1) Robson RAH, Paulus I, Clarke GG (1965). An evaluation of the effect of a clinic treatment program on the rehabilitation of alcoholic patients. Quart J Stud Alc 26:264-78. Two matched groups post hoc, consisting of 200 alcoholics treated in outpatient settings. Half attended one to four sessions (aver 2.5) and half five or more (aver 16). The had similar abstinence rates at follow-up of 10 to 46 months, although those in longer treatment showed greater overall improvement and greater reduction in severity of drinking. For those going to AA, the length of outpatient treatment was unrelated to improvement.

2) Edwards G, Guthrie S (1967). A controlled trial of inpatient and outpatient treatment of alcohol dependence. Lancet i:555-9. No difference for 40 patients randomly assigned to an average of nine weeks of in-patient vs. an average of 7.5 visits of out-patient care with 6 month and 12 month follow-up for drinking and social adjustment measures although trends favor the outpatients. Inpatients showed greater use of the hospital during follow-up.

Ritson B (1968). The prognosis of alcohol addicts treated by a specialized unit. Brit J Psychiatry 114:1019-29. No difference in-patient and out-patient care.

3) Pittman DJ, Tate RL (1969). A comparison of two treatment programs for alcoholics. Quarterly J Stud Alc 30:888-9. Providing aftercare did not have any significant effect on patient drinking altho it helped psychosocial recovery. Pittman DJ, Tate RL (1972). A comparison of two treatment programs for alcoholics. Int J Add 18:183-93. They randomly placed 255 alcoholics into either 3-6 weeks of inpatient plus aftercare with outpatient visits and AA vs only 7 to 10-day detox. At 12 months (95% contacted) no difference were found on measures of health or employment. Four deaths were reported in the inpatients vs one in the controls. No significant difference in abstinence or reduced drinking was found.

4) Kissin B, Platz A, Su WH (1970). Social and psychological factors in the treatment of chronic alcoholism J Psychiatric Research 8:13-27. They assigned 458 alcoholics to four alternatives: outpatient drug treatment, outpatient psychotherapy, inpatient rehabilitation, or no treatment. Random assignment was violated by allowing inpatients to opt out to either outpatient, an option exercised by two third of those clients. All treatment appeared better than no treatment, no substantial differences appeared among treatments over 12 months follow-up. The follow-up rate was only 49%.

5) Kish G (1971) J Stud Alc. No difference between a 56 day and 90 day treatment in one year follow-up.

6) Gallant DM, Bishop MP, Mouledoux A, Faulkner MA, Brisolara A, Swanson WA (1973). The revolving-door alcoholic: An impasse in the treatment of the chronic alcoholic. Arch Gen Psych 28:633-5. 210 alcoholics were randomized to inpatient vs outpatient but they failed to locate 92% of their sample at 12-month follow-up. Although there were no significant differences, the poor follow-up means their results are uninterpretable.

7) Willems P, Letemendia F, Aroyave F (1973). A two-year follow-up study comparing short with long stay in-patient treatment of alcoholics. Brit J Psychiatry 122:637-48. No difference between long-stay 3 month (8-26 weeks) inpatient vs short-stay ( up to 4 week) inpatient with two year follow-up. 69 patients with 97% contacted. Differences in abstinence plus improved cases favored the shorter care but not statistically significant. There was very slightly more abstinence for the longer stay patients at 12 months.

8) Hedberg (1974) J Behav Ther Exp Psych (Dec.). Family therapy did best. All out-patient treatments.

9) Wanburg KW, Horn JL, Fairchild D (1974). Hospital versus community treatment of alcoholism problems. Int J Add 3:160-76.

10) Miller, P (1975) Arch Gen Psych (July). Chronic public offenders in Jackson, Mississippi were given lodging, cigarettes, and the opportunity to work with Manpower type services. If they were found to have drunk alcohol, they were suspended for five days and had to sober themselves up to regain admission. Arrests decreased 80% and work increased 300% (3 hours to 12 hours per week) vs controls

11) Mosher V, Davis J, Mulligan D, Iber FL (1975). Comparison of outcome in a 9-day and 30-day alcoholism treatment program. J Stud Alc 36:1277-81. They randomly assigned 200 alcoholics to 3 weeks of inpatient after 9 days of detox or no further inpatient, i.e. 9-day vs 30-day. All were assigned outpatient care. No significant differences were found for abstinence, drinking time, work status, drug use, or anxiety at 3 months (91% contacted) or 6 months (82% contacted). Patients assigned to continued inpatient care thought it of value and only 3% dropped out.

