In Memoriam G. Alan Marlatt 1941–2011

The field of alcohol studies mourns the loss of G. Alan Marlatt, Ph.D., who passed away on March 14, 2011, from kidney failure due to melanoma. A truly creative, courageous, and groundbreaking scientist, he leaves behind an enormous legacy of contributions to the field of addiction research.

Alan was born on November 26, 1941, in Vancouver, British Columbia. He received his bachelor's degree in psychology with honors from the University of British Columbia in 1964 and his doctorate in clinical psychology from Indiana University, Bloomington, in 1968. He taught at the University of British Columbia and the University of Wisconsin before joining the Department of Psychology at the University of Washington in Seattle in 1972. Alan founded the Addictive Behaviors Research Center within the Department of Psychology at the University of Washington in 1981, creating an atmosphere of excellence and a supportive environment within which numerous innovations in the prevention and treatment of addiction were born.

During his 42 years as a clinical and academic psychologist, Alan authored, co-authored, or edited 23 books, including Relapse Prevention (1985, 2005), Assessment of Addictive Behaviors (1988, 2005), Harm Reduction (1998; 2nd edition in press), and Brief Alcohol Screening and Intervention for College Students (BASICS): A Harm Reduction Approach (1999). He also authored or co-authored more than 300 articles and book chapters on theoretical and methodological topics as well as empirical research results regarding the assessment, etiology, prevention, and treatment of addictive behaviors.

Alan's impact on the addiction field was widely recognized, and he received numerous prestigious awards. These included, among others, the Jellinek Memorial Award (1990), a MERIT Award from the National Institute on Alcohol Abuse and Alcoholism (NIAAA; 1990–2000), a Research Scientist Award (K05) from the NIAAA (1987–2008), the Annual Research Award from the Society of Psychologists in Addictive Behaviors (1991), the Distinguished Scientist Award from the Society for a Science of Clinical Psychology (2000), an Innovator's Award from the Robert Wood Johnson Foundation (2001), the Network of Colleges and Universities Committed to the Elimination of Drug and Alcohol Abuse Visionary Award (2002), the Distinguished Researcher Award from the Research Society on Alcoholism (2004), the Harriet Tubman Freedom Award for Outstanding Community Activism and Lifetime Achievement to Improve Health (2007), the Distinguished Scientific Contribution Award from the Division of Clinical Psychology from the American Psychological Association (2009), and the Lifetime Achievement award from the Association for Behavioral and Cognitive Therapies (2010).

Alan's research had a major impact on understanding the interaction between thoughts, emotions, and situations as predictors of addictive behaviors. His brilliant, productive, and influential career changed how scholars, clinicians, policy makers, and members of the larger society think about alcohol consumption, the problems it causes, and what we can do about these problems at both the clinical and public health levels. From his first alcohol research publication in 1972—a study investigating how alcoholics and social drinkers respond differentially to varied extinction contingencies—to his most recent publications on cognitive approaches to treatment and harm reduction, Alan focused his research career on working to develop an evidence base for helping men and women to overcome the negative social and health problems caused by excessive alcohol use and other addictive behaviors.

Alan's research approaches were pioneering and established a precedent for much of the behavioral alcohol research that followed. For example, early in his career he created the Behavioral Alcohol Research Laboratory (BARLAB)—a simulated bar in the University of Washington Department of Psychology, complete with all the accoutrements of a local tavern in addition to two-way mirrors, hidden cameras, and microphones. He used the BAR-LAB to study the effects of “set” (expectations, thoughts, attitudes) and “setting” (environment, cues) on alcohol use. In addition, to independently study the pharmacological and psychological effects of alcohol on behavioral outcomes of drinking (e.g., becoming more social or outgoing), he developed innovative procedures such as the “Balanced Placebo Design.” First introduced in a study with his colleagues Barbara Demming and John Reid in 1973, this design involved giving participants different instructional sets about the expected content of beverages to be consumed (that they did or did not contain alcohol), crossed by the actual beverage content in a 2 × 2 factorial design. This study, which was designed to assess the differential effects of alcohol administration and expectancy as an experimental analogue of “loss of control drinking,” is Alan's most frequently cited journal article and was featured as a “Seminal Article in Alcohol Research” in the special edition of Alcohol Health and Research World published for the 25th Anniversary of the NIAAA. In this classic study, Alan demonstrated that increased consumption (“loss of control”) following an initial dose of alcohol was not actually due to the pharmacological properties of the alcohol itself but rather to the belief or expectation that the beverage contained alcohol. This finding challenged the prevalent disease model of addiction. The balanced placebo design has since been used in a wide variety of human alcohol administration studies to demonstrate that expectations, rather than pharmacology, are primarily responsible for many social and behavioral effects of alcohol. In his 1973 study, Alan also developed the taste-rating task, which was designed as an unobtrusive measure of ad lib alcohol consumption in which subjects were told that the ostensible purpose of the task was to make comparative taste-ratings among various beverages, sampling each in an ad lib manner during a fixed period. Various independent variables can be manipulated (e.g., expectancy set, stress level, social modeling) to assess effects on ad lib alcohol consumption as the dependent variable. In his early alcohol administration studies, Alan and his students conducted a number of studies designed to investigate the validity of the tension-reduction hypothesis by manipulating stress levels before the assessment of ad lib drinking rates, including threat of shock and fear of interpersonal evaluation.

