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Articles, News and Blog

"The Sad Death of My Friend, Audrey Conn Kishline"





In their purest form, depression and suicide have plagued both 12 step abstinence programs and the harm reduction movement--i.e. the tragic suicide of Audrey Conn, author and supporter of Moderation Management as well as former long time member of Alcoholics Anonymous.  Audrey committed suicide last December, 2014.

As some harm reductionists did with Robin Williams, could people point blame at Moderation Management or Alcoholics Anonymous for the suicide?

I see this as a call for more treatment choices.   The time is way overdue for behavioral health professionals to channel our efforts into developing new programs within the spectrum of behavior modification.

  



Addiction, Drunk Driving, and Suicide:  The Struggles of Audrey Conn, Founder of 'Moderation Management'

By Gabrielle Glaser
1-11-2015

Audrey Conn founded Moderation Management as an alternative to A.A. In December, almost 15 years after killing a father and daughter while drunk driving, Conn killed herself.

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 Daniel Maloy 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.

Two months later, with a blood alcohol level three times the legal limit, Conn drove the wrong way down a highway in Washington State.  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.  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.

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.”

Audrey Conn founded Moderation Management as an alternative to A.A. In December, almost 15 years after killing a father and daughter while drunk driving, Stern and Malloy-Davis reported that Conn killed herself.

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 Daniel Maloy 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. 

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.

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.

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.”


Scott Stern, a Manhattan psychotherapist who was a friend and colleague of Conn’s, said her death highlights the need for a variety of scientifically proven treatment options.


“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 AA 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 AA 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 moderate drinking.com, in its national registry of evidence-based treatment programs. AA is not included.


While neither MM nor AA 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.”




4 Comments to "The Sad Death of My Friend, Audrey Conn Kishline":

Comments RSS
Victor Mc Cormack on Thursday, April 23, 2015 4:46 AM
Thank you very much for this post. Moderation Management is new to me and it is very interesting to read about other people's/organizations viewpoint about alcohol addiction and recovery. Having been down the road myself I can identify with Audrey Conn's struggle. It is very sad that ending her own life was the only way out for her. I do agree wholeheartedly with dr Tatarsky that the emotional issues which lead to excessive drinking in the first place should be addressed in the process of alcohol rehabiliation.
Reply to comment


Scott W. Stern on Monday, April 27, 2015 8:19 PM
I concur with Dr. Tatarsky. I don't believe in merely treating a diagnosis (i.e. substance use disorder - severe), it is crucial to treat co-occurring disorders as well. We are treating whole people, not isolated ailments. Thank you for your comment and empathy.
Reply to comment


Patrick Neeser on Tuesday, March 22, 2016 10:19 PM
I am a Clinical Social Worker and have worked in the AUD treatment field for 25 years. I currently have 38 years of total abstinence.The last ten years I have focused on physicians who have been mandated to a five year program of monitored recovery. In addition to the urinalysis and AA meetings my group psychotherapy has proven to be absolutely necessary to the 95% success rate of participants at five years. Abstinence is required. I am convinced by my clinical experiences that moderate to severe alcohol use disorderd people must seek abstinence as the end goal. Without this commitment many fail at sobriety where they would otherwise succeed and live long and fulfilling lives. The cravings brought about by using alcohol at any level lead inevitably to a full blown relapse. The cravings are the demon here and are predictable when continuing to use alcohol in any amount. Sorry, MM just doesn't work for this population.
Reply to comment
 
Scott W. Stern, Psychotherapist/Empowerment Professional on Wednesday, March 23, 2016 6:06 PM
Patrick, your experience may be quite different from the norm. How do you define and measure your 95% success rate? Do you track your patients after treatment? Extensive research from 12 Step Treatment Programs such as The Hazelden Betty Ford Foundation, Department of Health and Human Services, the ONDCP and ASAM have presented findings that of patients who completed treatment, only 5% continued to attend 12 Step Programs and remained abstinent for one year or longer. No program works for everyone, but a 5% success rate is truly abysmal. Of the many substance users who "succeeded" with Twelve Step Facilitation (TSF) and mutual help support groups, 95% of the millions of substance users in need either drop out, relapse, or avoid seeking help all together. I would agree that MM is not for everyone, but neither is TSF. TSF has helped many, but the majority of substance abusers aren't using it. We need to create as many treatment options as possible to keep substance abusers and the general public safe. Unless you believe TSF works for everyone, which research shows is not the case. In terms of your preference of TSF, it sounds based on your personal experience. But to be fair, it also sounds like you've had little experience with MM or harm reduction treatment.

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