Variation in alcoholism treatment orientation: differential impact upon specific subpopulations

Measuring treatment philosophy: a scale for substance abuse recovery programs

The assessment of the philosophy that guides substance abuse treatment programs has been a difficult subject to approach by those working in treatment research. Differing treatment philosophies are generally represented by multi-dimensional theoretical constructs that do not easily lend themselves to assessment by quantitative means. In the U.S., substance abuse treatment programs have been suggested as fitting into a disease (or medical) model, a social learning (or psychological) model, or a social community model in designing a treatment regime for clients. This paper presents a Social Model Philosophy Scale (SMPS) to classify the extent to which a given treatment program follows a social model approach to treatment. The final version of the SMPS (available from the first author) contains 33 questions for use in residential programs, divided into six conceptual domains: physical environment, staff role, authority base, view of substance abuse problems, governance, and community orientation. Overall internal reliability is high (alpha = .92), with subscale alphas ranging between .57 and .79. Test-retest analyses showed that the information obtained from the SMPS is consistent across time, administrators, and respondents. In addition, the SMPS is brief and easy to administer. Methodology used in item creation and final item selection is reported. Although not designed to distinguish philosophies other than social model, early results suggest that the SMPS may also be used to classify other program philosophies.

Developments in alcoholism treatment

Alcohol treatment systems expanded and diversified considerably over the past decade. This reflects adaptation to a variety of forces, including developments in national health care financing and policy, changes in other health care systems with which alcohol treatment had strong ties, the more diffuse effects of social movements and a "drying trend" in American public opinion, as well as agitation by advocacy and provider groups within the alcohol field. Drawing on national monitoring data, this chapter reviews developments at the levels of financing policy, organizations, client populations, and treatment modalities, documenting expansion in private sector alcohol treatment units, a growing emphasis on providing outpatient treatment, a merger between services for alcohol and drugs at the organizational and conceptual levels, increases in service delivery to coerced populations, as well as demographic change in alcohol treatment caseloads during the 1980s.

Prediction of resumption of drinking in posttreatment alcoholics

The ability of five factors (depressive symptomatology, neuropsychological performance, psychosocial maladjustment, previous treatment history, and childhood attention deficit disorder symptomatology) to predict relapse was examined in a follow-up experimental design. Fifty-eight male and 45 female alcoholics were interviewed immediately following release from inpatient treatment units. Fourteen months later, 41 subjects (41%) were classified as resumers; 62 (59%) were abstainers. Resumers showed significantly poorer scores than abstainers on all five of the predictor variables. Discriminant function analysis resulted in 75% correct classification of resumers and abstainers (chi 2 = 22.1, p less than .001). Stepwise multiple regression resulted in isolation of depressive symptomatology as the best single predictor of relapse.