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Can Alcoholics Cut Back? Abstinence camp blasts moderation

By MARY JANE FINE Daily News Staff Writer, From: News and Views | City Beat | Sunday, July 16, 2000. Also available from:  http://www.doctordeluca.com/Documents/CanAlcCutBack_DailyNews7-16-2K.htm

To drink or not to drink?
That is the question that cost Dr. Alex DeLuca his job as chief of New York's prestigious Smithers Addiction and Treatment Center of St. Luke's-Roosevelt Hospital and has reignited a furor over how best to treat problem drinking. 

Adele Smithers-Fornaci, widow of Smithers Addiction and Treatment Center founder, last year with Charisse Strawberry, wife of Darryl Strawberry. The situation erupted after an all-agog New York magazine article revealed the Smithers clinic was adding a self-help, controlled-drinking option called "moderation management" to the abstinence-only model on which it was founded 30 years ago. Such a shift, the magazine crowed, was "tantamount to the Catholic Church reversing its position on abortion."

Smithers, after all, is a pioneer in the field. Among the center's alumni: author Truman Capote, Yankee pitcher Dwight Gooden, ex-Met Darryl Strawberry and former Ted Kennedy spouse Joan Kennedy. "I was absolutely floored," says Stacia Murphy of the New York-based National Council on Alcoholism and Drug Dependence. "Time has taught us that abstinence offers the safest and most predictable treatment."

Even more floored was Adele Smithers-Fornaci, widow of clinic founder R. Brinkley Smithers. "I thought it was a disgrace to my late husband's memory," says Smithers-Fornaci, also president of the Christopher D. Smithers Foundation, named for her son but no longer linked directly to the 44-bed clinic. She fired off a letter to 92 National Council affiliates in 31 states, sharing her displeasure with moderation management, which touts cutting back on rinking instead of cutting it out. She placed an outraged, full-page ad in several newspapers. "Using the Smithers name in conjunction with this type of treatment is an abomination," the ad read. "The seductive appeal of controlled drinking ... will cause needless loss of life and destruction of families." Within a week, St. Luke's-Roosevelt Hospital announced DeLuca's resignation from Smithers and reaffirmed its own "long and proud tradition of treating alcoholism by advocating total abstinence."

With that, the debate was on. Again. Moderation management debuted in 1994 with the publication of "Moderate Drinking" by Audrey Kishline. A flurry of publicity followed: Time magazine, "The Oprah Winfrey Show," National Public Radio. More recently, the curb-your-drinking movement got an unwanted splash of notoriety and more than a dash of bitterness. Kishline, worried about her own drinking, left the moderation movement to join Alcoholics Anonymous.

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A Tragic Crash
Then, on March 25, in Washington State, Kishline ran her pickup truck head-on into another vehicle, killing a 38-year-old man and his daughter. Kishline, 43, was so drunk her blood-alcohol level was more than three times the legal limit. Now in an Oregon treatment program, she has declined all requests for interviews. Her attorney, John Crowley, however, released a statement she made in court last month: "I pray that my story can touch at least one other alcoholic," it read in part. "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."

Proponents on both sides of the alcoholic- therapy debate point to the other's failure to help her. "My heart goes out to Ms. Kishline, but I hope it's the thing that gets attention," said the National Council's Murphy. "How many more body bags do we want?" Countered Dr. Brian Kern, a California-based psychologist and moderation-management board member: "Is it really that moderation management failed her or is it abstinence that failed?" The warring factions use the debate as a rallying point. Murphy says the combination of Kishline's accident and the clinic's embrace of abstinence will become "an organizing principle for the recovery community." Kern maintains that the public forum will educate people about moderation management. "There is a misperception of what moderation management is about," he said. "It's designed for the early-stage alcohol-dependent person, not a program for alcoholics." The American Society of Addiction Medicine endorses AA's view of alcoholism as a "chronic, progressive and frequently fatal" disease and its abstinence-only approach.

Moderation management is neither the first nor only alternative to challenge that idea. Those who attend weekly moderation-management meetings are offered a whatever-works- for-you approach and told they can choose either moderation or abstinence. "We do find that people who go to 12-step meetings do better," DeLuca told New York magazine. "But it doesn't work for some, and I'm not going to tell them, 'Come back after you have suffered some more and are ready to do it our way.'"

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The End for DeLuca
Soon after the magazine hit the newsstands, "He had his head handed to him," Kern said. "He just walked in the door and was told he was leaving. Now." Smithers-Fornaci's letter-writing campaign, Kern said, reportedly spurred some National Council members to threaten to withhold referrals of the rich and famous. The Long Island Council on Alcoholism & Drug Dependence wrote DeLuca that it intended to "continue to refer its clients to facilities offering them the best chance of lasting recovery upon discharge. That philosophy was established 65 years ago last month in Akron, Ohio" a reference to AA's 1935 founding. DeLuca will not talk to the media. Hospital spokeswoman Carol Bohdan declined to comment, saying only, "We really can't say anything more about this whole thing."

A Tale of Two Therapies
In Moderation Management: Members use a nine-step program to limit alcohol consumption. Meetings are anonymous. Members set moderate drinking limits for women, three or fewer drinks per day, nine or fewer per week; for men, no more than four a day, 14 a week. Also: Do not drink every day. There are no religious or spiritual elements. Members reduce and take control of their drinking. Members may choose moderation or abstinence. In Alcoholics Anonymous: Members use a 12-step program to quit drinking alcohol entirely. Meetings are anonymous. Members adhere to total abstinence from alcohol. Members acknowledge an affiliation with a "God of one's understanding," a "higher power." Members acknowledge that they are alcoholics and "powerless over alcohol." No drinking whatsoever is permitted.

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

Alexander DeLuca, M.D.

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Originally posted:  3/21/2001

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