Ndjour sup

25th Anniversary Supplement
April 2001
Published by the
NEW DIRECTIONS IN THE STUDY OF ALCOHOL GROUP
Designed and produced by Sheila Raby at Aquarius E•T•C New Directions in the Study of Alcohol
Editor: Robin Davidson
Assistant Editors: Sheila Raby & Marilyn Christie
The New Directions in the Study of Alcohol group is a multi-disciplinary forumestablished in the mid-seventies for people interested in swapping ideas on allaspects of alcohol use and problem drinking. It organises an annual conferenceand produces an annual publication: the journal. Members are encouraged tocontribute to this journal! The content of contributions can be wide-rangingand could include for example early research findings, short case discussions,practical problems relating to treatment, prevention and training, news of localinitiatives, letters, book reviews as well as conference papers. In short, any-thing which may be of interest to members and others in the field. As ever thesuccess of the booklet depends on continuing support from members.
SUBMISSIONS to the journal should be sent to the Editor:
Dr Robin Davidson, Northern Ireland Centre for Clinical Oncology,
Belvoir Park Hospital, Hospital Road, Belfast, Northern Ireland BT8 8JR.
Submissions will not be subject to any formal review system although theeditors or the committee reserve the right to exclude or edit contributions. Thegroup does not put any limitations on the personal freedom of authors to usematerial contained in their contributions in any other works.
Submissions should be on PC format disk in any common word-processed
application, with a hard copy (double-spaced) on A4 paper. Where references
are included they should preferably follow the Harvard system: author’s name
and date in the text; references in full at the end of the paper, listed in alpha-
betical order. All graphs and diagrams should be clear and appropriately
headed, and preferably provided separate to the text.
Non-members can obtain information on joining the Group and can purchase
copies of the journal by writing to the Editor at the above address.
Editor’s Note to this Supplement
The 2001 meeting in Dumfries is the 25th anniversary of the NewDirections in the Study of Alcohol Group. In order to mark thisimportant date we have published Doug Cameron’s personalrecollections of the group as a special supplement to the journal.
It was originally a review of the group’s first 15 years when wepublished it in Vol. 18, 1992, and Doug has kindly updated andre-edited it for this supplement.
The article charts the evolution of thinking in the New Directionsgroup. As well as being of historical interest, it is also a crackinggood read, written in Doug’s typical laconic, easy, literate style.
Twenty-five years on it is quite appropriate that the roadshow wecall New Directions has returned to its Scottish birthplace.
Robin Davidson
Northern Ireland Centre for Clinical Oncology, Belfast
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 MINSTRELS OF THE DAWN II
Still singing after all these years!
PERSONAL RECOLLECTIONS OF 25 YEARS OF THE
NEW DIRECTIONS IN THE STUDY OF ALCOHOL GROUP
Douglas Cameron
University of Leicester
This is an update of an article presented as an opening address at the NewDirections in the Study of Alcohol Group annual conference in Llandudno in1991. It remains just a story: the story of the group as I have seen it. People frequently ask me about the group and its roots. I wanted to see if Icould disentangle some of the threads of the fabric of the organisationbecause it has been notable how recurring some of the themes are. In someways I am the right person to try and track the history of this group, in otherways I am completely wrong. I am right because I am unique, being now the only person who has attendedevery conference of the group since its conception in 1976. 1980 was a nearmiss: I had to escape temporarily from a hospital bed to put in a brief visit,and therefore could not get more than a snapshot. But apart from that, I havebeen present and a full, some would say too full, participant in thedeliberations. To the best of my recall, I was also at all the Leeds meetings ofthe Northern Chapter, and have been to one of the Midlands ‘warm shed’meetings. For about half of the past 25 years I have been on the committeewearing some hat or other. I am the wrong person because I have not been an objective observer, I havebeen in it and therefore not watching it. Also, as the sands of time trickle past,my memories become increasingly unclear. Attitudes and feelings govern myrecall more than facts and what l still remember are events important to me atthe time. I am also the wrong person because the group has been and is of great New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 importance to me. For reasons which will become obvious as I write, this forumhas been one that has sustained me in my professional life more than any other. So this account is in the oral tradition rather than in the elegantly
documented historical tradition. But I have also used the group’s documents.
I still have all twenty-three booklets, and copies of our two books. I have also
wandered through copies of minutes and other bits and pieces. But it is a
personal view I present. Someone else would need to write the objective
account and try to place the work of the group in the wider national and
international context. I could never do that.
As soon as I started to address the topic of the history of the group, I thoughtof Spike Milligan’s war memoirs. Milligan was just a private in the British armyduring the second world war but called his memoirs Adolf Hitler: My Part inhis Downfall. And I thought perhaps that’s it. This group has been a little cogin the huge machinery of change that has taken place in our views of and waysof responding to people with declared alcohol problems. By itself it is of no realsignificance. But then I became less humble. Some of us: Ray Hodgson, NickHeather, Ian Robertson, Anthony Thorley, Jim Orford, Robin Davidson, BillSaunders, among others, have been far from ‘privates’. They have writtencopiously outwith the group’s activities and some of their books, like Nick andIan’s Controlled Drinking and Jim’s Excessive Appetites (which he has justreworked into a second edition - a real labour of dedication and love) havebeen milestones. Others of us have not communicated particularly by writingbooks and papers. Our methods are verbal: lecture, debate and seminar. I wouldname David Davies, Ian Cameron, Bill and Margot Kenyon, George Gawlinski,Steve Green, Ron McKechnie, Jean Werner, Trevor McCarthy and me asbelonging more in that group. And that was the first thing that dawned on me.
The group contains people who communicate in all sorts of ways at all sorts oflevels. During this next conference we will no doubt rediscover that. But what itdoes mean is that to understand the Group’s impact, we need to recognise thatmuch of what the group achieves is not tangible. It is alive in many of us all overthe world. It has changed us.
