Behavioral Treatment of Alcohol Problems: Individualized Therapy and Controlled Drinking (The Plenum Behavior Therapy Series)

Ideas about the nature of alcohol problems have been undergoing dramatic change over the past several years. This book summarizes the clinical research we have conducted over the past eight years; research which has evoked controversy and which, we hope, will be evaluated as having been influential in the development of a scientific approach to the clinical treatment of alcohol problems. Although we reference many studies from the general behavioral literature on alcohol problems, we make no pretense of presenting a thorough review of that literature. By and large, this book focuses on the research we have conducted, the rationale for that approach, and a detailed discussion of methods and results which cannot be presented in journal articles. The book begins by giving the reader a perspective on traditional concepts in the alcohol field, and why those concepts are now being challenged. Within that conceptual framework, we then trace the development and sophistication of our clinical research, presenting for the first time in a single work a complete consideration of the rationale, methods, and results of the study of Individualized Be­ havior Therapy (IBT) for alcoholics. Following a discussion of many of the more subtle aspects of that study and its results, we describe how IBT can be used in an outpatient setting-the setting in which we have conducted clinical research for the last six years.

1 The Nature of Alcohol Problems.- Traditional Concepts of Alcohol Problems.- Alcoholics Anonymous.- Jellinek’s Disease Concept of Alcoholism.- A Conceptual Reformulation.- Differences between Traditional and Empirically Derived Concepts.- Conclusion.- 2 Alternatives to Abstinence: A Departure from Tradition.- “Once an Alcoholic, Always an Alcoholic!”: Tradition Contradicted.- A New Look at an Old Problem.- Individualized Behavior Therapy (IBT): A Nontraditional Approach.- Traditionalists Respond to the Mounting Evidence.- Nonproblem Drinking Outcomes: Unexpected Consequences.- Conclusions and Cautions against Misinterpretation.- 3 The Functional Analysis of Drinking Behavior.- A Functional Analysis Model of Drinking Decisions.- What Constitutes a Drinking Problem.- A Detailed Consideration of the Model.- Implications: Strategies for Intervention.- Further Considerations.- 4 The Early Patton Studies: An Empirical Foundation.- The Research Setting, Circa 1969.- Baseline Drinking Behavior.- Videotape Self-Confrontation: A Demonstration of the Value of Scientific Method in Clinical Research.- Modifying Drinking Behavior.- Reinterpreting the Adage: “First Drink, Then Drunk”.- Evidence for a Learning Deficiency.- Integrating the Early Research.- 5 Individualized Behavior Therapy (IBT): A Broad-Spectrum Behavioral Approach.- Experimental Design.- Subjects.- Assignment to Experimental Conditions.- Treatment Procedures.- Facilities.- Overview.- Modification of the Drinking Response—Avoidance Contingencies.- Videotaped Drinking: Sessions 1 and 2.- Education: Session 3.- Videotape Replay: Sessions 4 and 5.- Analogue Failure Experience: Session 6.- Problem Solving Skills Training: Sessions 7 through 16.- Videotape Contrast and Summary: Session 17.- 6 IBT: Emergence of New Treatment Evaluation Measures and Procedures.- IBT Follow-Up Procedures.- Tracking Procedures.- IBT Outcome Measures: Drinking Behavior.- IBT Adjunctive Outcome Measures of Life Health.- General Adjustment.- Vocational Status.- Occupational Status.- Residential Status and Stability Index (RSSI).- Valid Driver’s License Status.- Marital Status.- Use of Therapeutic Supports.- Possession of Research Program Do’s and Do Not’s Card.- Physical Health Evaluation.- Summary Measures of IBT Outcome.- Length of Follow-Up: How Long is Long Enough?.- A Look Back at IBT Follow-Up And a Look Ahead.- On the Use of Self-Reported Data.- Concluding Comments.- 7 IBT: Results.- Within-Treatment Results.- Nondrinker Experimental (ND-E) Subjects.- Controlled Drinker Experimental (CD-E) Subjects.- Follow-Up Results.- Data Sources.- Drinking Outcome: Functioning Well.- Drinking Outcome: Controlled Drinking.- Adjunctive Outcomes: General Adjustment.- Adjunctive Outcomes: Occupational Status.- Adjunctive Outcomes: Vocational Status.- Adjunctive Outcomes: Residential Stability and Status.- Adjunctive Outcomes: Driving Status.- Adjunctive Outcomes: Physical Health Status.- Adjunctive Outcomes: Marital Status.- Adjunctive Outcomes: Use of Therapeutic Supports.- Adjunctive Outcomes: Ancillary Evidence.- Adjunctive Outcomes: Research Program Card.- General Measures of Treatment Outcome.- Predictors of Treatment Outcome.- Method.- Findings.- Summary of IBT Results.- Within-Session Findings.- Treatment Outcome Findings.- 8 IBT: Interpretation of Results.- Follow-Up Procedures and the Interpretation of Outcome Variables.- The Value of Multiple Measures of Outcome.- Case Example: CD-E Subject J. L.- Case Example: CD-C Subject E. M.- Case Example: ND-C Subject R. N.- Controlled Drinking as an Outcome.- Other Considerations.- A Final Analysis.- 9 IBT in Retrospect.- Specific Treatment Components.- Shock-Avoidance Schedules.- Videotape Replay of Drunken Behavior.- Consumption of Alcohol.- Individual Therapy Sessions.- Control Group Assignments.- Controlled Drinking from the Subjects’ Viewpoint.- Follow-Up as Continued Care.- Care, Interest, Concern, Help.- Someone to Talk to.- Awareness, Reminder.- It Will Help Others and Research Element.- General Likes and/or Dislikes.- Reflections on a Large-Scale Clinical Research Project.- 10 IBT in Private Practice and Outpatient Programs.- Differences between Inpatient and Outpatient Treatment.- General Considerations.- Compliance and Planning Treatment.- Shaping.- Addressing Immediate Treatment Needs.- Outpatient Behavioral Treatment Methods.- Methods Which Primarily Involve Changing the Antecedents or Correlates of Drinking.- Methods Which Primarily Involve Changing Behavioral Repertoires.- Methods Which Primarily Involve Changing the Consequences of Behaviors.- Concluding Comments.- References and Selected Readings.