Alan's interest in social learning theory was applied to alcohol research in several studies designed to assess the role of modeling (exposure to other drinkers who are trained to drink at different rates) as a determinant of social drinking as assessed in a simulated tavern setting (the BARLAB). The results of these studies showed that modeling could serve to both increase and decrease drinking rates among college student drinkers depending on the model.

Alan's research did more than shed light on the psychological mechanisms that led to and maintained problem drinking and other addictive behaviors. One major contribution in the area of treatment has been his analysis of the cognitive and behavioral determinants of relapse in alcohol treatment and the subsequent development of Relapse Prevention as a cognitive-behavioral treatment approach with demonstrated empirical efficacy. In contrast to prevailing attitudes at the time this work began in the 1970s, which focused primarily on biological and pharmacological explanations for relapse, Alan observed that relapse often occurred in interpersonal, intrapersonal, or environmental “high-risk situations,” and that failing to adequately cope with such situations increased the likelihood of relapse. Alan and his students developed and tested the efficacy of a skills-training program as a prototype of the Relapse Prevention approach, which was subsequently elaborated on in an influential treatment text on Relapse Prevention, co-authored with Dr. Judith Gordon and published in 1985. The Relapse Prevention model provided an integrative cognitive-behavioral treatment that has subsequently been widely replicated and adopted in many treatment outcome studies (including Project MATCH). His taxonomy of relapse situations served as the impetus for a special NIAAA research replication project to assess high-risk situations for alcohol relapse. Relapse Prevention is listed on National Registry of Evidence-Based Programs and Practices from the Substance Abuse and Mental Health Services Administration (SAMHSA) and continues to have a major impact on alcohol treatment, in both practice and research settings, as well as in the treatment of a variety of other disorders such as eating disorders and depression.

Alan was also one of the first U.S. advocates of harm reduction, a pragmatic and humane approach to reducing the harms (both individual and societal) associated with addictive behaviors. Harm reduction promotes policies and strategies that serve as an alternative to “zero-tolerance” or abstinence-only approaches and is designed to encourage movement in the direction of reduced harm by meeting addicted individuals “where they're at” and providing flexible options rather than insisting on immediate or total cessation of use. He recognized early on that requiring abstinence as the only treatment goal often deterred substance users from seeking treatment. As Maia Szalavitz wrote in an obituary in Time (March 15, 2011), “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 .... When I look back through the stories in which I've quoted him, his kindness and sympathetic nature come through in every sentence.” Alan's work in this area was also recognized in a Seattle Times obituary by Jim Brunner as having “profoundly changed” attitudes about addiction (March 17, 2011).

Alan's most recent work in the area of harm reduction applied these concepts to the costly and heartbreaking social problem posed by chronic homelessness. In partnership with Seattle's Downtown Emergency Service Center, he and his colleagues demonstrated that provision of permanent supportive housing for severely alcohol dependent, chronically homeless individuals, without requiring abstinence or treatment attendance, was associated with substantial cost savings to the public as well as significant decreases in alcohol use. The housing project, which generated considerable community and media controversy, allowed individuals to continue to drink in their rooms. Results of the evaluation, which was published in the Journal of the American Medical Association in 2009, indicated the project saved taxpayers over $4 million dollars in the first year of operation alone as a result of reduced use of taxpayer-funded crisis services such as emergency medical care, detoxification facilities, sobering centers, and jail.

Alan was also a leader in developing effective prevention programs to reduce harmful drinking by college students. Even before the public health threat posed by excessive drinking on college campuses was widely recognized, Alan and his colleagues were active in research evaluating risk and protective factors for college drinking and adapting the skills training approach pioneered in his Relapse Prevention model for a prevention context. Today his Brief Alcohol Screening and Intervention for College Students (BASICS) approach, which he developed with his colleagues at the University of Washington, is the most widely disseminated, evidence-based approach for prevention and treatment of excessive drinking in college and other young adult populations. BASICS is considered a Tier I intervention for college student drinking by the NIAAA and, like Relapse Prevention, is also listed on SAMHSA's National Registry of Evidence-Based Programs and Practices. Alan also worked to develop prevention programs for diverse and underserved communities. For example, he and his colleagues worked closely with the Seattle Indian Health Board to develop a culturally relevant alcohol prevention program for Native American and Alaska Native youth, entitled “Canoe Journey, Life's Journey: A Life Skills Manual for Native Adolescents.” The manual, co-authored with Dr. June La Marr with contributions from numerous colleagues, draws on the Northwest Native tradition of the canoe journey as a metaphor for life skills. This project has since expanded to additional tribal communities in the Pacific Northwest.