I plan to spend more time on the earlier history of the group: later events arebetter known to many of us. But before I go back to the humble beginnings ofthe Group in the mid-seventies, I want to take people back to that time andremind them or tell them what the alcohol problems world was like then. Toquote Carly Simon, “It was so easy then”.
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 People who presented with alcohol problems were alcoholics. The job of thetreatment agencies was to convince them of that fact and assist them towards‘recovery’ from their disease. That was never a completed task, since it was aninexorable disease that could be arrested, not cured. The way to arrest thedisease was to stop drinking. It was as simple as that.
David Davies’s classic 1962 paper Normal drinking in recovered alcoholaddicts had to a great extent been marginalised. Everyone reviewing thetreatment literature now quotes it as being a watershed paper. But they did notdo that then. Most specialist agencies and generic workers in Britain either didnot know about it or ignored it. But David Davies never let it go. Indeed, whenhe heard that there were a number of folk up and down the country whowanted to get together to talk about controlled drinking, he happily put theresources of the Alcohol Education Centre behind the enterprise. He was Chairof the A.E.C. at this time.
It was not the D L Davies paper that kindled the Group. It was one from SidLovibond, whom at that time none of us had met. He, an Australianpsychologist, had been doing heretical things in New South Wales. In the late1960s a number of workers had discovered that normal volunteers could betaught to know their own blood alcohol concentration. This was done byfeeding back to subjects what their B.A.C. was after asking them what bodilysensations they were experiencing. Bodily sensations worked better thanemotional states. But after relatively few training sessions, these normalvolunteers got quite good at that. What was important was that the feed backwas given promptly. That was now possible because of a new invention: theBreathalyser. The heresy that Sid Lovibond committed was to train alcoholicsto do it, and then he gave them electric shocks if their B.A.C. went above 70mg%. Not only did Sid Lovibond do this, he also broadcast the fact in aninternational conference on alcohol and drug problems in Australia in 1970.
The paper was published as a technique and with very short follow-up. Myfirst inkling that something important was going on was when Jim Drewerygave me one of those waxy paged photocopies, like an old FAX, of Lovibond’sconference presentation and said, “There might be something in this for you,Douglas”. Only a life’s work, as it transpired.
Worldwide, a number of us started trying out Lovibond-type experiments, verycovertly and tentatively. Famous names in the United States entered the game: New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 The Sobells and Mansell Pattison. The game was to restitute ‘controlleddrinking’ in people whose drinking was assumed to be out of control. InDumfries, Mary Spence and I set up a little controlled drinking group which didnot use electric shocks, but used education, drinking diaries, spouseinvolvement and other more subtle coercion. It also involved taking the groupmembers down the pub for ‘drinking practice’. I well remember the sense ofapprehension that accompanied Mary and me on the first of these. Don’tforget, we were committing heresy, we were advocating continued drinking foralcoholics, and we were going down the pub with them to help them to do it.
Despite the fact that we had convinced ourselves that it was theoreticallypossible, we didn’t really know. I was bloody terrified. In fact, I also rememberthat it was Mary and me who really wanted to get the drink down us on the firstof these sessions. The clients knew what would happen. We suspected, but wedidn’t know. We still partially believed the alcoholism movement’s propaganda.
We presented the short-term results of this group at the first aggregation ofpeople interested in controlled drinking organised in Dumfries under theauspices of D L Davies’s Alcohol Education Centre in early 1976, anddiscovered that we were not alone. It was because the first meeting was held inDumfries that we decided to return this year for the 25th meeting.
At that first meeting, folk from Newcastle, Norfolk, Cambridge, Glasgow and theMaudsley also chipped in their experiences. Some were using cue exposure,others electric shocks and others simply talk. There was a mixture. Some weresimply reporting controlled drinking as a tolerable by-product of abstinenceoriented treatment whereas others were trying to institute it deliberately. Therewas also one member of Mary and my group there, representing the consumer.
There were very few of us, perhaps twenty, and the discussions in the bar ofthe Swan Hotel at Kingholm went on feverishly. Are there two kinds ofalcoholics, the equivalent of the reactively and endogenously depressed? Iremember having a disagreement with D. L. Davies about the nature ofaddiction. He told me that he thought smoking was just as much an addictionas alcoholism was. It is interesting that in the May 1991 edition of the BritishJournal of Addiction, a special on tobacco, Griffith Edwards and Martin Raw’seditorial asked “What are the scientific, clinical and policy implicationswhich stem from the realisation that the tobacco habit is nicotinedependence?” What indeed? New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 Regardless of the intellectual disagreements that we had, an emotional bondformed, the same bond that forms between heretics, between apostles, betweenpeople who think they are alone in a hostile world discovering friendly kindredspirits. And the outside world was hostile. I can tell horror stories of going topresent the early controlled drinking group results in other settings. Aconference in Exeter, I remember particularly. My talk was greeted withabsolute, stony silence. Eventually a member of the audience said somethinglike “Thank you for your presentation, young man. No doubt in due courseyou will come to understand the nature of the disease”. Also, after a bit ofpublicity in the media, an appearance on the Jimmy Young Radio 2 programme,I got letters forwarded. Here’s an example: “. Will you therefore try to put right the very grave damage done by adoctor’s statement on yesterday’s (31.12.74) programme, that in HIS opinion,Alcoholics could be trained to be able to drink a certain amount of Alcoholwithout further damaging their health. All alcohol is poison to an alcoholic.
If by some chance this Doctor could in the future prove his point, I think it ishighly irresponsible of him to, in the meantime, relax the difficult efforts ofAlcoholics who are now trying very hard to win this battle against alcohol.” Looking back twenty five years, from these days of minimal interventions andself-help manuals and safe limits, it is difficult to believe that was how it was.
But what we were doing was attacking a faith, a well established, accepted folkscience. No amount of scientific or clinical data coming in from the UnitedStates, Australia or from our own work was going to undermine the faith. Theonly place where I felt safe to discuss these new beliefs and experiments washere, in New Directions Conferences. This view was obviously shared by anumber of us. For after that first meeting we reckoned that getting together wasa good idea, and the wandering conferences were born. They have always beenat the core of the Group.
