What You Can Change _. And What You Can't - Martin E. Seligman [163]
The first apparent exception was Antabuse (disulfiram). For the best studies of Antabuse (double blind, placebo controlled) see J. Johnsen, A. Stowell, J. Bache-Wing, et al., “A Double-Blind Placebo Controlled Study of Male Alcoholics Given a Subcutaneous Disulfiram Implantation,” British Journal of Addiction 82 (1987): 607–13; and J. Johnsen and J. Morland, “Disulfiram Implant: A Double-Blind Placebo Controlled Follow-up on Treatment Outcome,” Alcoholism: Clinical and Experimental Research 15 (1991): 532–38.
The second apparent exception was lithium: In the first well-done study, a 67 percent abstinence rate after one year in a controlled, random-assignment design was found. See J. Fawcett, D. Clark, C. Aagesen, et al., “A Double-Blind Placebo-Controlled Trial of Lithium Carbonate Therapy for Alcoholism,” Archives of General Psychiatry 44 (1987): 248–56. These results were promising, and were thought to be independent of lithium’s effect on manic-depression, until a major replication was undertaken: A double-blind study of 457 male alcoholics, both depressed and not depressed, showed no effect of lithium on alcohol drinking. See W. Dorus, D. Ostrow, R. Anton, et al., “Lithium Treatment of Depressed and Nondepressed Alcoholics,” Journal of the American Medical Association 262 (1989): 1646–52.
23. The aversion treatments make up a large literature. The best recent reviews are found in the debate between Terry Wilson and Ralph Elkins. See G. T. Wilson, “Chemical Aversion Conditioning as a Treatment for Alcoholism: A Reanalysis,” Behaviour Research and Therapy 25 (1987): 503–16; R. Elkins, “An Appraisal of Chemical Aversion (Emetic Therapy) Approaches to Alcoholism Treatment,” Behaviour Research and Therapy 29 (1991): 387–413; G. T. Wilson, “Chemical Aversion Conditioning in the Treatment of Alcoholism: Further Comments,” Behaviour Research and Therapy 29 (1991): 415–19. The lone controlled study is D. Cannon, T. Baker, and C. Wehl, “Emetic and Electric Shock Alcohol Aversion Therapy: Six-and Twelve-Month Follow-up,” Journal of Consulting and Clinical Psychology 49 (1981): 360–68.
I have to remark, again, that it is little short of a scandal that the therapies for alcoholism that patients have had for decades—inpatient hospitalization, aversion, and AA—do not have large-scale, random-assignment, controlled studies to document their alleged effectiveness. This is particularly scandalous when there is so much precedent showing that in this area, controlled studies usually suggest that treatment does not improve on the natural recovery rate.
24. J. Volpicelli, A. Alterman, M. Hayashida, and C. O’Brien, “Naltrexone in the Treatment of Alcohol Dependence,” Archives of General Psychiatry 49 (1992): 876–80; S. O’Malley, A. Jaffee, G. Chang, et al., “Naltrexone and Coping Skills Therapy for Alcohol Dependence,” Archives of General Psychiatry 49 (1992): 881–87.
25. Here are the three most useful sets of references as to whether AA works.
First, two studies in addition to Vaillant’s that show better prognosis for people who attend more AA meetings: M. O’Leary, D. Coastline, D. Haddock, et al., “Differential Alcohol Use Patterns and Personality Traits Among Three Alcoholics Anonymous Attendance Level Groups: Further Considerations of the Affiliation Profile,” Drug and Alcohol Dependence 5 (1980): 135–44; V. Giannetti, “Alcoholics Anonymous and the Recovering Alcoholic: An Exploratory Study,” American Journal of Drug and Alcohol Abuse 8 (1981): 363–70.
Second, the only studies that actually use a randomized assignment to treatment: One (K. Ditman, G. Crawford, C. Forgy, et al., “A Controlled Experiment on the Use of Court Probation for Drunk Arrests,” American Journal of Psychiatry 124 [1967]: 160–63) shows no difference among AA, clinic attendance, and no treatment; another (J. Brandsma, M. Maultsby, and R. Welsh, Out-Patient Treatment of Alcoholism [Baltimore, Md.: University Park Press, 1980]) shows that AA does worse (more dropouts) than insight therapy, behavior therapy, or paraprofessional behavior therapy. Both these