Most recently, Alan's research focused on the integration of meditation techniques with cognitive behavioral relapse prevention skills to help individuals recognize and cope with common triggers for relapse such as depression, anxiety, or environmental cues. This work in many ways represented the culmination of a lifetime of personal and professional interest in mindfulness meditation and spirituality, woven together with the empiricism and scientific rigor inherent in the development of the original relapse prevention model. Alan's initial study of Vipassana meditation with prisoners demonstrated that meditation could reduce cravings and substance use following release from custody. He and his colleagues subsequently demonstrated that mindfulness-based relapse prevention (an 8-week, outpatient group approach incorporating mindfulness meditation practice) was a feasible and efficacious aftercare approach for individuals after they complete intensive treatment for substance use disorders. The mindfulness-based relapse prevention manual that he co-authored with Drs. Sarah Bowen and Neharika Chawla was recently published and the treatment is already being incorporated into substance abuse treatment programs across the United States and internationally.

Although Alan's research and productivity have had a major impact throughout his career, his contributions to the field of addiction transcend his visionary scholarship. Many leading alcohol and substance abuse researchers are former trainees, as are many of the rising stars in the field (the list is too numerous to include). Over the past four decades, an ever-increasing number of students and fellows were drawn to the University of Washington for the opportunity to train with him. It is also not surprising that many senior substance abuse researchers from around the world have journeyed to Seattle to spend months in his laboratory. More generally, it would be impossible to find a clinical or social psychologist in the addictions area who would not claim Alan as a major scholarly influence. He was an inspiration to all who knew him or his work.

Alan's service to the profession is also noteworthy. He served as President of the Association for Advancement of Behavior Therapy (now Association for Cognitive and Behavioral Therapies) (1991–1992), the Section for the Development of Clinical Psychology as an Experimental Behavioral Science (1985–1986), and the Society of Psychologists in Addictive Behaviors (1983–1984). He has served on the editorial boards of more than 30 scientific publications, including the most prestigious outlets in clinical psychology and served as the first Psychology Field Editor for the Journal of Studies on Alcohol. He was also a fellow of several scientific organizations, including the American Psychological Association and the American Psychological Society. In addition, he served as a consultant to numerous research projects throughout the world, generously offering his advice, support, and resources to assist in the common cause of improving services and reducing the harm associated with addictive behaviors. Alan responded personally to every request for assistance, whether from a senior scholar or an undergraduate at any institution in the world, serving as a role model for collegiality.

Although his contributions to the field establish him as a visionary, Alan will be remembered for much more than his scholarly contributions to research, mentoring, and service. He was a generous and kind soul who truly lived by the “Golden Rule.” A deeply loyal friend and colleague, he expected the best of others and gave them the benefit of the doubt—often with the result that they would rise to the occasion, becoming more than they would otherwise have been. He also loved to create opportunities for others and could be counted on to provide a glowing reference, a personal phone call, or a passionate argument in support of those in whom he believed. As his son, Kit, wrote, “He was also a father and grandfather, a husband, a lover, a teacher, a Buddhist. He loved moments of peace and quiet, the gathering of friends and colleagues and moments of joy. He laughed with a twinkle in his baby-blues. He was a writer, a mentor and a muse. He played piano and had a deep love of music.”

Alan passed away peacefully, surrounded by his family, at his beloved retreat on the Puget Sound. He is survived by his wife Kathryn (Kitty) Moore, his son Christopher Alan (Kit) Marlatt, his daughter-in-law Ashley Rachel Marlatt, his half-brother Robert Whitehead, his step-daughters Melanie and Charlotte Miller and Iara Cotrim, his step-son Colin Maclay and Colin's wife Rachel Hunt, step-granddaughters Amanda and Seraphina White and Hazel Maclay, his grandson Aidan-Jack Marlatt, and more than 100 “best friends.” The field has lost a gentle giant, and he will be sorely missed.

Helene R. White, Ph.D.
Rutgers University, Piscataway, NJ

Mary E. Larimer, Ph.D.
University of Washington, Seattle, WA

Kenneth J. Sher, Ph.D.
University of Missouri Columbia, Columbia, MO

Katie Witkiewitz, Ph.D.
Washington State University-Vancouver, Vancouver, WA