The present volume contains a large variety of treatment approaches to the long-term rehabilitation of the alcoholic, ranging from the biological to the physiological to the psychological to the social. The multiplicity of proposed therapies, each of which has its strong proponents, suggests that alcoholism is either a complex medical-social disease syndrome requiring a multipronged treatment approach or a very simple illness for which we have not yet dis- covered the remedy. The latter may, indeed, be true, but we cannot use what we do not know and must use what we do know. We do, however, have the obligation to be responsible in our treatment, to provide the best that is known at this time, and to be discriminating in our prescription of appropriate treat- ment for individual patients. If there is one conclusion we would like to offer in our preface, it is that alcoholics constitute a markedly heterogeneous popula- tion with widely disparate needs, for whom, at least at our present level of knowledge, a broad spectrum of treatment modalities is necessary. If this is true, then probably most of this book has validity. With this volume on the treatment and rehabilitation of the chronic alco- holic, we bring to completion our five-volume series, The Biology of Alcoholism. As the title of the present volume indicates, we have departed from our original intention to deal solely with biological aspects of the syndrome and have attempted rather to produce a more comprehensive work.

Table of Contents:
1 Theory and Practice in the Treatment of Alcoholism.- The Development of Alcoholism.- Predisposing Factors.- The Development of Primary Psychological Dependence.- The Addictive Cycle.- Alcoholism as "Symptom" or "Disease".- A Pathogenetic Classification of Alcoholics.- Biological Mechanisms.- Psychological Mechanisms.- Social Mechanisms.- Implications for Therapy.- Breaking the Addictive Cycle.- Special Problems in the Rehabilitation Process.- The Core Problem.- Treatment Models in Alcoholism.- The Medical Model of Alcoholic Rehabilitation.- The Behavior Modification Model.- The Psychological Model.- The Social Model.- The Alcoholics Anonymous Model.- The Multivariant Model.- The Multimodal, Multidisciplinary Approach to the Treatment of Alcoholism.- The Multimodal Approach to the Treatment of Alcoholism.- The Multidisciplinary Approach to the Treatment of Alcoholism.- Continuity of Care in the Treatment of Alcoholics.- Public Health Treatment Systems in Alcoholism.- References.- 2 Medical Management of the Alcoholic Patient.- The Role of the Physician in the Treatment of Alcoholism.- The Role of the Physician in Private Practice.- The Role of the Physician in General Hospitals.- The Role of the Physician in Special Alcoholism Programs.- Criteria for Diagnosis.- Criteria for Referral and/or Treatment.- The Therapist of Choice.- The Treatment Model of Choice.- Designing a Specific Treatment Plan.- Special Problems and their Treatments.- The Core Problem and its Treatment.- References.- 3 Psychotherapeutic Approach.- General Considerations.- Initial Phase.- Relationship and Relationship Building.- Pretherapy Factors Affecting Treatment.- Drinking or Not Drinking.- Setting Goals and Confrontation.- Therapeutic Contracts.- The Hostile Patient.- Middle Phase.- General Aims and Issues.- Homework and Other Techniques.- Drinking Episodes.- Late Phase and Termination.- Relationship Issues.- The Patient.- The Therapist.- Individual Psychotherapy in Relation to Other Treatment Methods.- Summary.- References.- 4 Engaging the Alcoholic in Treatment and Keeping Him There.- Detection of the Alcoholic.- High-Risk Groups.- Factors Hindering Identification.- Methods of Identification.- Engaging the Patient at the Referral Stage.- Referral Failures: Extent and Causes.- Remedies.- Keeping the Alcoholic in Treatment.- Dropping Out of Treatment: Extent and Causes.- Remedies.- References.- 5 Toward a Social Model: An Assessment of Social Factors Which Influence Problem Drinking and Its Treatment.- Biological Model.- Psychological Model.- The Origins and Perspectives of a Social Model.- Social Systems Theory and Its Role in the Social Model.- Supracultural Orientation.- Specific-Culture Orientation.- Substructural Orientation.- Social Etiological Factors in Drinking Behavior.- Religious Aspects.- Social Class Influences.- Family Influences.- Ethnic Aspects.- Age, Sex, and Urbanization.- Treatment Approaches.- Alcoholics Anonymous.- Therapeutic Communities.- Halfway Houses.- Group Therapy.- Activity Groups.- Family Therapy.- The Social Learning Approach.- Education Approaches.- Conclusion.- References.- 6 Group Psychotherapy in Alcoholism.- Alcoholics Anonymous.- The Psychology of A. A.- A.A. as a Group.- A.A. as a Therapeutic Network.- A Survey of Group Therapy with Alcoholics.- Conjoint and Family Groups.- Summary.- References.- 7 Family Therapy in Alcoholism.- Family Therapy as a Treatment Modality.- The Family as a System.- The Concept of Homeostasis.- The Concept of the "Identified Patient" or "Scapegoat".- Communication Patterns.- Behavioral Context.- Boundaries.- Family Therapy in Alcoholism.- Phase I: Early Interest in Family Issues and Alcoholism.- Phase II: The Alcoholic Marriage.- Phase III: Concurrent Therapy for Alcoholics and Spouses.- Phase IV: The Adaptation of Family Theory to Alcoholism Therapy.- Phase V: Conjoint Therapy with the Alcoholic Family.