It was actually about 18 months before the next, which took place in Newcastlein February 1978. This one was the same format as the last. This time there weremore of us: 31. We still sat in a circle, very 1960s, and had open discussionduring and after the informal presentations. Two stuck out in my mind from thattime. One was from the late Jean Werner, who just shared some case studies onsome very dilapidated citizens under her care in Cambridge. She was veryaccepting of their continued drinking and realistic about what could beachieved by and with these folk. In reality, she was advocating what is now New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 called harm minimisation. More importantly, she was demonstrating continuingcommitment despite her patients’ continued drinking. The other was fromGeorge Gawlinski. He talked about himself, how he had been brought up as aRoman Catholic, and the sense of fear and excitement engendered in him bybreaking free of that faith. He said that breaking free of ‘alcoholism’ was thesame process and produced in him the same feelings. George had, I think, readthe emotional tone of the meeting perfectly and converted us into disciples of afaith without frontiers. It was exhilarating. We agreed to meet again in sixmonths.
Six months later took us to Birmingham. My recall of that is of a miserable time.
In retrospect, the conference organisers made four grave errors. First, we werebooked into a temperance hotel, which was cold and unwelcoming. Second, theconference took place well away from the hotel: we had to drive there acrossthe city. Third, a conference dinner was arranged and had been paid for by adrug firm. This meant that half of us refused to go and went out as a group,feeling virtuous and untainted by commercialism. Finally, the seating in theconference room was in theatre style rows rather than in ‘our’ circle.
Eventually, after much debate, we returned to the circle. It is interesting to notethat even now, with numbers much bigger, old lags like me will still skulk in tothe room and arrange chairs in a circle prior to the final sessions on ‘WhitherNew Directions’. That is a relic of the Birmingham conference.
As is our wont, we do not repeat the same mistakes at the next conference:usually we wait till the one after. Hence the belief that the right conferenceformat was not like the last one but the one before that! Slow learners, us. Butthe mistakes made in Birmingham were not made in Cromer. We were alltogether in a big seaside hotel, and that has tended to be the deal since. Notalways seaside but usually a big hotel out of season. The Cromer conference,we are now in 1979, was great fun. More people came, more results of ourenterprises and reviews of other people’s were scrutinised. Anthony Thorleyshowed us his Venn diagram of consumption/harm/dependence which becameso influential, even though it also became known as ‘Thorley’s balls’. The NewDirections Conference was becoming an annual highlight. People would comeregardless of the difficulty. At Cromer, Mike Hopley couldn’t afford the hotelcosts so slept in his van in the public car park. We smuggled food out to him.
The Group was establishing great loyalty. We decided that we were notephemeral but were a sustaining influence. We were here to stay. We wouldbecome a proper organisation, register as a charity. Nick Heather, Steven Green New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 and George Gawlinski followed the suggestion first made at Birmingham furtherand wrote a constitution.
Over the next year, the constitution was steered through the CharityCommission and a year later, at Southport in 1980, we became a constitutedcharitable organisation. We had 59 members. George Gawlinski became the firstChairman, Bill Kenyon the first Vice Chairman. Steve Green became Secretary,Guliz Elal Lawrence became Treasurer.
The 1980 Conference in Southport was another notable success. Conceptually,we were moving on. We were still interested in controlled drinking outcomesand studies. Nick presented a report of the four year follow-up of the RandCorporation’s study which, in part because it showed some moderatedconsumption as an outcome, had been the subject of vehement criticism in theStates. But the group took a real swipe at alcohol dependence, or son-of-alcoholism as it could have been called. Three of us, Jonathan Chick, AnthonyThorley and me, produced papers which in their very different ways,highlighted the inadequacies of the concept.
Nick’s article became part of his book, Controlled Drinking and the other threeappeared in more coherent form in the first New Directions book. All fourappeared in New Directions Booklet No. 1 which Nick offered to startproducing. Bill Saunders’s contribution to this conference: ‘Treatment does notwork’ marked the beginning of something the group has been rather good at:knocking our own and other people’s efforts.
The group had come of age. It was properly constituted, forward thinking andcreative. In 1980, you could possibly take a shy at alcoholism but not at thereplacement, alcohol dependence. Not unless you were at the New Directionsconference, that was. Also, interestingly at this time we started to look atourselves. Nick did a survey of our attitudes and practices, and found that wepractised what we preached. We were not reified researchers. We were talkingabout what we were doing. The tendency to look at ourselves continues. Wehave, over the years, done multiple surveys. We have looked at our attitudes,our drinking, our clients and at our definitions of normal and abnormal drinkingand our current skills and experience.
Not only had we come of age, we had also become visible. I quote from theexecutive committee minutes of 5 January 1981: New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 “George reported that . he asked Chris Ralph (of the DHSS) if he could havecoffee with him just to tell him about the New Directions Group and he foundhimself facing an hour’s interrogation by a full team of 16. They wereparticularly querying who was in the group, why wasn’t it affiliated to theAlcohol Education Centre, what was its relationship to other bodies, etc.
They then asked what we wanted from them and George was able to saynothing yet but will make a further approach.” It is probably that George had stumbled in to the Department at a time whenthey were formulating plans to dismantle the four non-statutory pillars of thealcohol world: the National Council on Alcoholism, the Medical Council onAlcoholism, the Alcohol Education Centre and the real, beloved, cuckoo in thenest, the Federation of Alcoholic Residential, later Rehabilitation,Establishments, FARE.
I’m not sure if it was because of that encounter or not, but a posse ofDepartmental officials turned up at our next conference, at Canterbury (1981),and followed us around for the next few years. George Winstanley from theBrewer’s Society Social Problems Committee did the same thing. Canterburywas chosen for our 1981 conference because Terry Spratley and AlanCartwright were there and we wanted them to engage with us. Many of usconsidered Responding to Drinking Problems to be something of a Bible andwe thought our group needed them. They came up trumps, moving us onfurther. Not conceptually at this point, but in terms of our domestic roles aseducators and therapists. Our debates about the nature of dependencecontinued, unresolved.