12) Stein LI, Newton JR, Bauman RS (1975). Duration of hospitalization for alcoholism. Arch Gen Psychiatry 32:247-52. No difference between long-stay impatient vs short-stay impatient. 58 alcoholics were randomly assigned after detox treatment to aftercare or 25 day inpatient program of milieu, AA, psychotherapy groups, OT, RT, and lectures plus aftercare. No significant difference were found at 2,4,7,10, or 13 months including drinking, readmissions, psychological status, and life adjustment.

13) Azrin NH (1976). Improvements in the community reinforcement approach to alcoholism. Behav Res Ther 14:339-48. A behavioral program did better than lesser treatment controls. Although this innovative behavioral and community intervention program is one of the few to show some success, it is virtually unused in standard treatment according to Miller (86).  The degree of Azrin success in various studies has been hard for others to replicate.

14) Orford J, Oppenheimer E, Edwards G. (1976). Abstinence or control: the outcome for excessive drinkers two years after consultation. Behav Res Ther 14:409-18. Found a single session as effective as a more intensive approach.

Edwards G, Orford J, Egert S, Guthrie S, Hawker A, Hensman C, Mitcheson M, Oppenheimer E, Taylor C (1977). Alcoholism: A controlled trial of "treatment" and "advice." J Stud Alc 38:1004-31. Two groups of 50 alcoholics each received either one counseling session or several months of in- and outpatient treatment. One year later there were no significant differences in outcome between the two groups on drinking, subjective ratings, social adjustment, but the treatment patients spent significantly more time back in the hospital (24 days vs 5 days) and missed more time off work. There was no difference at 12- or 24-month follow-up with 94% and 75% contacted.

15) Scoles P, Fine EW (1977). Short-term effects of an educational program for drinking drivers. J Stud Alc 38:633-7. The researchers found that DUI offenders' mean scores on two measures of alcohol impairment decreased over a 30-month period, there being a similar decrease in both treatment and control groups.

15) Smart RG, Finley J, Funston R (1977) So some alcoholics do better in some types of treatment than others? Drug and Alc Abuse 3:65-76. Random assigned 114 detoxed alcoholics into outpatient, halfway, or inpatient. Patients were permitted to choose another assignment or refuse treatment. Only 60% entered treatment. At 6 months, none of the halfway clients were successful, 25% of inpatients, 50% of outpatients, and 50% of refusers.

? Smart (1977) Am J Drug & Alc 102 patients after detox referred to long stay farm, half-way, or no referral and no difference in drunkenness or re-admission. Another study of 184 after detox referred to hospital treatment or halfway or out-patient or AA. Only 45% arrived at the treatment programs and there was no difference in those that arrived and those that didn't in follow-up. There were no difference between programs although those attending over 10 out-patient sessions did do better. "The rehab potential of treatment facilities may have been oversold."

16) Vogler (1977) J Cons Clin Psychol (Apr). Four different approaches researched, three behavior combos and one alc ed. No difference in outcome for 80 problem drinkers at 1 year follow-up although 2/3 were doing better. Notes that others have found 2/3 do better no matter what and "maybe no treatment should be considered more promising than any other form until further evaluation." Personality made no difference in outcome.

* 17) Chaney EF, O'Leary MR (1978). Skill training with alcoholics. J Cons Clin Psychol 46:1092-1104. A longer program did better than a shorter one.

18) Marlatt (1978) Biofeedback (June). No difference between relaxation, medication or placebo bibliotherapy in the drinking rate of 41 heavy drinking male students.

19) Penk WE, Charles HL, Van Hoose TA (1978). Comparative effectiveness of day hospital and inpatient psychiatric treatment. J Cons Clin Psychol 46:94-101. 48 matched psychiatric patients were treated in day treatment or inpatient and evaluated 2 months after intake. Alcohol abuse was common and followed. Day treatment did better that hospital on employment, social activity, and anxiety reduction. No difference was found for alcohol abuse.