- Phase VI: Multiple-Couples and Multiple-Family Group Therapy Approaches.- Al-Anon Family Groups.- Discussion.- References.- 8 Behavioral Assessment and Treatment of Alcoholism.- Behavioral Theories of Alcoholism.- Behavioral Assessment Techniques.- Behavioral Assessment in the Laboratory.- Behavioral Assessment in the Natural Environment.- Behavioral Assessment: Overall Evaluation.- Behavioral Treatment Approaches.- Goals of Treatment.- Modifying the Drinking Response: Aversive Conditioning.- Modifying the Drinking Response: Operant Methods.- Modifying the Drinking Response: Blood Alcohol Level Discrimination Training.- Modifying Associated Behavioral Problems: Systematic Desensitization.- Modifying the Drinking Response and Associated Behavioral Problems: Broad-Spectrum and Multifaceted Therapies.- Modifying the Natural Environment: Community-Reinforcement Counseling and Contingency Management.- Behavioral Treatment in Perspective.- References.- 9 The Role of the Halfway House in the Rehabilitation of Alcoholics.- Halfway Houses.- Origins of Halfway Houses.- A Definition of Halfway Houses.- One Example: The Compass Club.- Major Characteristics of Halfway Houses.- Some Types of Halfway Houses.- Residents.- Patterns of Dependence.- Alcoholics: White-Collar, Blue-Collar, and Skid Row.- Reaction, Impairment, and Resources.- Halfway Houses and their Clientele.- Rehabilitation.- A Definition of Rehabilitation.- Indices of Rehabilitation.- The Social Conditions of Rehabilitation.- Research Findings on Rehabilitation Outcomes.- A Theory of Rehabilitation.- Strains of Group Membership.- Authority and the Halfway House.- Social Types: Ways of Coping with Halfway House Authority.- Ex-Resident Social Roles.- Halfway House Social Types and Ex-Resident Social Roles.- Some Hypotheses on Social Types and Ex-Resident Social Roles.- Types of Halfway Houses and Halfway House Social Types.- Summary and Conclusions.- References.- 10 Evaluation of Treatment Methods in Chronic Alcoholism.- Treatment Goals and Outcome.- Treatment Length.- Spontaneous Improvement, or What Happens to the Untreated Alcoholic?.- Inpatient Treatment.- Effectiveness of Inpatient Treatment.- Patient and Treatment.- Treatment Length and Outcome.- The Effectiveness of Inpatient Psychotherapy.- Hospital versus Outpatient Treatment.- How Necessary Is Aftercare?.- Outpatient Treatment.- Dropping Out of Treatment.- Basic Issues of Outpatient Treatment.- Alcoholics Anonymous (A.A.).- General Considerations.- A.A. Population Characteristics.- Predictors of Success in A.A.- The Effectiveness of A.A..- A.A. Attendance as a Predictor of Success in Other Settings.- Behavioristically Oriented Psychotherapy.- General Considerations.- Aversive Conditioning.- Systmatic Desensitization.- Operant Conditioning.- Drug Treatment.- Implicit Assumptions.- Negative Results in Drug Studies with Alcoholics.- Outcome in Drug Studies.- Summary and Conclusions.- References.- 11 Factors in the Development of Alcoholics Anonymous (A.A.).- Introduction: Crisis for a Hungover Doctor.- The Growth and Size of A.A.- In English-Speaking Lands.- A.A. Growth Worldwide.- The Development of A.A. and Its Structure.- Earliest A.A. Origins.- From"The Big Book" to the G. S. Conference (1938-1955).- Developments Since 1965.- Evaluations of A.A. Effectiveness.- Survey Method.- Representativeness of the Sample.- Findings of the A.A. Board Surveys.- The Literature on A.A.- Material Published by A.A.- Bibliographies.- Significant Early Publications in Mass Media.- Professional, Scientific, and Technical Publications.- Criticisms of A.A.- References.- 12 Role of the Recovered Alcoholic in the Treatment of Alcoholism.- Definitions.- Scope of Chapter.- Roles of the Recovered Alcoholic, Past and Present.- Independent Lay Therapists and Group Programs.- Religious Programs.- Independent Facilities.- Medically and Psychiatrically Sponsored Programs.- Industrial Programs.- Antipoverty Programs.- Courts and Correctional Facilities.- Public Education and Information Agencies.- The Alcoholism Counselor as Member of a Treatment Team.- Unique Advantages of the Recovered Alcoholic as Counselor.- Motivation of Counselors.- Selection of Candidates to Be Counselors.- Training.- Job Responsibility.- Problems Unique to the Recovered Alcoholic as Counselor.- Remuneration and Status.- Thoughts on the Future of Recovered Alcoholics as Counselors.- References.- 13 Training for Professionals and Nonprofessionals in Alcoholism.- Significant Components of Training.- Objectives.- Target Groups.- Settings.- Teaching Methods and Models.- Subject Matter.- Examples of Programs.- Research Program.- University Program.- Community Leaders Program.- Paraprofessionals Program.- Evaluation.- Guidelines for Designing a Training Program.- Conclusion.- References.- 14 Public Health Treatment Programs in Alcoholism.- Alcohol Problems in the United States.- The Rise of Organizational Interest in the Problem of Alcoholism.- Social Involvement with Problems of Alcoholism.- Changing Legal Patterns in the Public Approach to Alcoholism.- Involvement of the Federal Government in Alcoholism Problems.- Patterns of Alcohol Use and Abuse within Communities.- The Scope of Public Health Problems Involved in Alcoholism.- Community Alcoholism Treatment Services.- Using Available Agencies: The Experience of Industry.- A Model Alcoholism Treatment Program.- Prevention of Alcoholism.- Summary.- References.