THE NATURAL HISTORY OF ALCOHOLISM By George E. Vaillant

Causes, Patterns And Paths To Recovery Based On 45 Years Of Studies

First Edition later printing, Copyright 1983

Harvard University Press Publishing, Cambridge, Massachusetts

George E. Vaillant, M.D., joined AA's General Service Board as a Class A (nonalcoholic) trustee in 1998. He is professor of psychiatry, Harvard Medical School, director of the Study of Adult Development, Harvard University Health Services, and director of research in the Division of Psychiatry, Brigham and Women's Hospital. The author of The Natural History of Alcoholism Revisited, a comprehensive study of alcoholism, George lectures widely on alcoholism and addiction and is one of the foremost researchers in the field.

Alcoholism is a disorder of great destructive power. The damage it causes falls not only on the alcoholics themselves but on their families and friends as well.

To me, alcoholism became a fascinating disease. It seemed perfectly clear that ... by turning to recovering alcoholics [A.A. members] rather than to Ph.D.'s for lessons in breaking self-detrimental and more or less involuntary habits, and by inexorably moving patients from dependence upon the general hospital into the treatment system of A.A., I was working for the most exciting alcohol program in the world.
But then came the rub. Fueled by our enthusiasm, I and the director, William Clark, tried to prove our efficacy. ...
... After initial discharge, only five patients in the Clinic sample never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment were no better than the natural history of the disease. ...
Not only had we failed to alter the natural history of alcoholism, but our death rate of three percent a year was appalling.
The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 283-285.

Interview: A Doctor Speaks-
Valliant in the AA Grapvevine

The Natural History of Alcoholism Revisited May 1995
George Vaillant

A follow-up to Vaillant's (psychiatry, Harvard Medical School) 1983 classic in which he returns to such questions as whether alcoholism is a symptom or a disease and whether it is progressive with the perspective gained from 15 years of further study

The Natural History of Alcoholism Revisited is a revised and updated version of [what] was, and still is, regarded as a classic and certainly broke new ground during the 1980s...The new text provides an update based on developments over the past 15 years; and its importance again derives from the fact that almost all the alcohol abusers identified in the first version have been followed up for an additional 15 years to make 50 years in all. It goes without saying that 50-year follow-up studies are few and far between...Vaillant's 50-year follow-up now stands as a milestone within the addiction literature...It is required reading...The data are beautifully presented and described and the conclusions eminently reasonable.

George E. Vaillant is/was Professor of Psychiatry, Dartmouth Medical
School and Director of the Study of Adult Development, Harvard
University Medical Services. He first wrote about a 45 year
(beginning in the late 1930;s) longitudinal study (not a slice in time
looking retrospectively, but a continuation study starting with three
groups of people before any developed alcoholism)) and published his
findings in a book entitled, The Natural History of Alcoholism. He
later wrote a follow up to that book. Here is one excerpt from his
book.

What we learn about the etiology of alcoholism must affect our
treatment. We must stop tying to treat alcoholism as if it were
merely a symptom of underlying distress. We must learn to mistrust
recent retrospective studies like Tyndel's which after reviewing the
charts of 1000 patients admitted to the medical unit of Toronto's
Addiction Research Foundation decreed that 100% of alcoholic patients
in an uncommonly large series of investigated cases lead to the
conclusion that the development of the disease process of alcoholism
is inconceivable without underlying psychopathology. Instead we must
learn to heed an old Japanese proverb: First the man takes a drink,
then the drink takes a drink, then the drink takes the man.