20) Smart RG, Gray G (1978). Minimal, moderate and long-term treatment for alcoholism. Brit J Add 73:35-8. They constructed post hoc matched groups completing one outpatient visit (n = 66), more than one but less than 6 months (n = 133) or more than 6 months (n = 311). At 12-month follow-up no significant difference were found, although more patients were totally abstinent in the longest treatment group (16%) vs. shorter (11%) vs. one-session (3%).

21) Wilson A, White J, Lange DE (1978). Outcome evaluation of a hospital-based alcoholism treatment program. Brit J Add 73:39-45. 45 alcoholics received inpatient and 45 were randomly sent to programs in the community. The outpatients did better in self-concept, general adjustment, and reduction in symptoms of alcoholism at 5-month follow-up (64% located). These difference were no longer significant at 10 months and 15 months

22) Annis HM, Liban CB (1979) A follow-up study of male halfway-house residents and matched nonresident controls. J Stud Alc 40:63-9. Used official records to match 35 alcoholics entering halfway houses with 35 others receiving only detox. At three month follow-up after treatment there was no difference in drunkenness frequency. Those in halfway-house were more likely to return to detox but less likely to be arrested for drunkenness.

23) Hamilton JR (1979). Evaluation of a detoxification service for habitual drunkenness offenders. Brit J Psychiatry 135:28-34. A random assignment study of 100 patients with half sent home after arrest for public intoxication and the other to detox. Detox patients had a 59% increase in days in the hospital (primarily for detox) vs. a 21% decrease. Detox had more future admissions for detox and court cases (60% vs 30%). No difference was found in employment or death rate.

24) McCrady B (1979) Add Behav. Compared joint admission vs. couples vs. individual and all three groups improved at 6 months. Concludes that there is no advantage to joint admission.

25) Ogborne (1979) J Stud Alc (Jan). 6 months of counseling vs no treatment for Skid Row alcoholics found no difference in life styles or drinking behaviors.

Ogborne A (1979) Br J Add (Sept). Detox treatment averaged 6 weeks with 1/4 breaking the rules and 1/2 disappearing. In follow-up they had a 100% increase in detox admissions and results were unrelated to length of stay. "Empirical evidence and common sense suggests that significant rehab of public inebriates through detox centers is a rare phenomenon."

26) Page RD, Schaub LH (1979). Efficacy of three- versus five-week alcohol treatment program. Int J Add 14:697-714. No difference at the Walla Walla VA in Washington for 86 alcoholics randomly assigned between 3 week and 5 week treatment with 6 month follow-up in measures of self- and collateral-reported drinking and MMPI profiles.

Ritson (1979?) Am J Psychiatry (Dec). Says only 10% of alcoholics use existing resources anyway and this dampens hope that new treatment will make any difference.

27) Stinson DJ, Smith WG, Amidjaya I, Kaplan JM (1979). Systems of care and treatment outcomes for alcoholic patients. Arch Gen Psychiatry 36:535-9. A Univ of Illinois, Rockford study of intensive vs peer in-patient (i.e. varied ratio of staff to patients) and out-patient network vs none with a randomized assignment of 466 alcoholics found no clear differences although the peer did better at 18 months with a 86% contract rate. The value of in-patient treatment is questioned. Extensive out-patient treatment with halfway house available of no addictive value. Looked at Global assessment, employment, social functioning and drinking.

Finney J, Moos R, Mewborn C (1980). Post-treatment experiences and treatment outcome of alcoholic patients six months and two years after hospitalization. J Cons Clin Psychol 48:17-29. Providing aftercare did not have any significant effect on patient drinking altho it helped psychosocial recovery.

Kish G (1980) J Stud Alc. No difference between a 60 day and 84 day VA treatment with a 6 month follow-up.

28) Miller WR, Taylor CA (1980). Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers. Add Behav 5:13-24. No differences were found between alcoholics randomly assigned to a minimum contract self-directed behavioral approach and 10 weeks of therapist-directed sessions with 24 months of follow-up.

