Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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B: Treatment Modalities: Process and Outcome
B: Treatment Modalities: Process and Outcome
Pages 511-549
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From page 511... ...
In an effort to close this gap, the sections below survey research focusing on a number of topics of interest: specific treatment approaches, traditional treatment programs, the intensity and duration of treatment, aftercare, and the treatment process itself. In the final section, the committee presents its conclusions and summarizes the opportunities for further progress in treatment research.
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Relapse prevention strategies have been incorporated into treatment programs. Principles underlying some of these strategies are described in Chapter 3.
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From page 513... ...
Fuller and Williford (1980) , in a urinalysis of a randomized clinical trial, reported that two groups of alcoholics who were given disulfiram showed significantly higher abstinence rates at 12 months, compared with those who were given no disulfiram.
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However, at least one double-blind study found no differences in side effects between disulfiram and placebo groups (Christensen, Ronsted, and Vaag, 1984~. The following questions represent opportunities for research on antidipsotropic medications: .
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It may be useful to combine such pharmacotherapy with psychological interventions designed to enhance motivation and medication compliance. The following questions represent opportunities for research on effect-altering medications: .
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The following questions represents opportunities for research on psychotropic medications: ~ For persons with dual diagnoses (e.g., major depression, bipolar disorder, schizophrenia) , does appropriate psychotropic medication reduce the risk of relapse and improve other aspects of outcome?
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Chemical aversion pairs alcohol with nausea and vomiting induced by emetic drugs. Aversion therapy is a mainstay of alcohol treatment in the Soviet Union and continues to be used in some U.S.
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. The following questions represent opportunities for research on aversion therapies: Does the addition of chemical aversion therapy to an alcohol treatment program significantly improve long-term outcomes?
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The following questions represent opportunities for research on psychotherapy and counseling: Are certain therapies (e.g., cognitive-behavioral therapy) differentially effective in preventing relapse to drinking for persons manifesting concomitant psychopathology (e.g., depression)
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GINO studies reported very poor retention of treatment-relevant information by alcoholics (Sanchez-Craig and Walker, 1982; Becker and Jaffe, 1984~. The following questions represent opportunities for research on didactic approaches: ~ What contributions to treatment outcome are made by educational lectures within the context of a multimodal treatment program?
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From page 521... ...
Systematic outcome research on mutual help groups for alcoholics and their families represents a promising avenue for future study. The following questions represent opportunities for research on mutual help groups: ~ What are the long-term impact and cost-effectiveness of participation in mutual help groups, relative to alternative approaches?
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From page 522... ...
, who also worked with DWI offenders, reported that BSCI resulted ~ significantly reduced consumption, whereas two random control groups showed no change. Four controlled studies offering BSCI' to outpatient problem drinkers and randomly assigning them to abstinence versus moderation goals found no long-term differences in outcome based on the assigned goal (Sanchez-Craig, 1980; Stimmel et al., 1983; Sanchez-Craig et al., 1984; Orford and Keddie, 1986; Graber and Miller, 1988)
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From page 523... ...
, wives of alcoholics who were given eight weeks of treatment showed significantly greater reductions in anxiety and enabling behavior and significantly enhanced self-concepts relative tO a random waiting list control group. Although recent studies provide support for the effectiveness of behavioral marital therapy, current alcohol treatment programs include a much wider range of interventions for couples and families.
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From page 524... ...
Controlled studies with nonalcoholic drinkers have found modest short-term suppression of alcohol consumption through aerobic exercise but not through meditation (Murphy, Pagano, and Marlatt, 1986) , although uncontrolled studies suggest a correlation between the long-term practice of meditation and a reduction in substance abuse (Aron and Aron, 1980, 1983~.
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The following questions represent opportunities for research on broad-spectrum treatment strategies: ~ What broad-spectrum treatment strategies (social skills training, stress and mood management training, etc.) effectively decrease the likelihood of relapse following treatment?
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RESEARCH ON TRAI) ITIONAL TREATMENT PROGRAMS In practice, alcoholism treatment programs in the United States typically offer a combination of modalities that includes detoxification and health care, AA groups, lectures and films, group therapy, individual counseling, recreational and occupational therapy, medication.
