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studies use court-referred involuntary subjects. They strongly suggest that AA is not useful for such subjects, on average, but they do not bear directly on the effectiveness of AA with voluntary subjects. A third randomized-assignment study, Walsh et al., “A Randomized Trial of Treatment Options,” assigned alcoholic workers to AA or to hospital-based detoxification (but with a strong AA component) and found that those assigned to AA alone did most poorly.

Third, some studies that look at AA effectiveness with voluntary attenders, but with substandard methods: D. Smith, “Evaluation of a Residential AA Program,” International Journal of the Addictions 21 (1986): 33–49; AA World Services, “Analysis of the 1980 Survey of the Membership of AA” (unpublished report, New York, 1981); G. Alford, “Alcoholics Anonymous: An Empirical Outcome Study,” Addictive Behaviors 5 (1981): 359–70.

This literature is usefully reviewed by B. McCrady and S. Irvine, “Self-Help Groups,” in R. Hester and W. Miller, eds., Handbook of Alcoholism Treatment Approaches (New York: Pergamon, 1989).

26. When data first came to light that some alcoholics could recover and still tipple, AA attacked in full force. For the beginnings of the scientific debate, see M. Sobell and L. Sobell, “Second Year Treatment Outcome of Alcoholics Treated by Individualized Behaviour Therapy,” Behaviour Research and Therapy 14 (1976): 195–215, versus M. Pendery, I. Maltzman, and L. West, “Controlled Drinking by Alcoholics? New Findings and a Re-evaluation of a Major Affirmative Study,” Science 217 (1982): 169–75. “Alcoholics could die because of this,” AA spokesmen were quoted as saying. That at least a few alcoholics recover through controlled drinking is now widely accepted. G. Nordstrom and M. Berglund, “A Prospective Study of Successful Long-term Adjustment in Alcohol Dependence: Social Drinking Versus Abstinence,” Journal of Studies on Alcohol 48 (1987): 95–103; J. Orford and A. Keddie, “Abstinence or Controlled Drinking in Clinical Practice: A Test of the Dependence and Persuasion Hypothesis,” British Journal of Addiction 81 (1986): 495–504; G. Edwards, A. Duckitt, E. Oppenheimer, et al., “What Happens to Alcoholics?” Lancet (30 July 1983), 269–71.

For the data that less-severe alcoholics recover through controlled drinking and that more-severe alcoholics recover through abstinence, see Vaillant, The Natural History of Alcoholism, 221–35.

27. M. Sobell and L. Sobell, Individualized Behavior Therapy for Alcoholics: Rationale, Procedures, Preliminary Results, and Appendix (California Mental Health Research Monograph no. 13) (California Department of Mental Hygiene, 1972); Pendery et al., “Controlled Drinking by Alcoholics?” See especially H. Fingarette’s lucid discussion on pages 124–29 of Heavy Drinking, and the references in note 26, above.

28. See chapter 2, “Can Alcoholics Control Their Drinking?” of H. Fingarette’s lucid little book Heavy Drinking; and A. Marlatt, “The Controlled Drinking Controversy,” American Psychologist 38 (1983): 1097–1110.

29. S. Curry, G. A. Marlatt, and J. Gordon, “Abstinence Violation Effect: Validation of an Attributional Construct with Smoking Cessation,” Journal of Consulting and Clinical Psychology 58 (1987): 145–49; and G. A. Marlatt and S. Tapert, “Harm Reduction: Reducing the Risk of Addictive Behaviors,” in J. Baer, G. A. Marlatt, and R. McMahon, eds., Addictive Behaviors Across the Lifespan: Prevention, Treatment and Policy Issues (Newbury Park, Calif.: Sage, 1993), 243–73.

30. See chapter 5, “Heavy Drinking as a Way of Life,” in Fingarette, Heavy Drinking.

31. See chapter 7, “Social Policies to Prevent and Control Heavy Drinking,” in Fingarette, Heavy Drinking.

PART FOUR epigraph

1. In J. S. Grant, ed., The Enthusiasms of Robertson Davies (New York: Penguin, 1990), 235–36.

CHAPTER 14 Shedding the Skins of Childhood

1. P. Davis, The Way I See It (New York: Putnam, 1992), 33–42.

2. Adapted from John Bradshaw’s immensely popular Homecoming: Reclaiming and Championing Your Inner Child (New York: Bantam, 1990), 227,