29) Miller WR, Taylor CA, West JC (1980). Focused versus broad-spectrum therapy for problem drinkers. J Cons Clin Psychol 48:590-601. Self-directed treatment with 6 or 18 weeks of randomly assigned outpatient counseling found no differences in improvement rate over 6 to 8 and 24 months of follow-up. Miller WR, Baca LM (1983). Two year follow-up of bibliotherapy and therapist-directed controlled drinking training for problem drinkers. Behav Ther 14:441-8. This report contains the 2-year follow-up data for both above studies.

Swenson PR, Clay TR (1980). Effects of short-term rehabilitation on alcohol consumption and drinking-related behaviors; an eight-month follow-up study of drunken drivers. Int J Add 15:821-38. DWI offenders were tracked for a number of months and the researchers found that treatment had no differential effect on alcohol consumption and drinking related behaviors of problem drinkers or social drinkers. Not clear if any controlled research aspect.

30) Miller WR, Gribskov CJ, Mortell RL (1981). Effectiveness of a self-control manual for problem drinkers with and without therapist contact. Int J Add 16:827-37. 31 problem drinkers were randomly assigned to either evaluation plus a single session to explain a self-directed behavioral treatment program or evaluation plus 10 weeks of outpatient counseling using the same methods. Both groups improved with no significant difference.

31) Swenson PR, Struckman-Johnson DL, Ellingstad VS, Clay TR, Nichols JL (1981). Results of a longitudinal evaluation of court-mandated DWI treatment programs in Phoenix, Arizona. J Stud Alc 42:642-53. Univ South Dakota study of DWI treatment workshop of 6 sessions totaling 15 hours vs. Power Motivation Training with 4 sessions of 32 hours vs home-study minimum exposure treatment with random assigned of 351 subject found no difference at 6, 12, and 18 months follow-up for alcohol use, abuse, and abstinence. The authors say that finding "raises doubts of effects of short-term treatment of DWI". All groups showed some, but not dramatic, improvement.

32) Azrin NH, Sisson RW, Meyers R, Godley M (1982). Alcoholism treatment by disulfiram and community reinforcement therapy. J Behav Ther Exp Psych 13:105-12. The treatment was successful but remains virtually unused.

33) McLachlan JFC, Stein RL (1982). Evaluation of a day clinic for alcoholics. J Stud Alc 43:261-72. Day clinic vs 4 week hospital with one year follow-up in a randomized study of 100 patients found both treatment equal. 97 were located at follow-up with no differences on any measure including alcohol or drug use, emotional, suicidal ideation or attempts, marital, or assertiveness. The day clinic clients had 79% fewer days of hospitalization during the follow-up year compared to before treatment vs a 38% increase for the inpatient group.

34) Kristenson H, Ohlin H, Huttlin-Nosslin M et al (1983). Identification and intervention of heavy drinking in middle-aged men: Results and follow-up of 24-60 months of long term study with randomized controls. Alcoholism: Clin Exp Res 7:203-9. A very brief treatment as effective as a more extensive one. The very brief intervention group did better than no intervention.

35) Longabaugh R, McCrady B, Fink E, Stout R, McAuley T, Doyle C, McNeill D (1983). Cost-effectiveness of alcoholism treatment in partial vs inpatient settings: Six-month outcomes. J Stud Alc 44:1049-71. Day hospital of 14 weekdays was randomly compared with in-patient of 14 days in 174 alcoholics following detox. At six months there was no significant differences in drinking, employment, or interpersonal functioning. The day hospital patients reported more subjective well-being and life satisfaction (p<.07). At 24-month follow-up, the day hospital patients showed more abstinence, less negative emotions, and more life satisfaction although at the 24-month point, no significant differences remained (Fink EB, Longabough R, McCrady BM, Stout RL, Beattie M, Ruggieri-Authelet A, McNeil D (1985). Effectiveness of alcoholism treatment in partial versus inpatient settings: Twenty-four month outcomes. Add Behav 10:235-48).

36) Walker RD, Donovan DM, Kivlaha DR, O'Leary MR (1983). Length of stay, neuropsychological performance, and aftercare: Influences on alcohol treatment outcome. J Cons Clin Psychol 51:900-11. 245 alcoholics were randomly assigned to 2 vs 7 weeks of behaviorally oriented inpatient alcoholism treatment. Follow-ups were conducted at three, six, and nine months (88%, 84%, and 78% located). No significant differences emerged on any measure of outcome and the direction of differences favored the group receiving shorter treatment. Improvement was found correlated with participation in outpatient aftercare.

