• Choose a category
• All
• Classic-Fiction

By Root 1007 0

behavior therapy, medical treatment for complications, aversion therapy, a comfortable setting, and AA-type groups. You can have all or some of these. Long-term outcome sometimes seems quite good: For example, one unit points with pride to a recent ten-year follow-up of two hundred former patients. Sixty-one percent were “completely” or “stably” remitted.16 But the patients from this study were not from skid row—they were socially stable, and so could be expected to have roughly this good an outcome anyway. To determine if such programs do any better than natural recovery, a matched control group is required. This study lacked one, and, indeed, controlled-outcome studies of inpatient units are rare. The patients are usually paying customers, they don’t want to be randomly put into a control group, and they will go elsewhere for treatment if so assigned.

However, there have been some attempts to do controlled studies. A particularly dramatic one was done in London fifteen years ago. One hundred married male alcoholics were randomly given either of two treatments. The first treatment was elaborate: a year of counseling and social work, an introduction to AA, aversion therapy with drugs, drugs to alleviate withdrawal, as well as free access to inpatient medical treatment. The second treatment was merely one session of advice, involving the drinker, his wife, and a psychiatrist. The psychiatrist told the couple that the husband had alcoholism and that he should abstain from all drinking. Further, he should stay in his job, and the couple should try to stay together. The theme was that recovery “lay in [the couple’s] own hands and could not be taken over by others.” Twelve months later, the two groups looked the same: About 25 percent from each group were doing better.17

George Vaillant found the same result when he compared his own program of intensive clinic treatment at the Cambridge (Massachusetts) Hospital to no treatment. His one hundred patients dried out, received medical and psychiatric consultation, halfway housing, an alcohol-education program, and twenty-four-hour walk-in counseling for themselves and their relatives. Two years later, one-third were improved and two-thirds were doing poorly. Vaillant pooled four more similar treatment studies and had roughly the same results: one-third improved, two-thirds doing poorly. Then he compared all these treatment outcomes to three pooled no-treatment studies. With no treatment, one-third improved and two-thirds did poorly.18

One study of 227 union workers newly identified as alcoholic contradicts these results. The workers were randomly assigned to either inpatient hospital treatment, or compulsory attendance at AA for a year without hospitalization (or they could choose no treatment). The hospital treatment, which lasted about three weeks, included drying out and AA meetings, and was aimed toward abstinence; afterward, these workers were required to attend AA three times a week for a year and to be sober at work. The compulsory AA group had the same constraints, but without hospitalization. Two years later, the hospitalization group was doing much better than the other two groups: It had twice as many abstainers (37 percent versus 17 and 16 percent), almost twice as many men who were never drunk, and only half as many who needed to be hospitalized again.19

Putting all this information together, I can recommend inpatient treatment, but only marginally. It is expensive, and there is only one decent study showing that it improves on the natural course of recovery; many studies, admittedly of lesser quality, contradict that study.

As for outpatient psychotherapy, there is no evidence that any form of talking therapy—not psychoanalysis, not supportive therapy, not cognitive therapy—can get you to give up alcohol. There has been only one small-scale study of behavior therapy. In it, alcoholics learned skills of how to control their drinking. The study had promising results, but little follow-up of this treatment has taken place.20 Once abstinence has taken hold, however,