A few days before Christmas, in a Portland suburb, Audrey Conn committed suicide in her mother’s house. Her death, like her life, was immediately seen as something larger in a vituperative debate over whether all problem drinkers need to entirely abstain. Conn, 56, was a founder of Moderation Management, a behavioral program for non-dependent drinkers who seek to change their habits.
She came into national headlines in 2000 after a tragic accident. In January of that year, Conn, who then used her once-married name, Kishline, announced to MM members that moderation wasn’t working for her, and that she was leaving the group to attend Alcoholics Anonymous and other abstinence-based programs.
Two months later, with a blood alcohol level three times the legal limit, Conn drove the wrong way down a highway in Washington State. She plowed into an oncoming car, killing Danny Davis and his 12-year-old daughter, LaShell.
The story ignited a huge controversy. Omitting the fact that Conn/Kishline had been attending AA at the time of her accident, prominent abstinence-only proponents used the tragedy to attack moderation. The National Council on Alcoholism and Drug Dependence (NCADD), which is widely considered A.A.’s mouthpiece (A.A. does not comment publicly on what it calls “outside issues”), released a statement that said the incident “provides a harsh lesson for all of society, especially those individuals who collude with the media to continually question abstinence-based treatment for problems related to alcohol and other drugs.” Journalists seized on the news, and condemnatory articles and television segments followed.
What those stories failed to capture was the complexity of those who struggle with “alcohol use disorder,” the clinical term the most recent edition of the Diagnostic and Statistical Manual, the 2013 DSM-V, uses for risky drinking. It denotes a spectrum, from mild to moderate to severe, and replaces the DSM-III’s term “alcohol abuse” and “alcohol dependence.” (Those terms, published in 1980, replaced the much older “alcoholism.”)
Like many women who drink riskily, Conn also struggled with depression, said Dr. Marc Kern, a psychologist at Addiction Alternatives, a substance and alcohol use treatment center in Los Angeles. He was a friend and colleague, and is board chairman of Moderation Management.
Conn, Kern said, didn’t identify with the A.A.’s embrace of the disease theory of alcoholism, which can loosely be described as this: drinkers who can’t control their consumption have a brain disease that, if not halted by abstinence, will continue to worsen.
“Audrey had the courage to say, ‘One size doesn’t fit all,’” Kern said. Conn sought to address the disparity between programs for severely alcohol-dependent people and those in the milder stages of problem drinking. The National Institutes for Alcohol Abuse and Alcoholism estimate that of the 18 million Americans with AUD, about 15 percent are in the severely dependent range. (For the severely dependent, abstinence is typically considered the best route to recovery.)
In the early 1990s, when Conn was trying to change her own drinking habits, there was little help available outside abstinence-only programs designed for the severely dependent. Like other unhealthy behaviors, risky drinking is more easily addressed when the problem is mild.
Conn, her friends say, had tried A.A.’s 12-step program, which was founded in 1935 when knowledge of neurology was in its infancy. Its tenets include declaring one’s powerlessness over alcohol, accepting the aid of a higher power in maintaining abstinence, and relinquishing one’s ego. Conn found herself at odds with A.A., and contacted prominent researchers who had published numerous peer-reviewed studies that proved the ability of many problem drinkers to cut back. (In the intervening years, such studies have continued to mount.) With their help, Conn developed the program by setting moderate drinking guidelines and limits, drink monitoring exercises, goal-setting techniques, and strategies for identifying triggers.
During her three-year prison stay, LaShell’s mother and Danny’s ex-wife, Sheryl Maloy-Davis, a devout Christian, approached Conn with forgiveness, and in 2007, the two women published a book about their experiences called “Face to Face.” Maloy-Davis, 50, said this week from her home in central Washington that she made a decision for her two surviving sons not to let bitterness consume her. “I told Audrey I forgave her, but she always had such a hard time accepting that,” Maloy-Davis said.
After prison, Conn struggled with guilt, shame, and, as a convicted felon, the inability to find employment, Kern says. She also continued to battle alcohol. “She really wanted to be able to not drink but it had a hold of her,” Maloy-Davis said.
Conn attended A.A. daily for the past several years, Maloy-Davis said, but fell off the wagon repeatedly. That, in turn, compounded her guilt. “She knew the damage she’d done with her drinking and knew what her choices had done to others but couldn’t fix it like she would liked to have,” Maloy-Davis said.
Conn’s social media posts reveal sharp shifts in mood. Women with alcohol use disorder are twice as likely as men to be diagnosed with anxiety and depressive disorders. They’re also more likely to self-medicate unpleasant feelings with alcohol. In A.A., such conditions are considered “outside issues.”
“A.A. tells you, ‘Don’t drink, don’t think, come to meetings, and you’ll be fine,’” said Dr. Andrew Tatarsky, a Manhattan psychologist who is also an MM board member. “The problem is the drinking, the cure is abstinence, and the program is the way.” While many people find benefits from the mutual support and camaraderie A.A. offers, he said, it doesn’t address the complex emotional issues that drive so many people to excess drinking in the first place.
Holding abstinence as an ideal—which is reinforced by A.A., the vast majority of U.S. treatment centers, and the broader culture—can help contribute to a desperate cycle of shame, guilt, and an escalation of drinking or substance use, Tatarsky said. “In A.A. there is a tendency to blame the person who keeps drinking,” he said. “If they were just following the program, they wouldn’t be drinking.”
Scott Stern, a Manhattan psychotherapist who was a friend of Conn’s, said her death highlights the need for a variety of scientifically proven treatment options, including FDA-approved pharmacological treatments, such as naltrexone and acomprosate, that have been shown to help reduce cravings and curb drinking. Others, such as topirimate and varencicline, have been found to help reduce drinking as well but are currently used off-label to treat AUD.
It is important to note that the Substance Abuse and Mental Health Services Administration lists MM, in conjunction with a web-based program called moderatedrinking.com, in its national registry of evidence-based treatment programs. A.A. is not included.
While neither MM nor A.A. worked for Conn means only one thing: they didn’t work for Conn, Stern said. “There’s a spectrum,” Stern said. “It’s not that you’re either this or that. What this tells us is that we should put more effort into creating more choices.”