37) Chick J, Lloyd G, Crombie E (1985). Counselling problem drinkers in medical wards: A controlled study. Brit Med J 290:965-67. 731 men admitted to medical wards were identified as problem drinkers without previous treatment. 161 met inclusion criteria and 156 agreed to be randomly assigned to a session of counselling from a nurse while the others routine medical care, i.e. no alcoholism counseling. The very brief treatment was somewhat more effective at one year follow-up than no treatment at all on consumption and problems related to alcohol at one year follow-up as well as on liver function testing.

38) Powell BJ, Penick EC, Read MR (1985). Comparison of three outpatient treatment interventions: A twelve-month follow-up of men alcoholics. J Stud Alc 46:309-12. 174 males were randomly assigned following inpatient alcoholism treatment to (a) medication only, disulfiram and chlordiazepoxide; (b) active support with 100 hours of contact in medication, counseling marital/family therapy, vocational assistance, relaxation training, and urged to go to AA, or (c) brief monthly medical exams. At 12-month, no significant differences were observed on drinking, incarceration, hospitalization, compliance, health, family and employment adjustment, or overall functioning.

Saunders B (1985). Counselling problem drinkers-Research and practice. In: J Lishman (Ed) Research Highlights in Social Work: approaches to addiction pp 45-61. New York, Univ Aberdeen. A very brief treatment as effective as a more extensive one.

39) Buck K, Miller WR (1986). Minimal intervention in the treatment of problem drinkers: A controlled study. (reported in WR Miller, American Psychol 41:794-804. No difference was found between self-directed and therapist-directed change programs, although both produced superior improvement in comparison to two control groups receiving no intervention or self-monitoring only.

40) Eriksen L (1986). The effect of waiting for inpatient alcoholism treatment after detoxification: An experimental comparison between inpatient treatment and advice only. Add Behav. Assigned 17 Norwegian alcoholics after detox to either inpatient or a four-week waiting list with biweekly check-in visits. There was no significant difference between groups on the four postdetox weeks compared to the four posttreatment weeks on drinking, working, sick leave, or institutionalization. Those on the waiting list had a higher compliance with disulfiram. The sample size and dismal outcomes weakens this study.

41) Singh JK, Chapman H (1987). Evaluation of aftercare in alcoholism treatment. New Zealand Med J 100:596-98. A separate but related study to Chapman (1988) of aftercare of the same alcoholics concluded that prolonging treatment does not seem to provide the answer to making treatment more effective. 55 patients either signed a contract to participate in aftercare and were actively followed up if they didn't or were merely encouraged to attend aftercare. The contract did increase attendance in aftercare but made no difference in drinking.

42) Chapman PLH, Huygens I (1988). An evaluation of three treatment programmes for alcoholism: An experimental study with 6- and 18-month follow-ups. Brit J Addict 83:67-81. 133 detoxified alcoholics were randomly assigned to a 6-week inpatient, a 6-week outpatient, or a single confrontational interview. Drinking and general functioning at 6 and 18 months after intake showed no treatment consistently more effective. Those who stay in treatment did not show significantly more long-term improvement than those who refused or dropped out of treatment. Abstinent subjects felt better and there were many positive differences in their apparent lifestyle. Almost half the subjects located had either abstained or were not drinking heavily.

43) Chick J, Ritson B, Connaughton J, Stewart A, Chick J (1988). Advice versus extended treatment for alcoholism: A controlled study. Brit J Addict 83:159-70. A Royal Edinburgh Hospital study of 152 alcoholics were randomly assigned to one session of advice or extended in or out-patient treatment. Two years later, the group who were offered extended treatment were functioning better, in that over the year prior to the independently conducted interview they had accumulated less harm from their drinking than those only treated briefly. Abstinence was not more common however. The simple advice group received only 5 min. of advice. The amplified advice group was a 30-60 min. session. The extended treatment included in or out-patient for 2-4 weeks, group work. AA was encouraged but only one became a regular. Six of the advice group ended up with AA. 21% of the advice only group were determined as treatment failures during the treatment and put into intensive treatment. The social worker agreed to try "social drinking" at some point in 48% of the extended patients. Continuing drinking problems at two years were present in 61% of the advice only groups and 44% of the extended treatment. The extended group did no better as to the amount of drinking in the previous seven days but did have fewer heavy drinking days in the past year. Total abstinence was about equal and low. Employment and family stability was also equal. More extended care patients 22% vs 2% had psychiatric admissions during follow-up (I think. Paper confusing on this point due to apparent erroneous choice of word).