The membership of the group continued to change and expand. We nownumbered 86. Nick Heather became chairman. But most regrettably, Bill Kenyondied on 5 April 1981, just at the beginning of one of his wonderful LiverpoolInternational Conferences. Bill was a remarkable, charismatic enigmatic man. Hehad a drinking problem himself at one point and became a long-term abstainer,believing in the disease concept. He grew out of that and became a veryoccasional light drinker. To the best of my knowledge it was only his immediatefamily and his pals in New Directions with whom he could share that.
David Davies ceased regular attendance in 1979 when he retired. We asked ifhe would become our honorary president, a post he held until his death in 1982.
The D. L. Davies Prize was instituted in his memory. (George Gawlinski told me New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 after I first gave part of this account as a lecture at the Llandudno conference in
1991 of the occasion when he went to offer D. L. Davies the presidency. DL said
that he thought that the group needed to be much more radical than he could ever
be. He could therefore be supportive of the group but not be of the group.
Therefore he wished to have the title Honorary President rather than President).
1982 saw us go to Bollington, near Manchester. This gave the floor to otherlong-standing New Directions adherees Tony Ford, Liz Smith and Ken Jones,who followed a tradition of using the first plenary session to update us onwhat was new on their patch. Again we broke new ground. We looked atcommunity based prevention three years before David Robinson and PhilipTether published Preventing Alcohol Problems, and we were not preoccupiedwith reducing consumption. This may have been related to finding a smallvillage pub staggering distance from the hotel which sold real ale, a constantlack at New Directions Conferences, and which considered itself immune topermitted hours legislation! We also looked at relapse in a symposiumorganised by Bill Saunders and Steve Allsop. Relapse and relapse preventionwas newsy at this time, following the work of Alan Marlatt. And we were there,thinking about it.
Booklet No 4, which contains a number of articles from the BollingtonConference, also contains correspondence from Mark Sobell and Alan Marlattabout the acrimonious state of affairs in the United States where the Sobellshad recently been accused of falsifying the results of their classic controlleddrinking experiments undertaken in the early 1980s. Since there was the whiff oflitigation around, the correspondence was circumspect. But we in the grouphad to accept that the ‘alcoholism movement’ was fighting back, andvenomously. Mark Sobell said in his letter (August 26,1982) to Nick … “We, as you, have been outspoken for some time with regard to asserting thatthe alcohol field is in the midst of a ‘scientific revolution’. With thetheological zeal that characterises many in the alcohol field, it would appearthat the revolution has now escalated to full scale warfare”. As a result of excellent organisation, the Bollington conference put theorganisation substantially into the black financially. We had enough money toorganise a really big conference in 1983 in a really big plush hotel in NorthBerwick, and could afford to invite Robin Room, one of our heroes from theUnited States, to stop off on his way from Geneva to California and address us.
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 But for me it wasn’t Robin’s address that was memorable. It was Ian Cameron’sextraordinarily evocative Moralizing in the Fifties. It is printed in Booklet No 6.
I’ll give you just a flavour of it: “Psychiatrists raised expectations of cure which they couldn’t deliver. They’doversell psychiatry at dinner parties or on the T.V., where they were in greatdemand, and then disappoint clients in the clinic looking for lastingsolutions to their problems. “Chronic alcoholism was the drinking disease of the 50s - the preponderantcauses of which were said by Mayer-Gross, in the first edition of his textbookto be ‘environment and social’. But when the alcoholic claimedenvironmental and social reasons for being the way he was, Mayer-Grossquoted Kraepelin at him. Kraepelin’s study of alcoholic excuses for excessivedrinking; (included) “trivial rationalisations” like the “example andcompany of other”, “membership of a Club accustomed to meet at an Inn”,“visiting a pub to shelter from the rain”, “special family occasions”,“celebrating passing an examination”, or “successful business deals”,“Professional meetings”, “standing rounds among friends” and so on.
Mayer-Gross went on to say that the Chronic Alcoholic never blamed himself(which he clearly thought he should do).” (Following an account of hospital-based treatment, Ian Cameron reports): “Patients were impressed by all of this because, to begin with, in hospitalthey had no inclination to drink. They felt good and believed that one of thetechniques (narcosis or aversion) had done the trick - when they were asleepperhaps. They had a reasonably interesting time doing O.T. and met the girlsfrom the female wards in the evening. When the family began to visit, and indue course when the patient went home for the day or weekend, thingschanged, i.e. he discovered that nothing really had changed. Life was stillrather more complex than he could cope with. He felt swindled, I think, by hishi-jack to hospital, by the inhuman processes that brought about hissubmission and by his lack of participation in any of the planning up to now.
On returning to hospital from the weekend he’d bring back half a bottle,drink it on the ward - usually with another alcoholic for company andconsolation. He would then express some of his feelings about the hospital,bluntly, in front of the staff, confirming their view that alcoholics werehopeless and aggressive. Anger escalated. Blows were struck, reinforcements New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 called and punishment given out or discharge against medical adviceprescribed with the recorded comment that the patient’s motivation had neverbeen good anyway, or that there was underlying psychopathy of theinadequate or aggressive type.” There were other gems at the 1983 conference. Ken Roberts talking aboutalcohol from the perspective of a sociologist of leisure and the late Fred Yates,ever the enthusiast, struggling to make sense of the cultural dimensions ofalcohol use. There was also Steve Green and George Gawlinski’s complex gamewhich got us all to look hard and work hard at understanding where our littletreatment services fitted in, and just how vulnerable they were to politicalwhim. All these themes led to plans that next year’s conference should addresshead-on the concepts of normality and abnormality in drinking.
