innovative and effective unit that had bootstrapped a profitable research center within a working treatment center. Don't try to understand.

"Confusing the means with the ends" - Fred Rotgers, 7/14/2000. Really just a brief memo to me Re: references supporting the offering of moderation to some problem drinkers, but I very much like the way he characterizes AA, controlled drinking, abstinence, naltrexone, MM, etc as means that we tend to confuse with the ends, a happier, more joyful, more productive existence. Fred's favorite harm reduction references included. Dr. Rotgers ended up being collateral damage in this affair -- he was fired as part of the mopping up operation several months after my departure in a classic case of guilt by association.

"When even one drink is too much" - by Anthony Browne and Edward Helmore, Guardian/Observer archives, 7/16/2000. Excellent, thoughtful review from the U.K. Includes comparisons of U.S. and U.K. approaches, statistics, case studies, and an 'are you an alcoholic' test.

"More Fallout at St. Luke's - Roosevelt; Widow Sues To Remove Smithers' Name- by Larry Neumeister, ASSOCIATED PRESS 7/26/00. More of the same, with an emphasis on the ongoing problems between Roosevelt Hospital and the Smithers foundation in the wake of my firing. Looks like throwing me overboard didn't make the sharks go away, huh Roosevelt Hosp.? Here mostly for completeness.

A plague on both their houses!

"High-priced feud over letting drunks drink" by Joanne Laucius, Ottawa Citizen, 7/22/00.
It no longer news, it is news-salad, like psychiatric symptom "word salad." Cut and paste, and mix and match Kishline, Smithers, alcoholic patients being given alcohol, murderous drunk drivers, celebrity drunks, controlled drinking, AA, Moderation Management. Of course I get thrown, prominently, into the mix.

"Some people don't need 12 steps to kick habits" - By R. Roeper, Chicago Sun Times, 7/17/00. A small breath of enlightenment.

"Moderate' vs. Abstinent Therapies for Alcoholism" - Dr. Marc Kern, MM spokesperson rebuts Carolyn Knapp article ("An Alcoholic's Private Anguish," July 17, LA Times).

"Abstinence as the Only Treatment Goal: New U.S. Battles" - by Robin Room, from the journal: Nordisk alkohol- & narkotikatidskrift (NAT), Stakes Column, English translation. Circa 1/2/2000 (?). Entirely without sensationalism, Room considers these events in historical perspective. Also has a nice list of web references.

"Why Controlled Drinking Never Dies" - by Stanton Peele, 8-2-2000, From the Stanton Peele Addiction Website. Well written article from a guy who's been around (and around) this issue a long time.

"Old Battles: The Controlled Drinking Debate" - First line: "There's nothing quite like a controlled drinking debate to arouse the passions of even the mildest-mannered addiction professional." Note to self: 'never, ever, underestimate this phenomenon again.'

"AA makes alcoholics' problems 'worse'" - an unfortunate, IMO, article quoting Marc Kern, board member and oft-spokesperson for MM (and usually very reasonable man) as saying "... the abstinence world of AA has caused alcoholism to get worse." Article then turns to Kern and a Stacia Murphy of the NCADD insulting each other's organizations. Of course I get thrown into the mix.

AA is over a million mostly good people who go to meetings and who help each other. AA is a wonderful; AA is also huge and successful. AA has no public voice.The NCADD is an organization with an agenda: abstinence-uber-alles. It is one of the two Forces of Evil, the other being the Smithers Foundation. The Forces of Evil have behaved shamelessly throughout this entire affair, spending some $90,000.00 on a full page ad in the New York Times disgustingly trying to take advantage of a tragic automobile accident. Yecch! (Of course, I get thrown into the mix). The NCADD and the Smithers Foundation ought be ashamed of themselves, but Kern is making a big mistake generalizing his anger into a general attack on "AA", I think.

When the NCADD and the Smithers Foundation publicly apologize for their grotesque behavior in this episode, I will withdraw the "Forces of Evil" moniker from them.

"New roads to sobriety" - The immediate background: a 20-20 TV special which aired June 7th, 2000, and the reactions to it from various quarters, including people getting fired for publicly questioning the 'abstinence uber alles' approach of most treatment centers. The link is to a web page from that is packed with information and perspectives in a way that doesn't make it appear that the people being quoted are attacking each other. How odd.

"What is alcoholism? Dr. Nancy Synderman chats with Alcohol-Abuse experts" - another page captured from following up on the 20-20 special. Has rushed chat-room feel to it with people interrupting each other so it is difficult to clearly understand the different positions. Anyway, all the usual suspects: John Schwarzlose, president of Betty Ford, and Marc Kern Ph.D., MM spokesperson, moderated by Synderman of ABC and interrupted by questions from cyberspace. Here for completeness. Skip it.

"Can a drunk learn moderation?" - historical background, EXACTLY 5 YEARS TO THE DAY before my firing from St. Luke's/Roosevelt, 7/10/1995. From the Society section of TIME Domestic Volume 146, #2, a brief article about Audrey Kishline and MM back in 1995 after her book was published. Stanton Peele gets his licks in regarding the U.S. being uniquely abstinence-focused compared to other modern countries. Around and around and around we go. Sort of depressing that we're all still here. Five years later.

"After the Crash" - The alcoholism treatment establishment uses a drunk driving accident to silence dissent." By Stanton Peele, Reason Magazine, 11/2000 (links to in new window). Stanton reviews the events of this year and places them in the historical and research context of three decades.

"12 Steps Back" - by Maia Szalavitz in the Talk Back column of Brill's Content, Jan01. The circle is completed. Maia writes about how her story in New York Magazine was altered by it's editors and about how several stories and issues were conflated together and exploited; by the media, the NCADD, the Smithers Foundation, and by St. Luke's/Roosevelt Hospital Center, each for it's own narrow and gutless reasons. This is the most thorough, almost-entirely-correct, accounting of what happened, and I feel vindicated by it.

The End

P.S. - 

The December 2000 JCAHO audit of the Smithers Addiction Treatment and Research Center - said, in part, "Any one of your programs are head and shoulders above any other program in the country. When you put all your programs together, well, it's phenomenal. And what makes your program more memorable is that your patients are much more debilitated than the patients in other programs throughout the country."  
[See: Tooting Smithers Horn! - Summary of JCAHO Audit of Smithers Addiction Treatment and Research Center; Fred Rotgers; 2000-12-29]

That feels so good. I would so have loved to have been there and heard that in the company of my friends and colleagues at Smithers. <oh ouch!>

So, in the end, Smithers is doing OK. The research department embedded within the treatment center continues to bring in Federal dollars (a large proportion of which goes directly to St. Luke's/Roosevelt as "overhead"), and a system of assessment-driven, manual-based, researchable treatment has gained regulatory recognition. 

And Moderation Management is doing pretty well too. A very active tangle of cyber-support listServs and e-groups, is giving rise to 'face-to-face' meetings in NYC and in Chicago, and just this past week (1/27/2001) or so, Philly, I think. Groups starting up, conferences being planned, books being written... this young and very different self-help group might just have legs. We shall see.

But Audrey Kishline is in prison and Danny Davis and Laschell Davis are dead and we all spend too much time arguing about addictions and problem drinkers instead of being open to them where they are in all their diversity, and to helping them and each other. 

Here's to more light in the years ahead!

Alexander DeLuca, M.D., FASAM

Completed: 1/27/2001
Last Major revision: 4/7/2003
Last Minor edits and formatting: 2005-12-29



Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., MPH

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Originally posted: 2001-01-27

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