44) Ito JR, Donovan DM, Hall JJ (1988). Relapse prevention in alcohol aftercare: effects of drinking outcome, change process, and aftercare attendance. Brit J Addiction 83:171-81. A study comparing 8 weekly 90 min sessions of aftercare for recently hospitalized alcoholics with 6 month follow-up showed no difference in alcohol consumption, impairment, cognitive coping, drinking days, time to first drink, abstinence, or attendance overall. Seattle VA.

45) Zweben A, Pearlman S, Li S (1988). A comparison of brief advice and conjoint therapy in the treatment of alcohol abuse: the results of the Marital Systems study. Brit J Addict 83:899-916. The study was done at the Addiction Research Foundation of Ontario. It compared the effectiveness of a brief systems-based outpatient treatment program consisting of 8 sessions of conjoint counseling involving both the individual with an alcohol problem and spouse vs. a single 1 1/2 hour treatment session of "Advice Counseling" which also involved the spouse. Random assignment was used. The drinking goal could be defined as either abstinence or moderate drinking. A large variety of assessment measures were used. 55 of 185 couples dropped out of the 8 session treatment prematurely. Both groups showed a reduction in the % of heavy drinking days although there was no difference between the two treatments. At pretreatment both groups average 44% heavy drinking days. At 18 month follow-up the 8 session group was at 17% and the one session group at 18%. Abstinent days were 36 and 29% at baseline and 51 and 56% at 18 months. Spouse hardship and drinking consequences were roughly equal at 18 months although both improve. The five follow-up sessions for data collection may have had some therapeutic effect for the Advice Counseling group. The Conjoint Therapy group was happier with their treatment on two of four variables.

46) Hayashida M, Alterman AI, McLellan AT, et al (1989). Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 320:358-65. Alcoholics randomly assigned to out-patient treatment did as well as in-patients at six-month follow-up.

47) Walsh DC, Hingson RW, Merrigan DM et al (1991). A randomized trial of treatment options for alcohol-abusing workers. N Engl J Med 325:775-82. An employees Assistance Program coordinated care. 227 General Electric workers with alcohol problems were randomly assigned to 28 day hospitalization followed by AA, AA without initial hospitalization, or the treatment of their choice. In the third group, 59% chose AA. Between 11% and 17% of each group was fired, not much difference. Those abstaining for the two-year follow-up were considerably higher in the hospitalized group than in the other two. 63% of the AA group, 38% of the choice group and 23% of the inpatient group were hospitalized for additional treatment. Inpatient costs for the AA and choice groups were only 10% less because of their higher rates of retreatment. For those using cocaine within six months before their entry into the study, in-patient treatment results were even better. There were no differences between the groups on 12 job related measures in follow-up. A number of odd finding cause one to hesitate to call hospitalization better. In the choice group, Those choosing AA instead of hospitalization did best of any group. Those choosing hospitalization did worst in terms of total cost and number of hospital days. By coincidence, the choice group had by for the most cocaine abusers (54%) vs the hospital group (30%) and the compulsory AA group (36%). How the cocaine abusers in the choice group fared by choice of treatment is not reported. It was very likely, however, the opposite of the other two groups no matter which choice the cocaine abusers made. Certainly, the study suggests that if an employee in an EAP program wants to chose AA, that this choice is only half as costly as compulsory hospitalization and do essentially just as well. Clearly, the study needs to be repeated since there is some conflicting findings within the study itself.

48) Connors GJ, Tarbox AR, Faillace LA (1992). Achieving and maintaining gains among problem drinkers: Process and outcome results. Behav Ther 23:449-474. Problem drinkers were randomly assign to 6 months of group aftercare, telephone aftercare, or no aftercare following an 8-week outpatient drinking reduction program using a drinking moderation goal. A no-treatment comparison group comprised of drinkers concerned about their alcohol consumption who were not seeking treatment. Subjects reduced their monthly heavy drinking days by 64% at 16-month follow-up regardless of aftercare condition. The no-treatment subjects also did just as well.