But there were other currents beginning to flow in the group’s stream ofconsciousness. These were about whether we should incorporate the use ofsubstances other than alcohol into our dialectic. At this time, Ian Cameron wasin favour, saying “that would really be a new direction”. Bill Saunders arguedthat we should take account of findings from the wider drugs field; and thatwould be to our benefit. So for two thirds of the life of the group, we have beenarguing about the involvement-with-drugs issue, and about whether there werenew directions to be found. Second, the importance of the concept ofdependence continued to be a powerful undercurrent. Third, as a result of thegentle persuasion of folk like Gillian Tober, Rose Kent and Clare Wilson, genderissues became more central to our thinking.
The circus moved on. In 1984, we went to an odd hotel at Woodhall Spa in thewilds of Lincolnshire. The hotel seemed virtually unchanged since the secondworld war when it had been the officer’s mess of an R.A.F. squadron. Here welooked at normal drinking, including our own. Marilyn Christie reported backon our drinking diaries and coined the phrase “This was not a typical week”.
Indeed it was not, for during the week’s data collection, many of us had been atthe closing-down party of F.A.R.E., which involved consuming large quantitiesof alcohol, in the form of Asti Spumante, as I vaguely remember. What on earthwould Emil Kraepelin had made of us. Worse was to come. We set up anevening as a controlled drinking experiment, setting limits quite randomly onthe consumption of two-thirds of the participants at the conference. Gettinground the elaborate system of rules and vouchers became the name of thegame. People discovered that bottles of Pils were being given out for only one New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 unit. All stocks were soon depleted. People cheated, stole, skulked off andbehaved very badly. There were bitter complaints about the cost of nonalcoholicdrinks. The barman, drawn into the feedback session, claimed that he found itdifficult to believe that a group of professional people could behave so badly.
There was a political dimension to all this as well. The group has alwayscontained a preponderance of people of the left, with residual sixties liberalismalive and well. That was why Philip Tether received a rough ride from us. AsGeorge Gawlinski wrote in Booklet No. 8: “The speakers demonstrated that, if applied properly, we may have thetechnology to save people from their own problems. The session did,however, raise as many questions as were answered and left me particu-larly wondering if the risks to civil liberty were worth it, and what kind ofboundaries we, as a society, should place on the prevention lobby?” In the middle of the Thatcher years, as we then were, it was inevitable thatissues of care versus control should come onto the agenda. The Governmentwas putting money into drugs services. Many alcohol agencies for financialrather than ideological reasons were combining, and suppression of an illegalactivity had more face validity than suppression of the legal, and muchengaged in by N.D.S.A.G. members, activity, consumption of beverage alcohol.
The 1984 conference was highly introspective. It concentrated on us, how webehaved, and how we drank. Some were very irritated by it. Others still smirkabout it. Clearly, the next year would have to be different. Anthony Thorleyreplaced Nick in the chair. Difficult times were ahead.
But before the 1985 conference happened, the group reached anothermilestone. Our first book was published, under the editorship of Nick Heather,Ian Robertson and Phil Davies. It is still available. To the best of my knowledgeit has not been remaindered, and for a few years provided a few quid from itssales into our coffers. I believe that it remains a useful and elegant book. Itcontains three sections, on dependence, treatment and prevention, and arguesthe pros and cons of their value and efficacy in a balanced way. As a statementof the preoccupations of the group members during our first seven or eightyears, it is still of interest, perhaps now more to historians.
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 I think the 1985 Conference at the gorgeous Dyffryn House, near Cardiff, wasthe biggest ever. We now had 158 members. There were loads of newcomers,including newly-appointed members of Alcohol Concern staff, and perforce,the conference format moved away from groupey-experiential towards stand-upspeakers in front of more formal audiences.
There was a clear agenda too: now is the time to incorporate other drugs intoour conferences. After all, dependence was quite global and it was artificial tosegregate alcohol dependence as if it was fundamentally different from otherdependencies. And along came Mike Gossop from the Addiction ResearchUnit in the Maudsley to underline the argument.
This may appear hard, but I think that at Dyffryn, the group was subjected to aselling job, with interest in drugs and the concept of dependence being thegoods touted. Whether that was true or not, there was our most acrimoniousA.G.M. ever that year for Anthony Thorley to try and contain, with twomotions advocating constitutional changes generating particularly powerfulemotions. One was “That N.D.S.A.G. extends its focus to include otheraddictions”. The other linked to that was “That N.D.S.A.G. change its name tothe New Directions Group”. Entrenched positions and vehement debateseemed to be interminable. Hannan Rose, something of a constitutionalauthority, proposed the motion “next business”, a device to suspend anyfurther discussion on the first motion and the second motion rapidly sufferedthe same fate. And there the matter still stands. Looking back, it seems to methat the storm was not about interest in other drugs, it was about a rejection ofthe concept of dependence and at that time the two were being intertwined.
And so to Otterburn (1986), in the wilds of Northumberland. This was thesecond time that the Newcastle gang had organised the annual conference.
Fred Yates’s introduction to Booklet No. 11, containing some of the conferenceproceedings, said it all: “Putting together a conference programme for N.D.S.A.G. is rather like oneimagines casting a play from a gallery of wayward celebrities - the personaebegins to take over the plot. This year at Otterburn I felt that the main themeof research vs. practice survived and brought out the best in the groupbecause it exposed a tender nerve which is inflamed and not often openlydebated at our annual meetings. The central debate on the motion ‘Thishouse deplores the rise of psychological imperialism’ captured the spirit of New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 the weekend in an indescribable mix of theatre, genuine passion and, atmoments, rationality about the value of research.” For me Ron McKechnie’s killer blow in the debate was “How can psychologistspossibly be accused of imperialism when we’ve been trying to give ourknowledge away for years?” That is not only true of psychology, it is also trueof the N.D.S.A.G. generally.
Otterburn was also notable for the welcome return of Jim Orford to the group,and for a superb presentation of the pearls contained within his bookExcessive Appetites which had just been published. It was also notable for theappearance of Colin Brewer and the Antabuse debate, which is a microcosm ofthe care and control issue. At Otterburn gender issues remained high priority,and the group elected Gillian Tober to its Chair.
