Behavioral--chemical treatment of alcoholism: an outcome replication.

SVMMAaY. Follow-up o) alcoholics I year ajter behavioral and chemical aversive counter- conditioning revealed that 53 % o) the patients were abstinent. Outcome studies of conditioned-reflex treatment of alcoholism using chemical aversion have been reported by such investigators as Lemere and Voegtlin (1) and Wiens et al. (2). Reviews by Davidson (3), Nathan and Briddell (4) and Wilson (5) have, however, suggested that the relatively high abstinence rates achieved by this treatment may be as much a char- acteristic of the patients selected for treatment as they are an inherent element of the therapy itself. This hypothesis may now be evaluated because of recent changes in the composition of the patient population in private alcoholism hospitals. Specifically, increased coverage of chemical aversive counterconditioning by health insurance carriers (and more re- eently by Medicare) has allowed a greater proportion of patients from all soeioeconomie groups, including the disabled and elderly, to have access to such treatment. Although many criteria of successful treatment outcome have been advocated over the years, abstinence from alcohol remains an important and traditional measurement. The Raleigh Hills Hospitals have set a goal of total abstinence for their patients, while acknowledging the advocacy of controlled drinking for some patients with alcohol problems. Some reports indicate that cessation of drinking may occur spontaneously in some patients, without intervention or treatment. Other patients may achieve abstinence with relatively brief outpatient treatment. Medical records at the Fair Oaks Raleigh Hills Hospital indicate that most patients admitted between 1 January 1976 and 31 December 1978 had tried to stop drinking on their own at home (88%), and that many had gone to Alcoholics Anonymous meetings (32 %) or had had alcohol-related hospi- talization (45%) prior to their treatment at Fair Oaks. Inasmuch as admission to the Fair Oaks Raleigh Hills Hospital is entirely voluntary,