Appreciation: G. Alan Marlatt Brought Compassion to Addiction Treatment

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Many people claim to be pioneers in addiction treatment, but few have left a more important legacy than G. Alan Marlatt, professor of psychology at University of Washington, who died of melanoma on March 14, at age 69.

Marlatt, who was also the director of the university’s Addictive Behaviors Research Center, was one of the first researchers to understand the importance of relapse in addiction treatment — and, more importantly, to develop and systematically test ways to help prevent an addict’s momentary slip from becoming a full-blown relapse. Marlatt recognized that enforcing immediate abstinence often deters substance users from getting or adhering to treatment, and he advanced therapeutic approaches that focus on reducing alcohol- or other drug-related harm, without demanding strict abstinence.

Throughout his life, Marlatt labored to bring empathy and compassion into a field that had historically advocated harsh and coercive techniques that were not effective.

“Alan had an enormous influence on the addictions field that continues beyond his passing,” says Reid Hester, director of the research division of Behavior Therapy Associates, a clinical and research psychology program in Albuquerque, and himself a long time leader in addiction research. “His focus on harm reduction lowered the barriers for many to engage in treatment and self-change of their addictive behaviors. He was also warm, empathic and a dear friend to many. For those of us who knew him, he will be sorely missed.”

Marlatt also developed techniques to reduce harm associated with college binge-drinking, and his most recent studies had explored the use of mindfulness meditation in recovery from addictions and depression.

His friends, family and colleagues remembered him with great admiration:

“He showed that people with substance abuse problems need to be met ‘where they’re at, without prescriptions for what recovery ‘should’ be,” says author Anne Fletcher, who worked with Marlatt on her book Sober For Good.

“It is impossible to recount briefly how much Alan has meant to the field of addiction psychology, to addictions treatment and research, and to substance users not in treatment through his advocacy of harm reduction,” wrote Fred Rotgers, president of the American Psychological Association’s (APA) Division on Addictions, in an email posted to the APA’s listserv.

“Alan was a trail-blazing, game-changing researcher, clinician and academic. He was always out on the edge, challenging conventional wisdom in search of what is true about substance misuse and what is most helpful to people struggling with these issues. He was an early researcher examining controlled drinking. He was the person who invented relapse prevention,” says Andrew Tatarsky, a New York City psychologist specializing in addictions and a cousin by marriage to Marlatt.

I knew Marlatt through my work writing about and trying to understand my own addiction. When I look back through the stories in which I’ve quoted him, his kindness and sympathetic nature come through in every sentence. For example, in an article about New Year’s resolutions and staying on the wagon, this is what Marlatt said about dealing with relapses:

For starters, don’t berate yourself for being weak. Instead, tell yourself, “I made a mistake. What can I do differently next time? How can I learn from this?” says Marlatt. “This happens to almost everybody. It’s not just you.”

One of the most common mistakes addicts make is focusing on whether they are strong enough to change rather than on specific methods of coping. “It’s like trying to ride a bike,” says Marlatt. “You make mistakes and learn, and you don’t give up if you don’t immediately find your balance.” If the bicycle is missing a wheel or is otherwise broken, then it requires fixing — simply willing it to work is not going to help you ride.

Also, says Marlatt, “most people think that if they have urges or cravings, there’s something wrong, that you’re not supposed to have them.” In fact, they are a normal part of habitual behavior. “Notice and accept them.”

In a world so often focused on “treating” addiction with tough love, Marlatt showed through his work and his life that kindness simply works better. R.I.P., Alan: you are already missed.

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