With Gillian and Jeff Allison now both in Leeds, a new format was added to thegroup’s activities. These were the one-day ‘Northern Group’ meetings held inJanuary in that city. These meetings were well attended by members fromScotland, Northern Ireland and the Midlands and North of England. RobinDavidson wrote as Editor of Booklet No. 12, which task he had taken over fromNick Heather: “The New Directions Northern Members conference was held in Leeds at theend of January (1987). After all the animated debate over the last couple ofyears on whether to combine alcohol with other drugs this conference wasrefreshing in that speakers wandered unselfconsciously into the heroin,tobacco and benzodiazepine fields without any long, philosophical heart-searching . it does seem that members are now quite happy to draw oninformation from related areas as should be the case in any mature forum forexchange of ideas.” In 1987, the Annual Conference moved to Exeter. The diversity of the contentof this conference was striking. We decided we wanted to learn from otherfields, so we invited a learned anthropologist who fascinated by telling usabout khat usage in the Yemen and the yet to be famous John Banham, later tobecome Director General of the C.B.I. to address us. Also, we managed tocapture Marcus Grant to pay a return visit. The conference format had plentyof small groups, and as a result of the efforts of John Hinsley, a men’s liberation New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 group put in an appearance, only to be invaded by many women participants!But, for the first time, N.D.S.A.G. membership was falling.
Nick Heather had failed to secure continued support for his unit in Dundee andhad been appointed to a Chair in Sydney. We decided to offer him the post ofPresident, which had been vacant since David Davies died in 1982. Nick wassurprisingly touched by that: I guess he had failed to recognise how major apart he personally had played in the Group’s development and success.
Everyone else associated with the group knew. In keeping with tradition, heaccepted the post as Honorary President. Interestingly, it was around the timeof Nick’s departure that N.D.S.A.G. wrote the only lobbying letter it ever did, tothe Department of Health decrying the leaking away of talent in the Britishalcohol field to the Americas and the Antipodes. In retrospect, that wasprobably a mistake, for the group’s strength lies mostly in the fact that it is nota lobbying organisation or pressure group. It is a think tank. But it was at thattime a think tank under pressure. And some of our mates were being forcedabroad and we missed them.
Around this time, the group suffered a temporary setback in its fortunes. Therewas a feeling of some staleness, of some lack of direction and purpose. GillianTober captured this in her editorial of Booklet No. 13: “Charismatic groups must, by their very nature, change. If the ‘cause’ is lostthen the group disappears; if the cause wins the group must become part ofthe establishment just as the cause has done. You cannot keep fighting forsomething that has been established. And in this country at least -moderation goals in alcohol interventions are well accepted. The languageof social learning theory is creeping into the literature and practice. Notalways consistent but it’s there. So what happens? Charismatic groupsusually become routinised - rationalised, bureaucratised. It is this transitionthat precipitates not only the occasional constitutional crisis butparticularly the questioning about the direction of the group. Tricky - whenits charismatic nature is reflected in the very name.” The organisers of the Cambridge conference in 1988 thus had a particularlydifficult task. What happened was odd. We all turned up, like we do. But wehad a weekend party. The meticulous and serious content of the conferencetook second place to having fun together. At the time it was a real laugh, but New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 what we were actually doing was avoiding the real problems that confrontedus. And there was good content there. Robin Bunton’s social policy analyticalwork, Nura Paul’s personalised adult children of alcoholics and Tim Kidger’sconstruction of a model of effective treatment. But unforgivably, I think, wereturned to old habits: knocking the disease concept of alcoholism as personi-fied by Robert Lefever. Mary Spence, who like me had never missed a confer-ence before, put in a brief appearance and has not returned. Had we but seen it,there were in the Cambridge conference seeds of real new directions. We weretoo busy having fun. But as a result of the fun, the cohesion remained. In anodd way, our guilt increased the commitment. At the Cambridge conference.
Cambridge brought us back to our senses. So Crieff in 1989 was a much moreserious business. The conference benefited from a number of importedspeakers from a diverse collection of Scottish projects including communitydevelopment and community action, housing and AIDS. John Davies put in animportant piece about attribution. The conference in its cyclical way put asidemuch time for group discussion and development, and there was no feedingback from the groups to disinterested participants of the plenaries. Thus ourexperiences of the conference were all quite different. But the main theme ofcare versus control was retained high on the agenda throughout. At the Crieffconference, Gillian stood down as chair and I took over.
The 1990 conference took place at a mock gothic manor house inLeicestershire. Again it was a rich and diverse menu, with sessions on health,crime, gender, therapy and ideologies. Thus in keeping with our traditions, allhuman life was there. Particularly notable, I hear, were Betsy Ettore’s ‘Is genderan important dimension when considering alcohol problems?’ and TerrySpratley’s ‘How we damage our clients’.
In the final sessions, there was still alive and well the feeling of uncertaintyabout the group and its future. Also, the membership numbers continue to fallslowly and the conference attendance was the smallest for some years.
In 1991 there were two further developments. The bad news was thecancellation of the Leeds meeting because of lack of offers of participation. Thegood news was the publication of Counselling Problem Drinkers, the Group’ssecond book. It was edited by Robin Davidson, Steve Rollnick and IanMacEwan and used as a structure Prochaska and DiClemente’s stages of New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 change model. It was a very different book from the first, being much morepractical and less theoretical.
The 1991 Llandudno conference was another ‘hit’, notable for a feel of Welshethnicity, and an erudite and thought provoking presentation from MaryDouglas, the anthropologist and author of Constructive Drinking. How littlethe group really knew of the anthropology of drinking! It was also notable forhaving simultaneous translation into and from Welsh. So all looked set fair forthe 1992 conference back in Scotland.
