Practical Approaches to Alcoholism Psychotherapy-

Sodetal attitudes toward alcoholism are characterized by several types of denial, with disastrous personal and sodal consequences. Refusal to admit the extent of alcoholism as a major national health problem leads to a public policy which allocates relatively few resources to research, prevention, treatment, or rehabilitation. On an individual basis, the combination of sodally approved drinking and the stigma assigned to the chronic alcoholic results in individuals blinding themselves to the existence of the problem in family, friend, and self until it has reached such an advanced or obvious degree that denial is no longer possible. There is the third kind of denial, exemplified by therapeutic de- spair, which proclaims thatgaps in knowledge of the cause of alco- holism are so great and failures to treat alcoholics successfully so dra- matic that there is no assurance that efforts will lead to a positive outcome. This denial is perhaps the most troublesome because it re- flects an attitude of therapeutic helplessness. It discourages families from seeking help, and it reinfOlces the tendency of physidans and other human-services workers to overlook the presence of alcoholism as they treat its physical, sodal, and economic consequences. Denial frequently surrounds those who treat alcoholics with an aura of hope- lessness, which itself is a negative therapeutic force.

Theoretical Considerations.- 1 Principles of Alcoholism Psychotherapy.- Psychodynamics of the Alcoholic.- Treatment of Alcoholism.- Sociopsychological Factors Affecting Psychotherapy.- The Treatment Process.- Summary.- References.- 2 Working with the Preferred Defense Structure of the Recovering Alcoholic.- The Preferred Defense Structure (PDS) of the Recovering Alcoholic.- Tactical and Strategic Use of the PDS.- Summary and Conclusions.- 3 Critical Issues in Alcoholism Therapy.- Denial versus Premature Self-Disclosure.- Guilt versus Sociopathy.- Self-Blame versus Blaming Others.- Rebellion versus Compliance.- Acting-Out versus Repression.- Obsession with the Past versus Refusal to Consider It.- Indiscriminate Dependency versus Stubborn Independence.- Compulsive Socializing versus Alienation.- Perfectionism versus Inferiority.- Self-Obsession versus Obsession with Others.- Pessimist versus Pollyanna.- Summary.- Techniques of Treatment.- 4 Psychiatric Office Treatment of Alcoholism.- Methodology.- Results.- Case Histories.- Discussion.- Summary.- References.- 5 Group Psychotherapy in the Treatment of Alcoholism.- Why Group Therapy?.- Types of Groups in Alcoholism Treatment.- Setting Up the Group.- Goals and Techniques of Group Psychotherapy in Alcoholism Treatment.- Problems in Group Treatment of Alcoholism.- Summary.- Reference.- Suggested Readings.- 6 Psychodrama and the Treatment of Alcoholism.- Why Psychodrama in Alcoholism Treatment?.- The Formal Psychodrama.- Techniques Used in Psychodrama.- Application of Psychodrama Techniques in Alcoholism Education and Treatment Settings.- Case Histories.- Summary.- References.- 7 Behavioral-Modification Methods as Adjuncts to Psychotherapy.- Generalized Habit-Pattern-Disruption Techniques.- Discriminating Sober versus Alcoholic Behaviors.- Resolving the Alcoholic Identity Crisis.- Methods for Achieving Relaxation.- Fear-Reduction Procedures.- Altering Attitudes toward Self.- Summary.- References.- 8 Family Therapy of Alcoholism Celia Dulfano.- Family Therapy.- Family Structure.- The Influence of Alcoholism on Family Structure.- Family Therapy in Cases of Alcoholism.- Case Histories.- Discussion.- Conclusion.- References.- 9 Treatment of the Significant Other.- Getting Inside the Four Walls.- The People Living Inside the Four Walls.- The Treatment Plan: a Change in the Dance Steps, or Stop the Clock.- Touch System.- Summary.- References.- 10 The Folk Psychotherapy of Alcoholics Anonymous.- The Sponsor in AA.- An Empirical Investigation.- References.- Treatment of Specific Populations of Alcoholics.- 11 The Psychotherapy of Alcoholic Women.- Characteristics of Women Alcoholics.- Evaluation of Alcoholic Women.- Psychotherapy of Alcoholic Women.- Case Histories.- Conclusion.- References.- 12 Treatment of Socioeconomically Deprived Alcoholics.- Treatment Approaches: Black Alcoholics; Puerto Rican Alcoholics.- Evaluation of Treatment Outcome in Socioeconomically Deprived Alcoholics.- Discussion.- Summary.- References.- 13 Psychotherapy of Adolescent Alcohol Abusers.- Characteristics of Teenage Alcohol Abusers: Some Implications for Treatment.- Problems Encountered in the Treatment of Adolescent Alcohol Abuse.- Persons to be Excluded from Treatment.- Treatment of Choice.- Group Treatment Techniques.- Problems Arising within the Group.- Summary.- References.- 14 Psychosocial Treatment of Elderly Alcoholics.- Classification of Elderly Alcoholics.- Psychosocial Factors in Geriatric Alcoholism.- Psychosocial Treatment Techniques.- Location of Treatment Programs.- Applying the Concepts of the Therapeutic Community to the Elderly.- Use of Alcohol in Institutions.- Summary.- References.- Clinical Evaluation of Patient Progress.- 15 Evaluation of Patient Progress.- Inpatient Evaluation.- Outpatient and Follow-Up Evaluation.- References.- Suggested Readings.