We must spot the fallacious etiological implication in Kissen's
otherwise correct statement: 'It is a truism that most alcoholics
cannot cope. They cannot deal with the normal frustrations and
irritations of the external world.' They were not always so helpless.
When, after analyzing the MMPI of alcoholics Hampton wrote: 'The more
maladjusted the individual is on the average, the more need he seems
to show for alcohol as a crutch.' He was 180 degrees off course. A
more accurate statement of the data and Kissen's generalizations might
be: 'The more an individual abuses alcohol, the more maladjusted and
crippled he will appear.'

pp. 105

pp: 193, The Natural History of Alcoholism

In the treatment of alcoholism, Karl Marx's aphorism, 'religion is
the opiate of the masses' masks an enormously important therapeutic
principle. religion may actually provide a relief that drug abuse
only promises. ...a third major source of help in changing
involuntary habits comes from increased religious involvement. Only
recently have investigators begun to tease out the nature of this
principle. Let me explain what I suspect is involved. First,
alcoholics and victims of other seemingly incurable habits feel
defeated, bad, and helpless. They invariably suffer from impaired
morale. If they are to recover, powerful new sources of self-esteem
and hope must be discovered. Religion is one such source. Religion
provides fresh impetus for both hope and enhanced self-care. Second,
if the established alcoholic is to become stably abstinent, enormous
personality changes must take place. It is not coincidence that we
associate such dramatic change with the experience of religious
conversions.

Third, religion in ways, that we appreciate but do not understand
provides forgiveness of sins and relief from guilt. Unlike many
intractable habits that others find merely annoying, alcoholism
inflicts enormous pain and injury on those around the alcoholic. As a
result, the alcoholic, already demoralized by his inability to stop
drinking, experiences almost insurmountable guilt from the torture he
has inflicted on others. In such an instance, absolution becomes an
important part of the healing process.

pp. 194. It is a paradox that a major goal of AA--a strictly moral
and religious system--has been to view alcohol abuse as a medical
illness, not a moral failing.

Disease or Defense? click here to view
Review of the Natural History of Alcoholism,
by George E. Vaillant

Review by Stanton Peele

Foreword (1996) - Stanton's review of George Vaillant's The Natural History of Alcoholism revealed that the emperor was naked, and that the book was intellectually dishonest. Vaillant systematically created summaries that disputed his own data, while citing cases selectively to try to support what he perceived to be the safe positions to take. As a result of Stanton's review, Dr. Vaillant has for over a dozen years systematically attacked Stanton in speeches and workshops he gives around the nation, trying to square the circle by compulsively reinterpreting his (Vaillant's) data to show that alcoholics never resume controlled drinking.

New York Times Book Review, June 26, 1983, p. 10

http://www.harvard-magazine.com/issues/ja96/right.alcohol.html

Finally, previous Zinberg award-winner George Vaillant's most prominent work was his 1983 book, The Natural History of Alcoholism, which offered the following dismal results of Vaillant's assessment of his hospital and AA-based treatment for alcoholism:

It seemed perfectly clear that ... by disregarding motivation, by turning to recovering alcoholics rather than to Ph.D.'s for lessons..., and by inexorably moving patients from dependence upon the general hospital into the treatment system of AA, I was working for the most exciting alcohol program in the world.... [Trying to prove our efficacy, Vaillant instead found:] After initial discharge, only 5 patients in the clinic sample [out of 100] never relapsed to alcoholic drinking, and there is compelling evidence that the results of our treatment [after eight years] were no better than the natural [untreated] history of the disease. (pp. 283-284)

In other words, alcoholics were as likely to overcome alcoholism on their own as through undergoing Vaillant's program.

A study published in the March issue of the American Medical Association's Archives of General Psychiatry suggests that a five-year period of abstinence from alcohol is necessary to place recovering alcoholics out of danger of relapse (GeorgeE. Vaillant, MD, A Long-Term Follow-up of Male Alcohol Abuse, Archives of General Psychiatry, March 1996, p.243-249; Brenda Coleman, Five Years Without a Drink, Washington Post, March13, 1996, p.A12).

The study's author, GeorgeE. Vaillant of Harvard Medical School and Brigham and Women's Hospital in Boston, likened recovery from alcoholism to recovery from cancer: an individual needs a set period of freedom from the disease to be considered cured.

The study followed 724 men over a fifty-year period, and selected subjects from both privileged college campuses and low-income inner-city neighborhoods. Individuals in both groups who developed problems with alcohol were tracked from age 40 to age 60 or 70.