The conference was planned around what the organisers (I was one of them)thought was a timely and relevant topic ‘Oppression, integrity and survival, inour clients, our agencies and ourselves’. The programme included personalaccounts of being oppressed, in totalitarian states, in prison, by ethnicity, bydisability. It included workshops on strategies to survive oppression and onthe need to maintain networks. It also included a session on whether it wastime to establish a drinkers/drugtakers charter, on the rights and duties of beinga user.
But the conference was not to be. This was a time when most of us werefeeling under organisational and personal pressure. Our agencies andworkplaces were being ‘managed’ as they never had been before. Some smalleragencies were being closed down with staff, some of whom were N.D.S.A.G.
members, made redundant. In the NHS and universities, staff were all beinggiven performance targets and were having to justify how every minute wasbeing spent. Some of us became infested with the virus of managerialism andimplemented rigid systems ourselves. These were oppressive times indeed. Somuch so that many people thought that they could not justify time away fromtheir oppressive workplaces to examine how they were being oppressed. Oneobvious way in which this was done was by suppressing training budgets. Inthat introductory year of managerialism, many people’s training budgets weresimply removed completely.
Whatever the reasons, few people signed up to come. Some said theprogramme was irrelevant, some said Pitlochry was too far away, some said itdidn’t have anything to do with alcohol. And the Addictions Forum had beenborn, and was running, as it still does, a good number of training andeducational events which were well subscribed. Thus the 1992 conferencenever took place. Instead we held an AGM in Leicester in the middle of New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 England to decide what to do: should we wind up the organisation or try tokeep it alive. At this time, as he has done so often, Tim Kidger providedguidance. He had been a very able treasurer for a number of years, and morethan anyone else, kept the organisation on a firm financial footing. It was hewho suggested that we ran a loss-leading conference, either to wind up theorganisation, or to kick start it again. We gave Rose Kent some money and thejob of organising the event. And she delivered.
The 1993, 1994 and 1995 conferences all took place in Bowness-on-Windermerein the English Lake District. We did not know on day one of the conferencewhether the 1993 one would be a closing down party. It was not. Old lagsturned up in large numbers and folk like John Davies became regular features.
The N.D.S.A.G. bikers chapter was born. The papers and debates were theusual mix of the erudite and the good humoured. Who can forget Mike Hopleyallegedly pretending to be acting the role of train spotter, complete with specsmended with sticking plaster, ballpoint pen stains on his anorak pocket and realwild enthusiasm about trains in his eyes, or Jeff Allison the skydiver? Equally,who could forget the debate about the potential risks of brief interventions?And from someone with his fair share of paranoid genes, it was rich to hearNick Heather say that he’d been to brief interventions conferences all over theworld and never before heard any group air the suspicions, anxieties anduncertainties that we in New Directions had aired about the whole ideologybehind their implementation.
During these years we also invited people from the 12 steps movements. Not aswe had done in Cambridge, to paper over the cracks of our own divisions bylampooning a common ‘enemy’, but with real humility that these folk might beoffering something that we so-called hard headed scientists might not betaking sufficient cognisance of. This year’s conference probably had someseeds planted in 1994 beside Lake Windermere. Or on it, for the group hiredpleasure craft to experience rather closer the joys of boating on the lake. Orperhaps in the delicious lakeland pub, with delicious lakeland beer, the Hole inthe Wa’ in Bowness village.
The consequence of having conferences three years running in theWindermere hotel was that the group was again cohesive and vigorous. It wastime for the travelling circus to move on: to Bromsgrove (1996), Bath (1997)Sheffield (1998), Manchester (1999) and Torquay (2000).
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 Current members will all have their own particular memories of these past fewyears. But for me the main themes have been about trying to make sense of andlive within the new culture of managerialism. We have often said on planningmeetings “that’s a slot for a suit”. And we have friendly ‘suits’: Pete Forrester,Geof Cobbe and even Richard Velleman who is both one of us and a ‘suit’. Thatis scary. For we know that we have to do our best to live in the world between‘management’ and our clients. And we have statutory reminders of where wemight be going: Mike Hough, a ‘suit’ with Powerpoint talking about controllingdrugtaking and takers. It all harks back to the Pitlochry programme - the bestconference we never ran. Our language is different: we talk about risk manage-ment - as we did in detail at Torquay. But the underlying issues are there.
As ever, there have been spectacular conference moments: the late Fred Yatesbeing an enthusiast - this time about computers. Jim Orford and Alex Copellogetting all participants to be family members, therapists or clients. AlexGeorgiakis, Pip Mason and Barbara Elliot playing Trev McCarthy’s game inSheffield and saying what it was from the worlds of concepts, colleagues andcustomers that had most enthused them - just a delight. Robin Davidson,whenever he can be persuaded to speak, and in particular when talking of hisever burgeoning collection of five-stage models was a wonder to hear. Anddare we ever put Trev McCarthy, Pip Mason, Robin Davidson and BarbaraElliott on a debating platform together, without ready access to a cardiacresuscitation machine? We have talked about our attempts to export the ideology of the groupelsewhere, notably at the meeting in Bath, and about how hard it is to do. Forwe are not exporting a marketable package. We are exporting a vision thing, asGeorge Bush the elder called it. But actually all we have on offer is ourselves.
Many of us old lags are now doyens of the field. We are the people that weused to look up to, to resent, to emulate, to be jealous of and in awe of. Andyet I feel as lost as ever, as uncertain, as bewildered. I still am bowled over bythe quality of the material presented at New Directions conferences. I learnsomething new at every conference. It is still the best show in town.
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 Yes, but what new directions?
So that is the New Directions story so far. What sense can be made of it all?What has been going on? What have all these, at times vehement andpersonalised, disagreements and debates been about? What, if any, are theNew Directions? I’ve tried to remember what I believed at the time and what sort of response myviews created in others and similarly what response others generated in mewhen discussing these issues.