49) Worner TM, Zeller B, Schwarz H, Zwas F, Lyon O (1992). Acupuncture fails to improve treatment outcome in alcoholics. Drug and Alcohol Dependence 20(2):169-73. Worner did not find any benefit to acupuncture in a controlled trial

49) Keso L, Salaspuro M (1990). Inpatient treatment of employed alcoholics: A randomized clinical trial on Hazelden-type and traditional treatment. Alcoholism: Clinical and Experimental Research 14:584-9. Apparently found the Hazelden model to be of value.

Uncontrolled Studies of Interest

Bowen W (1980) Hosp & Comm Psych (May). No difference at Topeka VA in 100 waiting list patients who showed up for treatment compared to 100 who didn't at one year follow-up with 22% vs 24% abstinent. Not randomized and some difficulty contacting at follow-up.

Tuchfeld (1981) J Stud Alc 42:626-41. 62 individuals answered a newspaper add who had given up alcohol. 51 did so without treatment. Reasons were illness or accident (17), religious change (13), alcohol cost too much (11), family pressure(9), friend's intervention (7), alcohol education (6), alcohol problems in others (7), personal experiences, e.g. pregnancy, suicide attempt (15), alcohol-related legal difficulties (4). Social factors and changed environment were important. Identification with being an "alcoholic" not important.

Settli, Peter (1982) Psychiatric News 3/5/82. Notes the chemical dependency industry got a great boost when in 1976 a state legislature bill in Minnesota they had successfully drawn up and managed to get enacted into law required 28 days of in-patient and 130 hours out-patient insurance coverage. He notes some patients were diagnosed to fill treatment slots to help generate revenues for the treatment industry. The very high costs are a concern. The Minneapolis alcoholism treatment industry is so large it is able to treat one out of every 60 people living in town each year.

DFY research in Minneapolis found that a 19-year-old college student was able to purchase alcohol with a false ID in 50% of Minneapolis-St. Paul liquor outlets. While massive amounts of money are being spent trying to treat alcoholism after the fact, very little effort is going into enforcement efforts to deter underage drinking. Such efforts have been found to be highly effective and cost-effective in the case of tobacco sales to minors and research shows that a moderate amount of enforcement efforts directed at both sales to minors and underage drinking parties can have a considerable positive impact.

Pattison EM (1966). A critique of alcoholism treatment concepts. With special reference to abstinence. Quarterly J Stud Alc 27:49-71.No specific relationship between therapy type and abstinence.

Armor DJ, Polich JM, Stambul HB (1978) Alcoholism and treatment. Wiley, New York.

Polich JM, Armor DJ, Braiker HB (1981) The Course of Alcoholism: Four Years after Treatment. Wiley, New York.

Smith R (1981) Brit Med J 283:1043-45. Says Levinson study of 60 patients randomized to intensive in-patient insight treatment vs in-patient with no treatment found no difference at 1 year. Says of 384 studies of psychological treatment only five found significant benefit of one treatment over another and most of these were flawed.

Saxe L, Dougherty D, Esty K, Fine M (1983) Office of Technology Assessment. Health technology case study 22: The effectiveness and costs of alcoholism treatment (OTA-HCS-22) Washington, DC: U.S. Govt Printing Office.

Nathan PE, Skinstad A (1987) Outcomes of treatment for alcohol problems: Current methods, problems, and results. J Consult Clin Psychol 55:332-340.

The scientific research on the benefits of the treatment of alcoholism have not been nearly as encouraging as the alcoholism treatment industry would lead us to believe. While there is some favorable evidence for certain specific out-patient treatments and one medication in research development, the evidence is strong that the large majority of residential or in-patient treatment programs are a tremendous waste of public resources.

Another suggestion of the research is that alcoholism is a very difficult disease to treat even for the best therapists and that preventive steps would be much more cost-effective. Of course, the ideal preventive step is for those at risk never to start drinking and for those of us who can drink with impunity to abstain anyway as an act of solidarity with those who can't or shouldn't. While this will strike some as too dramatic a step, a review of the below evidence suggests that it is a wise position.

