This post provides some excerpts from an “Addiction Lives” interview with Paul Roman, a researcher in the alcohol and addictions field for 55 years, who talks about the early years of the NIAAA. You can read the full interview here.
The “Addiction Lives” interview project is a print and online collaboration between the Society for the Study of Addiction and the journal Addiction. The series explores the views and personal experiences of people who have contributed to the evolution of ideas in the Addiction journal’s field of interest.
“Addiction Lives” is edited by Professor Virginia Berridge and this interview was conducted by Points co-founder Trysh Travis in August 2021.
PR: On one occasion which I remember, maybe in 1973, a very large amount of money that had been earmarked for NIAAA but “impounded” by the Nixon Administration was suddenly released and NIAAA had a tiny window in which to allocate millions of dollars. So they brought together ad hoc review committees to go through the accumulated grant applications and recommend what could be funded. Time was so short that this had to be done over weekends when Federal buildings were closed and the committees held at least some of their meetings in the homes of NIAAA staff. I remember a living room floor covered with grant applications – oh I tell you the money got spent. […] Harry Trice and I each started to work on research proposal ideas and at the same time Harry and I started in 1971 pulling together a book about everything that was known about occupational alcoholism and industrial alcoholism and we managed to get that into print in 1972. I guess this partially fits the mold of the way science is supposed to work. It’s called ‘Spirits and Demons at Work: Alcohol and Other Drugs on the Job’ which turned out over time to be one of the best sellers of a division of the Cornell University Press called the ILR Press. It really was needed since it was clear that NIAAA was trying to invent a new field of practice but there was no textbook.
PR: NIAAA put a lot of early emphasis on workplace programming. It ended up developing a model approach called “broad brush” which I think was designed in large part to make its efforts different from what had happened in the past. This model casts a broad net to provide help to a wide range of problem employees and in the process is supposed to identify employees with alcohol problems. This worked for awhile but today there is almost no attention to employee alcohol problems in the descendants of the NIAAA broad brush programs which have been known for a long time as employee assistance programs (EAPs).
PR: The addiction field does not have a national voluntary organisation involving lay people to combat either alcohol or drug dependence disorders. Nearly every other “disease”in America has one. Look at the size and the potency of the American Heart Association, the American Cancer Society, Autism Speaks, and on and on. Psychiatric disorder is represented by the weirdly name National Association of Mental Illness, a supposedly powerful organization with deep pockets that are kept filled by Big Pharma. And in the midst of these thriving corporate giants, the slightly re-named descendant of the NCA, the National Council on Alcoholism and Drug Dependence, is dead and gone. It does not exist as a national level. Many of the local “councils” that the NCA established are still in existence, but you’d have to visit each one to find what is going on.
PR: Marty Mann (whose NCA title then was I believe Founder and Consultant) was on the first NIAAA Advisory Council. What Marty [Mann] was really shooting at, it seemed, were controlled drinking studies that explored whether alcoholics could be taught to become normal drinkers. This is another huge chapter in the history of NIAAA, one that they would surely like to forget. They had, in 1976, received from Dave Armor who was a sociologist affiliated with Harvard an NIAAA-funded report. It showed from NIAAA treatment center evaluation data that substantial numbers of persons who were alcoholics in treatment at Time 1(a significant minority that could not be ignored) had resumed drinking in what was called a controlled manner at Time 2, maybe 18 months later. In a moment of apparent insanity, NIAAA released this report without thinking and that led to immediate uproar with Marty Mann and NCA leading the pack. To me this was a signal moment defining that NIAAA and NCA could not be a partnership.
PR: So this was the essence of the Employee Assistance Programme, with an emphasis on alcohol. From 1973 this broad brush model was the watch word for the occupational programmes grants of the NIAAA. They essentially said that their funds will support programmes that identified and assisted people with all sorts of personal problems, because they knew that they’re a mechanism which will identify employees with alcohol problems. The emphasis by NIAAA was to make sure programme managers and programme coordinators as they were often called had been trained in a way that they could identify alcohol problems and guide their proper treatment but also were skilled in identifying other kinds of problems, so that people got referred to the right kind of community service.
PR: So the workplace programming model that had been promoted by NIAAA and widely adopted was being undermined by the withdrawal of NIAAA support for the alcohol emphasis within the broad-brush approach, by the squelching of research to back up this strategy, and by double-barrelled stigma from the merger of alcohol and drug treatment and the War on Drugs. If things could not be worse, we also have the managed care arriving on the scene, and it zeroes in on alcoholism treatment.
PR: So where are the “breakthroughs?” Our “new” icons of naltrexone, buprenorphine and naloxone were around in the early 1970s but it took 40 years to connect the dots. Rates of substance use disorders show no decline in any quarter, and of course many new patterns of misuse have blossomed and become embedded before action steps began. The American opioid epidemic has essentially become part of the institutional landscape.
PR: Lots of people use psychoactive substances without creating trouble for themselves and others, but this has been true since the beginning of recorded history. And despite massive growth, stigma abounds and flourishes for those whose substance use disrupts social order, for those with such problems with seek help, for those who try to help them, and for those who study those who try to help them. Despite fanfare and trumpet-blowing reminiscent of the presentation of the Emperor’s New Clothes, the acceptance and integration of this specialty into the overall health care complex is largely a delusion.