Of the college graduates with alcohol problems, 18% had died by age 60, 11.5% were abstinent from alcohol, and 59% were still abusing alcohol. Of the inner city group, 29% had died, 32% were abstinent, 11% were controlled drinkers, and 28% were still abusing alcohol. The discrepancies between the death rates of the two groups was accounted for by the poor nutritional habits of the city group. The differences in rates of continued abuse were attributed to the college groups' higher socioeconomic status, which may have supported or excused their alcoholism. Disadvantaged alcohol abusers were found to be more likely to become sober because their situation required it.

Among both groups of subjects, relapse occurred 40percent of the time after two years of sobriety, but was rare after five years without a drink.

The Talent for Aging Well:
The Vaillant Path

from http://www.harvard-magazine.com

In a way, the man who has headed the Grant Study for more than 30 years--and in that sense, is the world's leading authority on Harvard men--seems almost born for the role. George E. Vaillant '55, M.D. '59, is a big, handsome, humorous psychiatrist who appears to be at least a decade younger than his 66 years. His father, archaeologist George C. Vaillant '22, Ph.D. '27, died two years before his twenty-fifth reunion; when the 1922 class report arrived in the mail, his 10-year-old son perused it, fascinated--perhaps the moment when a twig was bent.

Vaillant as a college senior in 1955 (left) and in midlife, 20 years later.
Harvard Class of 1955 Yearbook (left), Diane Gilbert/Little, Brown

Born in Manhattan, Vaillant attended Phillips Exeter Academy, earned two Harvard degrees, and, right after college, married Radcliffe classmate Anne Bradley. This marriage lasted 15 years and was followed by divorce and marriage 30 years ago to his present wife, Caroline (Brown) Vaillant, an Australian. In addition to Vaillant's four children by his first marriage, the couple have a daughter of their own, Joanna.

Vaillant is a colorful character who hardly fits the buttoned-down WASP stereotype one might expect from his résumé. He admits to living in rumpled clothes as well as being a dreadful dancer and terrible athlete. I know little of modern life, he confides, recalling that he once turned down a television appearance on the Phil Donahue Show because he had never heard of its host. In politics, Vaillant declares, For 25 years I have loved Jimmy Carter, and still think Gorbachev deserved to be 'man of the century.'

Long ago, Vaillant decided that he preferred greenery to asphalt; today he and his wife live on 140 acres of Vermont woodland where he spends long weekends clearing brush and trails and cutting meadows. I'd like to be a gentleman farmer, he says. He plays tennis with his wife and daughter, but Vaillant takes a dim view of jogging. Even so, the doctor's health habits are generally sound, and Vaillant can boast of HDL to die for.

On Mondays he drives south to Boston in his five-year-old Volvo; Vaillant keeps a pied-à-terre in Cambridge and an o(infinity)ce at Brigham and Women's Hospital. As a researcher, he describes himself as an oppositional character. What I love is long-term follow-up and proving other people wrong. Trained as a psychoanalyst, he still maintains a clinical practice (clients are mainly physicians), though he has not psychoanalyzed anyone on the couch in 30 years. An impressive body of research on alcohol abuse, including the monumental 1983 book The Natural History of Alcoholism, has earned him the status of a Class A trustee for Alcoholics Anonymous. (The A is for amateur, since Vaillant himself has never been other than a moderate drinker.)

Play has always come easily. In college, he joined the Lampoon rather than the Crimson, where people seemed to be working too hard in their free time. His father directed museums, and Vaillant himself enjoys museums of all kinds; he also admits that, left to my own devices, I would have a fork in one hand and a Michelin guide in the other. Once or twice a year, he and his wife go abroad at someone else's expense.

Each winter, the Vaillants escape to southern Australia for three months, a time for writing and enjoying the house near the beach where they expect to retire. His own retirement plans? Stay with the Grant Study, play, create, enjoy my children and grandchildren, sow and re-sow the seeds of love, he says. You've got to learn to garden as you get older. My garden is the Grant Study.