Miller's 26 studies break down as follows:

)state although controlled studies have not yet been able to show this. Still, Miller notes that the in most programs some while six out-patient programs have been shown to be of some benefit over no treatment. The one favorable residential Outpatient: specialized An additional three out-patient programs have also been shown of some benefit and are noted below.

ger treatment. DWI: Aftercare: In-Patient or Residential: found (Kissin 70, Stinson 79). Halfway House: 9) and no difference was found.

Conclusion

or without bibliotherapy, may bedeally at least until age 21, appear to be strongly supported by scientific research on alcoholism treatment not

actually

Although there may not be controlled studies, uncontrolled research suggests that individuals under court order to take Antabuse do much better than those not under such court orders and that employees in danger of losing employment do much better than those not facing such consequences. Some evidence suggests that, like nicotine dependence, many people overcome partly or fully their alcohol problems due to factors unrelated to any treatment. A study of this type is noted at the end of this review. e.g.

(c) 1993. Doctors & Lawyers for a Drug Free Youth. P.O. Box 2653, Champaign, IL 61825. Tel: 217-328-3349. This review can be used and reproduced in any way as long as DFY is credited. we would like it to before have little impact and , unfortunately, who would develop alcoholism in the first place. Unfortunately, this is not very predictable. Fthe research would encourage us f solidarity with the many (i.e. longer hospital stays vs shorter ones), although the ability of others to replicate Azrin's success has never been reported

Acupunture: Only two studies have been reported (Bullock, 89 & Worner, 92) and have reported conflicting results. 46) Bullock ML, Clulliton PD, Olander RT (1989). Controlled trial of acupuncture for severe recidivist alcoholism. Lancet 1(8652):1435-9. Bullock found acupuncture to be of value.

Methodology

Controlled clinical trials are widely accepted as having the least bias. Randomization between two or more treatments, or treatment and minimal interventionis ideal. Blinding of evaluators as to which patient is receiving which treatment is important. Blinding of patients as well is ideal although this is only possible in double-blind medication studies. Follow-up of at least 6 months is considered vital although one or two years is considered better. Outcome measures including patient self-report, gauge changes in drinking, health, psychological health, and social functioning. Collateral report from family or friends is ideal.

50 Of 52ogalcohol abuse and alcoholism is a very difficult condition to treat but that several out-patient counseling strategies probably have some impact in helping to stop alcohol abuse and alcoholism. Several counseling techniques and A. F probably while and definitely worth might be greater much do better parameters thanemay be this is not very predictable. Even f, to set a good example for or won't be able to Also, since alcoholism is so hard to treat and since age of onset of drinking is strongly linked to later alcoholism, better enforcement and education supporting the 21-year-old drinking is needed. The findings favor outpatient Residential limited to only in the study are. Indeed, many programs will not provide out-patient services until after residential.

32)Nalmefene: a new opiate antagonist, similar to naltrexone, was used in a DB study of 20 mg. BID vs. 5 mg. vs placebo found well tolerated with 20 mg. groups having lower rate of relapse and fewer drinking days (p = .02). Barb Mason, U Miami Med, Amer Psychiatric Assoc Meeting 5/25/93.

54) 50-year follow study by George Vaillant of Harvard reports on 268 Harvard undergrads from 1940 and 188 poor Boston city teens from the same period followed for 50 years. 20% of Harvard and 33% of the city teens developed alcoholism at some point in time. The city men tended to develop alcoholism between 21 and 30 and to be severely effected. The college men tended to develop alcoholism between 41 and 50 and were not as severely effected. By age 60 only one in 5 alcoholics still abused alcohol. Alcoholics died three times faster than non-alcoholics with smoking alcoholics dying faster. The heaviest alcoholics both died and recovered most often. After 5 years of abstinence, alcohol abuse was rare, but those with shorter periods of abstinence often resumed heavy drinking. One-third of alcoholics received hospital treatment for alcoholism, but treatment did not affect the long-term course of their disorder. 40% attended AA regularly. A family history of alcoholism was common in both early and late-onset alcoholics. A troubled family life was associated with an earlier onset of illness (Sci News 143:356, 6/5/93, APA 5/26/93).

Thomas E. Radecki, M.D., J.D.

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