In 1976, we seemed to be believing that controlled drinking studies were ofgreat value, treatment for people with drinking problems of moderate value andwe were neutral about the value of the disease concept of alcoholism. By thenext meeting in 1978, we were becoming less convinced of the value ofcontrolled drinking treatment and of treatment generally. We were now hostileto the disease concept of alcoholism which we saw as holding us back. In1978-79, we were talking about dependence but neutral about it. In 1980, ourviews were moderately against the concept of alcohol dependence being ofvalue in understanding the nature of people with alcohol problems.
Some views gained a position and stayed there. Hostility to the diseaseconcept of alcoholism has been fixed since 1978, but our hostility to twelve-steppers has abated: these folk might have been on to something after all. Thevalue of the involvement of outsiders in our deliberations started with RobinRoom in 1983 and over the next four years became a fixed belief. Outsiders arenow seen as a valuable addition to our conference. Similarly, having had ourawareness of gender issues raised by Gill, Rose, Clare, Ian MacEwan and JohnTinsley, we have never doubted the importance and value of that perspective.
Interestingly, controlled drinking studies, having been the raison d’être of thegroup in its early days soon became a matter of indifference. There was a flurryof interest when the alcoholism movement struck back at the Sobells in 1982-83, butwhen Griffith Edwards published the 25 year follow-up of D L Davies’s magnificentseven in 1985 showing them to be doing rather badly, it hardly engendered anycomment. By then the floodgates of the feasibility of resumed moderateconsumption were already wide open. Within this group the conceptual leap hadoccurred and was irreversible.
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 One value, that of making sense of an individual’s drinking, varied betweenneutral and totally positive. In our group it has never been seen as of no value.
We had never adhered to Ian Cameron’s fifties model here.
Other issues, like ‘involvement in other drugs’, ‘value of treatment’ and ‘valueof the concept of dependence’ have veered over the years between positiveand negative. These have been the Group’s battlegrounds. It is to our creditthat we have not maintained fixed positions on these issues. The debate aboutthe value of treatment is finely balanced, with new data shifting our positionyear-by-year. Similarly, in the mid-1980s alcohol dependence did appear to havesome superficial validity. I believe that over the past decade, the Group ismoving beyond that. Terry Spratley’s comment at the end of the 1990conference at Harlaxton that “Dependence is now holding us back” and hisquestioning of the received wisdom of withdrawal phenomena, along withRobin Davidson’s factor analysis of the significance of dependence as adeterminant of drinking were powerful forces shifting the Group’s consensus. Itis interesting to me that the value of the concept of dependence and the valueof making sense of an individual’s drinking seem to mirror each other, as onegoes up the other goes down. It’s obvious, if you think about it.
So, what are the current pluses and minuses in our Group’s value system? Asusual, we don’t like the disease concept of alcoholism, and we may be growingaway from alcohol dependence. Controlled drinking studies are passé. Wecurrently believe somewhat in the value of treatment and in the sharing oflessons gleaned from the users of other substances. We are very keen onattempts to make sense of an individual’s drinking/drugtaking, on cognisanceof gender issues and on learning from outsiders to the alcohol and drugs field.
I don’t know whether you call those new directions or not. It all seems a bitchaotic really. If only we could get all us huskies to pull in the same direction,then we could really get this sled going fast. But if we wanted to do that, we’dappoint the equivalent of party whips and become unquestioning party hacks.
And that was the approach in the alcohol field when it became bereft of newdirections in the 1950s and 1960s. The fun for a New Directions husky is to tryto get as many other huskies as possible running for as long as possible inyour direction.
New Directions in the Study of Alcohol Group 25th Anniversary Supplement, April 2001 Finally, why did I call this commentary Minstrels of the Dawn? It’s the title ofan old Gordon Lightfoot song, and for me it characterises what the NewDirections in the Study of Alcohol Group actually offers. Like minstrels wewander the country singing songs. The songs we sing, in our various ways,are of the possibility of a new understanding of the nature of substance misuseproblems. We’ll sing about it but we won’t produce it - yet. So we are in a realsense Minstrels of the Dawn, proclaiming the possibility of the new. I wonderhow much closer to the dawn we’ll all end up after this next conference. I don’tknow. But there is one thing that I guarantee: It won’t be boring finding out.
REFERENCES
CAMERON, D & SPENCE, M T (1976) Lessons from an out-patient controlled drinking group.
Journal of Alcoholism 11,2: 44-55. DAVIDSON, R, ROLLNICK, S & MACEWAN, I Eds on behalf of the New Directions in the Study of
Alcohol Group (1991) Counselling Problem Drinkers. London. Routledge.
DAVIES, D L (1962) Normal drinking in recovered alcohol addicts in Quarterly Journal ofStudies on Alcohol 23: 64-104. EDWARDS, G (1985) A later follow-up of a classic case series: D L Davies’s 1962 report andits significance for the present. Journal of Studies on Alcohol. 46:181-190. EDWARDS, G & RAW, M (1991) The tobacco habit as drug dependence. British Journal ofAddiction 86:483-484. HEATHER, N & ROBERTSON, I (1981) Controlled Drinking. London. Methuen.
HEATHER, N, ROBERTSON, I & DAVIES, P Eds on behalf of the New Directions in the Study of
Alcohol Group (1985) The Misuse of Alcohol, London. Croom Helm.
LOVIBOND, S H & CADDY, C R (1970) Discriminated aversive control in the moderation ofalcoholics’ drinking behaviour. Behaviour Therapy 1: 437-444. ORFORD, J (1985) Excessive Appetites, Chichester. John Wiley.
SHAW, S J, CARTWRIGHT, A SPRATLEY, T A & HARWIN, J. (1978) Responding to Drinking
Problems. London. Croom Helm.
SOBELL, M B & SOBELL, L C (1973) Individualised behaviour therapy for alcoholics.
Behaviour Therapy 4:49-72. TETHER, P & ROBINSON, D (1986) Preventing Alcohol Problems. London. Tavistock.

Source: http://www.newdirections.org.uk/25yearsofnewdirections.pdf