following patient and treatment process factors have been significantly and repeatedly related to favorable outcomes.

         

      Patient variables associated with better outcome from rehabilitation included:

        a.  

        low severity of dependence,

        b.  

        few psychiatric symptoms at admission,

        c.  

        motivation beyond the precontemplation stage of change,

        d.  

        being employed or self supporting, and

        e.  

        having family and social supports for sobriety.

             

          Treatment variables associated with better outcome from rehabilitation included:

            a.  

            staying longer in/ being more compliant with treatment—especially through behavioral contracting for positive reinforcement;

            b.  

            having an individual counselor or therapist;

            c.  

            having specialized services provided for associated medical, psychiatric, and/or family problem;

            d.  

            receiving proper medications—both for psychiatric conditions and anticraving medications; and

            e.  

            participating in AA or NA following treatment.

                 

              In contrast to the above findings, it was surprising that some of the treatment elements that are most widely provided in substance abuse treatment have not been associated with better outcome. For example, our review of the literature has shown little indication that any of the following lead to better or longer lasting outcomes following treatment:

                a.  

                alcohol/drug education sessions;

                b.  

                general group therapy sessions, especially "confrontation" sessions;

                c.  

                acupuncture sessions;

                d.  

                patient relaxation techniques; and

                e.  

                treatment program accreditation or professional practice certification criteria.

                     

                  For the sake of brevity, studies of these five interventions were not described above. These findings are generally in accordance with a review of the alcohol rehabilitation field by Miller and Holder (1994), which concluded that there are a number of therapeutic practices and procedures that remain prevalent in the field that have not yet shown indication of success. It is important to note that "the absence of evidence" does not



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