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."

“A thoroughly superior book and a powerful contribution to the literature on alcoholism.” —Frank A. Seixas, M.D., former Medical Director, National Council on Alcoholism

Alcoholism is a disorder of enormous scope and destructive power that affects a third of all American families. Yet, despite extensive re-search, there are few uncontested answers to fundamental questions about this devastating disorder: Is alcoholism a true disease, or just a problem with living? Does its cause lie in the genes or the environment? Are some person-alities especially vulnerable? And what about treatment—does it demand abstinence, or can alcoholics safely return to social drinking?  Based on an evaluation of more than 600 individuals followed for over 40 years, George Vaillant’s monumental study offers new and authoritative answers to all of these questions. Beginning his observations before the onset of the disorder, Vaillant is able to determine whether particular family backgrounds, personality types, or genetic traits predispose a person to abuse of alcohol. He charts the prog-ress of alcoholism and the paths toward absti-nence, toward return to normal drinking, or, in some cases, toward premature death. His longitudinal vantage point also permits important inferences about successful therapy, showing that treatment may be most effective when it reinforces the natural healing process and enables it to take place. His findings on the efficacy of various treatment methods, in-cluding Alcoholics Anonymous, wifi prove in-valuable to physicians, social scientists, and alcoholics and their families. “A highly significant event in the evolution of our understanding of alcoholism.” —John A. Ewing, M.D., University of North Carolina School of Medicine

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."

"The Natural History of Alcoholism Revisited" 
George E. Vaillant pp 265-267

"For the last ten years, the life of this now 72 year-old member of
the College Sample has been manageable but not without alcohol related
difficulties.  After three years of abstinence, he drifted away from
AA.  After another year, he wrote, "I occasionally drink a little each
day for months before overdoing it and going back to AA.":  A month
after that writing he became abstinent again for two years.  At 67 he
again tried social drinking.  In a few months he again lost control of
alcohol and has reported stable abstinence up to 1992.

Despite the College man's less than perfect outcome, research during
the last 15 years has revealed growing indirect evidence that AA is an
effective treatment for alcohol abuse.  Direct evidence for the
efficacy of AA, however, remains elusive as ever.  One difficulty is
that the subject of AA, like the subject of controlled drinking and
the subject of whether alcoholism is a disease evokes adversarial
argument rather than dispassionate reflection.  For example, William
Miller, an advocate of professional intervention suggests that the
evidence is clear that AA is ineffective.  However, in an otherwise
very scholarly review,  he cites only four articles pertaining to AA.
In contrast, in a more even-handed review of the efficacy of AA,
Emrick (1989) was able to cite 56 studies that evaluated AA; 15 of
these demonstrated that AA was superior to alternative treatments...

In a balanced review, Nace (1992) has examined some of the facets of
AA that attract criticism.  First, because of its perhaps necessarily
ideological nature, AA members are not encouraged to take a scientific
and dispassionate approach to the study of its efficacy.  The
prevalence in AA of paraprofessional counsels and program
administrators who are also recovering alcoholics further confounds
dispassionate research.  Personally based loyalty to the ideology of
AA often comes into potential conflict with the empiricism of the
research community.  Second, although AA as an organization does not
hold opinions, individual members, like members of any partisan group,
can be extremely and erroneously opinionated.  Third, AA certainly
functions as a cult and systematically indoctrinates its members in
ways common to cults the world over.  The negative side effects of AA,
however, are perhaps more benign than those of any other cult with
which I am familiar.  For example, in contrast to other relatively
benign cults like fraternities, psychoanalytic institutes,
fundamentalist Christian sects, disarmament groups, political parties,
and even the Oxford Group on which AA was modeled, AA has avoided
schisms.  Nevertheless, in the absence of proven scientific efficacy,
critics are legitimate in suggesting that mandated AA attendance may
be criticized as a failure of proper separation between church and
state.  In response, AA as an organization has tried to redress this
difficulty by emphasizing the importance to its membership of 'wearing
two hats' when becoming involved in the alcohol treatment field.

On the positive side, Nace has clarified the ways in which AA captures
the effective ingredients of most successful psychotherapies and most
major religions.  He underscores that AA allows the individual
*release* (freedom from the compulsion to drink), *gratitude* (a
pigeon comes along just in time to keep his sponsor sober) *humility*
(a shift from self-centeredness to self acceptance), *tolerance* (live
and let live), and finally, most important, forgiveness for past sins.
Nace summarizes:

"The alcoholic who comes to AA is not asked to change, only listen,
identify and keep coming back.  The style of interpersonal contact is
non threatening...humor and friendliness abound.  Nevertheless the
meeting is serious...relapses or "slips" do not represent a failure on
the part of the alcoholic or AA.  Rather, slips are further
demonstration of the power of alcohol and, therefore of the necessity
of AA as a counter-force...  The AA program treats shame by enabling
the alcoholic to accept his or her need for others by promoting the
acceptance of others as they are...and by valuing and reinforcing
traits of honesty, sharing, and caring." (p 492)
 

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\

Agent Orange Analyses and Dissects Valliant

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 (George E. 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, March 13, 1996, p. A12).

The study's author, George E. 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 40 percent 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."

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