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From page 527... ...
These studies exemplify how reported success rates are significantly influenced by the stringency of outcome criteria. Reports of uncontrolled studies pose difficulties in interpretation.
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The following types of studies, which offer opportunities for research on traditional treatment programs, are particularly needed at this time: . evaluations conducted in ongoing treatment settings, involving collaborations of research teams with traditional treatment personnel and programs; ~ specification of the treatment methods and procedures that constitute typical and traditional alcohol treatment programs; ~ evaluations of the effectiveness of generic, traditional treatment procedures as offered by typical U.S.
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From page 529... ...
Even if there is no overall advantage in outcome from longer, more intensive, or hospital-based treatment programs, there remains the question of whether certain subpopulations of alcoholics my benefit differemialb from such approaches. Currently available data are limited but suggest that intensive residential treatment may be warranted for socially unstable individuals (e.g., unemployed or homeless persons; drinkers with more severe psychopathology)
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RESEARCH ON APTERCAR1E Relapse prevention as more broadly conceived includes any intervention that is designed to diminish, forestall, or attenuate relapses following treatment. Program components that are referred to as Aftercare have traditionally been designed to promote this same goal of maintaining gains following treatment.
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From page 531... ...
The Pavlovian learning theory basis of aversion therapies would require the establishment of a conditioned aversion response to alcohol as a precondition for successful outcome. Studies of both chemical aversion (Baker et al., 1984; Cannon et al., 1986' and covert sensitization (Elkins, 1980; Miller and Dougher, 1984)
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From page 532... ...
Self-reports do not necessarily identify the true determinants of outcome, but such inquiries can provide useful leads for further exploration. The following questions represent opportunities for research on the mechanisms of treatment efficacy: ~ For a particular treatment approach (e.g., cognitive therapy, marital/family therapy, AA)
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Still another dimension for exploration is the impact of the therapist's personal history of alcoholism. characteristics: The following questions represent opportunities for research on therapist ~ What role do therapist characteristics (e.g., empathy, self-disclosure, optimism, confrontiveness)
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Uncontrolled studies reflect roughly comparable outcomes among mandated and voluntary participants in treatment (Freedberg and Johnston, 1980~. Yet direct comparisons of mandated interventions with control groups have yielded inconsistent results.
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The following questions represent opportunities for research on motivation, compliance, and mandated treatment: . What interventions, therapist characteristics, or situational factors increase the probability that a problem drinker will enter, continue, and comply with treatment?
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Other currently or previously used treatment methods remain unproved. More than half of controlled clinical trials of alcohol treatment approaches have yielded negative results; that is, no significant differences in outcome among groups.
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A variety of specific alcohol treatment methods have been associated with increased improvement, relative to no treatment or alternative treatments, in controlled studies. Future research should continue to evaluate the effectiveness of alternative current and new treatment modalities.
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Posttreatment problems and experiences have been shown to be important determinants of outcome. Social skills training, marital and family therapy, antidepressant medication, stress management training, and the community reinforcement approach all show promise for promoting and prolonging sobriety.
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From page 539... ...
Graham et al. A controlled trial of relapse prevention procedures based on self~ff~cacy theory.
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Emetic and electric shock alcohol aversion therapy: Assessment of conditioning.
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Longabaugh et al. Adherence in a behavioral alcohol treatment program.
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From page 542... ...
Hall. Relapse prevention and alcohol aftercare: change process, and aftercare attendance.
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Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press, 1985.
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From page 544... ...
Covert sensitization: Alternative treatment approaches for alcoholics. Paper presented at the Second Congress of the International Society for Biomedical Research on Alcoholism, Santa Fe, 1984.
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From page 545... ...
Replieable abstinence rates in an alcoholism treatment program.
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W Health beliefs and compliance with alcoholism treatment.
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From page 547... ...
Random assignment to abstinence and controlled drinking: Evaluation of a cognitive-behavioral treatment program for problem drinkers.
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From page 548... ...
Ellingstad et al. Results of a longitudinal evaluation of court-mandated DWI treatment programs in Phoenix, Arizona.
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From page 549... ...
Length of stay, neuropsyehological performance, and aftercare: Influences on alcohol treatment outcome.
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