A follow-up evaluation of two contrasting alcoholic treatment programs

The effectiveness of a treatment program for alcoholism based on behavior therapy paradigms was compared with a program utilizing a more traditional treatment approach. Fortyeight alcoholic patients were treated at the VAH, Houston, Texas. TWenty-seven Ss (experimental group) participated in a one month 'broad spectrum' behavior therapy treatment program, in which covert conditioning techniques and action therapy (psychodrama) were employed for three hours per day. Subjects were treated in three groups ranging in size from 6 to 11. Twenty-one Ss (comparison group) received group psychotherapy three hours per day for one month. They were also treated in three groups which ranged in size from 5 to 8 patients. Each month only one program was run, and programs alternated months of operation over a six month period. Subjects were housed and treated on the same ward. A three month in-community follow-up interview with each patient and a collateral informant indicated that both experimental and comparison group Ss demonstrated significant pre-post improvement on measures of drinking behavior, vocational adjustment, symptoms associated with alcoholism, incidence of socially disruptive behavior, and use of community supports. In both groups, approximately 45% of the Ss were totally abstinent from alcohol during the 90 day follow-up period, 15% engaged in minimal, non-problem drinking, 15% engaged in extensive, non-bout drinking, and 25% engaged in clear problem or bout drinking. Measures of amount of alcohol consumed and functioning in other areas were assessed and showed a tendency for comparable improvement between groups. In addition to evaluating the comparative effectiveness of the two treatment programs, several analyses were conducted to explore the relationship between subject and treatment variables and therapeutic outcome. More specifically, the relationship between characteristics of alcoholics (subject variables) and degree of improvement was studied for both treatment groups. Eighteen variables found to be useful in discriminating between outcome categorizations in similiar investigations were correlated with degree of improvement. It was found that for comparison Ss, married Ss with an occupational skill, a higher IQ, and fewer arrests during the three months prior to treatment demonstrated greater total change than unmarried Ss, unskilled workers, Ss with lower IQs, and Ss reporting a greater number of arrests. For experimental Ss, none of the relationships studied attained statistical significance. The relationship between parameters of participation during treatment (treatment variables) and therapeutic outcome was also studied for both treatment groups. For both treatment programs, measures of participation during treatment were unrelated to degree of improvement during the 90 day follow-up period. For behavioral Ss, both total participation and unit level achieved during action therapy were unrelated to total change, even though the data were analyzed in various ways in attempts to identify such relationships. Similiarly, for comparison Ss, both relevancy of Ss' responses during group therapy and amount of participation were unrelated to total change, again in spite of analyzing the data in different manners in attempts to identify emergent relationships. Moreover, for both treatment groups the relationships between patient, group, and therapist ratings of benefit and actual benefit (in-community behavior) were studied. Again, no significant correlations were observed. Finally, for behavioral Ss, several measures were used to study both the relationship between degree of imaginal vividness and covert conditioning efficacy and the relationship between amount of practice of covert conditioning subsequent to treatment and posttreatment drinking behavior. It was found that degree of imaginal vividness, both in terms of stimulus components leading up to drinking and imagining UCS parameters, was, for the most part, unrelated to changes in parameters of drinking behavior subsequent to treatment. Where significant relationships were observed, Ss with poorer imaginal skills resumed drinking later after treatment and consumed less alcohol. It was also found that both practice versus no practice of covert conditioning scenes after treatment and frequency of practice were unrelated to degree of improvement.