Letters

From the August/September 2002 issue

(Page 2 of 5)

I loved booze from the first sip. My boss, on the other hand, has two drinks and starts to feel queasy or sleepy. A drinker he ain't. Since alcoholism runs in my family, and not his, I have every reason to believe those studies that show a genetic link at the root of some, if not most, alcoholism.

This suggests a chemical cause and justifies the search for a pharmacological solution, the "magical elixir" that Peele disparages. Maybe naltrexone doesn't work for alcoholics, and certainly methadone is a poor substitute for heroin, but the effort is scientifically justified.

Peele argues that psychotherapy, in particular an approach he calls "motivational enhancement," does as much good as attempts to induce total abstinence. While this may be true, before I believe moderation is an effective treatment for alcoholics, I will have to see studies that have multiyear follow ups and studies where the results are not dependent on the responses of the subjects being studied. After all, what sort of answer can you expect from the "Are you still beating your wife?" type of question?

I will tell you one thing about abstinence: It works. I haven't had booze for over 13 years, cigarettes for over 10. It's hard to implement but easy to maintain. Moderation, on the other hand, is easy to implement but hard to maintain. Let me give you an example: We all know people who have quit smoking, but how many people do you know who have gone from two packs of cigarettes a day to half a pack -- and kept it there? Or from a pack a day to just two or three cigarettes a day? Nice in theory, but almost impossible in practice.

If Peele is advocating moderation therapy as better than nothing, no one would disagree. But I don't think that's what he's preaching. He's preaching that abstinence is too tough, so don't even try it. Instead, put yourself in the hands of your friendly, trained psychologist. This might work for alcohol abusers, but not for the addicts, where loss of control is a given. "One is too many, a thousand not enough" is all too true.

Peter V. Burrows
Waupaca, WI

I could not possibly correct all of the selective uses of facts and misinterpretations in Stanton Peele's article without writing an article possibly longer than his, but here are some examples.

Peele completely ignores all of the rather extensive evidence for a genetic basis for addiction, especially alcoholism. He freely commingles facts related to drug dependence and abuse with addiction. They are three different conditions.

Peele severely distorts the views of Drs. Leshner and Gordis by saying that they believe that addiction should be treated primarily with drugs. This level of nonsense can only be due to willful lying or pathological ignorance. The idea of treating addiction with medicines is an area of research, but it is nowhere near a reality. When it does become a reality, it is not expected to obviate the need for treatment.

Peele completely ignores the fact that recommended treatment includes four of the five ingredients that he mentions: identifying the problem, getting the addict to believe that change is possible, making the addict responsible for carrying out changes necessary for his recovery, and letting addicts know that they have many people to support them on their path to recovery.

Peele is wrong that reducing substance use -- as opposed to abstinence -- is a viable treatment. Studies have shown that 2 percent or less of addicts can ever again use their addictive drug normally. Encouraging an alcoholic to drink is like giving someone who has an allergy to penicillin a week's worth of the drug and saying, "Here, take this, but just don't get a rash or stop breathing."

Finally, Peele confuses harm reduction with the real goal of treatment, which is to teach addicts how to have a good life. Those of us in the field of addiction medicine want the best for our patients, not just a little less misery.

James T. Hamilton, M.D., J.D., FAAFP
Newport Beach, CA

Green With Ideology

I am very disappointed by the content and slant of arguments presented in Ronald Bailey's "Green With Ideology" (May). While there may be a smear campaign against Lomborg, he should have expected it: His stance required him to find the right numbers and the perfect quotes, and to manipulate data to reach his predetermined conclusion. Many scientific experts have come to conclusions about the environment that are opposite Lomborg's.