What You Can Change _. And What You Can't - Martin E. Seligman [162]
This is not just an academic quibble. If this were a new treatment area, controlled study would not yet be mandatory. But this is a problem that costs the United States $100 billion or more annually and for which elaborate and expensive treatment has been going on for more than four decades. Fully cognizant of the practical problems, I nevertheless believe that controlled long-term studies are overdue.
The most complete reviews of controlled studies of alcoholism have been reported by William R. Miller of the University of New Mexico. On the whole, he is less optimistic than I am about AA and more optimistic about behavioral training (marital therapy, self-control training, and social skills training). My reservations about the behavioral modalities concern the need for large groups and very-long-term follow-up. Otherwise our reviews coincide. See H. Holder, R. Longabaugh, W. Miller, and A. Rubonis, “The Cost Effectiveness of Treatment for Alcoholism: A First Approximation,” Journal of Studies on Alcoholism 52 (1991): 517–40; W. Miller, “The Effectiveness of Treatment for Substance Abuse: Reasons for Optimism,” Journal of Substance Abuse Treatment 9 (1992): 93–102.
17. J. Orford and G. Edwards, Alcoholism—A Comparison of Treatment with Advice, with a Study of the Influence of Marriage (Oxford: Oxford University Press, 1977). See also Herbert Fingarette’s discussion of this study in his Heavy Drinking (Berkeley: University of California Press, 1989), 70–95.
18. Chap. 8 of Vaillant, The Natural History of Alcoholism, is must reading for all who would not have their hearts broken and rebroken by the chronic relapses of their patients and relatives. See also National Institute on Alcohol Abuse and Alcoholism, “Seventh Special Report to the U.S. Congress on Alcohol and Health” (Washington, D.C.: Public Health Service, 1990) (DHHS publication number ADM 90–1656); and W. Miller and R. Hester, “Inpatient Alcoholism Treatment: Who Benefits?” American Psychologist 41 (1986): 794–805.
19. This study stands alone as being methodologically adequate and as supporting the usefulness of hospital treatment. See D. Walsh, R. Hingson, D. Merrigan, et al., “A Randomized Trial of Treatment Options for Alcohol-Abusing Workers,” New England Journal of Medicine 325 (1991): 775–82. If replicated, it may be a watershed for inpatient alcoholism treatment.
20. E. Chaney, M. O’Leary, and G. Marlatt, “Skill Training with Alcoholics,” Journal of Consulting and Clinical Psychology 46 (1978): 1092–1104. This seems like a promising treatment package, and it should be followed up on a large scale. It is, however, too small-scale and tentative to warrant recommendation now.
21. See chapter 12, “The Place of Expert Help” in J. Orford, Excessive Appetites, for a telling review of psychotherapy and alcoholism.
22. The full range of psychotropic drugs have been tried in alcoholism. None seem to work. See J. Halikas, “Psychotropic Medication Used in the Treatment of Alcoholism,” Hospital and Community Psychiatry 34 (1983): 1035–39; and J. Sinclair, “The Feasibility of Effective Psychopharmacological Treatments for Alcoholism,” British Journal of Addiction 82 (1987): 1213–23.
There have been two apparent exceptions, neither of which, however, has worked out when large-scale controlled studies were