An evaluation of two contrasting alcoholism treatment programs



Journal Title

Journal ISSN

Volume Title



In light of the increasing number of inpatient alcoholic treatment programs based, on behavior therapy; paradigms, numerous investigators have observed the need for methodologically sound research comparing this more recent treatment approach with traditional psychotherapeutic Interventions. The present investigation systematically explored the comparative effectiveness of these two conceptually divergent treatment approaches. Forty-eight alcoholic patients were treated at the VAH, Houston, Texas. Twenty-seven patients (experimental group) participated in a one month 'broad spectrum' behavior therapy treatment program. Covert conditioning techniques and action therapy (psychodrama) were employed concommitantly for three hours per day. Patients were treated in three groups, the groups ranging in size from 6 to 11. The remaining 21 patients (comparison group) participated in a traditional group psychotherapeutic treatment program. Comparison patients were treated three hours a day for one month, and were also members of one of three therapeutic groups, ranging in size from 5 to 8. Each month only one program was maintained. Programs alternated months of operation across a six month time period. Patients were housed and treated on the same ward. Participation in the programs was voluntary and there was no difference in the willingness of patients to participate in the two types of programs. There were two primary areas of program evaluation involved in this research project—a process evaluation which is the area of investigation for this dissertation, and a three month follow-up evaluation which will be presented by Mel Gallen. Both programs were designed with evaluation as a primary factor in the planning and implementation stages of the program. A comprehensive description of the population of patients in the research project was developed by using data gathered primarily from a taped interview which was administered to each patient by one of the primary investigators. Because patients could not be randomly assigned to the two treatment programs, they were compared in terms of social and personal characteristics, pre-hospital employment, income and responsibilities for self and others, as well as pre-hospital alcoholic consumption and. factors related, to drinking. There was a noticeable variation between groups in occupations and amount of income earned over the three months prior to hospitalization, with the experimental group having more individuals employed in better paying jobs. There was no appreciable differences between groups in terms of amount of ethanol consumed, symptoms associated with drinking or any other parameters examined. Each program was carefully described. The primary emphasis wad placed on describing the experimental program, both action therapy and self-control training. There were several modifications in the administration of the covert conditioning but all other aspects of both programs were primarily executed as they had been designed. Both programs had an exceptionally low drop-out rate and were equally capable of maintaining the physical involvement of patients. The lack of differences in attendance, drop-out rates, absenteeism or tardiness suggests that all aspects of both programs were well accepted by the patients. Active participation as well as movement through identified therapeutic units were the immediate goals of action therapy. There were only seven individuals classified as low participants and only two individuals who did not progress beyond the most basic therapeutic unit. The immediate goal of relaxation training was to teach patients to relax. In the judgment of the experimenters every subject improved greatly in their ability to relax during this phase of self-control training. Self-report information regarding the participant’s ability to imagine covert scenes was the only source of data collected to assess the immediate goal of covert conditioning. There were only three individuals who reported they were unable to imagine the negative consequences of taking a drink and, therefore, were considered unable to successfully attain the immediate goal of covert conditioning. The immediate goals of the psychotherapy program were to involve the patients and for this involvement to be relevant to the group process. There were only two individuals who received scores which placed them in the low category for relevancy and six individuals who were classified as low in regard to activity level scores. In addition to establishing the Immediate goals of each aspect of treatment and placing Individuals In categories depending on their ability to attain the Immediate goals, Individuals were also rated as to the amount of benefit they received from the programs. Correlations between benefit ratings and participation parameters revealed that the patients1 perceptions of benefit received In action therapy were primarily a positive function of active participation. In group psychotherapy both the group and the therapist saw the relevancy of the individual’s comments In group as related to the amount of benefit received. Relationships were established between measures of Involvement In all treatment modalities and age, educational level and I.Q. Age was not related to any measurement of involvement and educational level was only related to activity level In the psychotherapy treatment groups. I.Q. was positively related to amount of participation In action therapy and to both activity level and relevancy In group psychotherapy. The reported ability to Imagine was not significantly related to any of the characteristics examined here. When exceptionally high and low performance Individuals were identified, for each treatment procedure, characteristics that might contribute to their performance were examined. The only characteristic that distinguished between high and low performers was I.Q.; often those who were identified as low performers also had low I.Q. scores. It appears that for both programs individuals with low I.Q.'s may be questionable candidates for the programs, although this is not a completely reliable indicator as some individuals with low I.Q.'s were capable of meeting the goals of treatment. This research indicates that both types of programs were appropriate for a wide range of individuals. Whether or not there exists any relation between the attainment of the immediate goals of treatment as presented in this dissertation and the long range goals will be determined by the three month follow-up study.



Alcoholism, Treatment, Evaluation, Alcoholism counseling