Failure of an Experimental Treatment Program to Inculcate Controlled Drinking in Alcoholics

Abstract

SammaryThis paper reviews an out-patient pilot experiment that attempted to inculcate controlled drinking behavior in alcoholics. The methods are detailed along with some of the problems experienced and solutions invoked. The nature of a long term follow-up study is discussed and the results are presented.Thirty-five patients were referred or self-referred to the experimental program. Ten people came one time only and decided that they did not want to participate. Eleven others came less than six times, some of them saying they felt that too much effort was required of them and that it would be easier to stop drinking altogether. A total of 14 people came at least six times and nine of these came on 12 to 24 occasions. Treatments were held weekly and lasted at least four hours.This follow-up is the longest yet reported of a program designed to maintain controlled drinking in alcoholics. The follow-up period ranged from 27 to 55 months since treatment was completed. Although patients who persisted in the program were very successful dt learning to recognize their levels of blood alcohol and at developing controlled drinking patterns while in the program, the follow-up results indicate that sooner or later all of them had begun to drink again with loss of control.

Evaluating the External Validity of Ewing and Rouse

“…In conclusion, one can only concur with Ewing and Rouse's (1976) assertion that: 'Based on our experience with these patients and a long-term follow-up, we have concluded that, in our hands at least, further attempts to inculcate controlled drinking by such methods are unjustified' (p. 134, italics added.) Their statement, it would seem, also suggests the appropriate limits of generalizability of their results.…”

“…The internal validity ofthe Ewing and Rouse (1976) study is diminished by major methodological problems, some of which become apparent only upon reading earlier descriptions of this same study (Ewing, 1972;Ewing and Rouse, 1973), Most importantly, the study was not a controlled investigation [no control subjects or control treatments were used). Further, it involved a highly selected group of subjects, Ewing (1972) initially described the study as a clinical trial conducted because he was frustrated with traditional abstinence oriented treatment methods, stating: 'The fact is that it is a rare alcoholic who will remain abstinent indefinitely and if we can offer a ray of hope, perhaps we should' (p, 12), Subjects were accepted for the study only if they had a history of failure with Alcoholics Anonymous and expressed an unwillingness to accept treatment approaches requiring total abstinence; applicants were excluded if they had a history of previous extended periods of abstinence or previous successful affiliation with Alcoholics Anonymous, Thus, the authors' 1976 description of their subject population as relatively nonselective seems at considerable variance with Ewing's 1972 statement that; 'So far I have only accepted those who have failed with Alcoholics Anonymous and with total abstinence goals, or have rejected such approaches for the time being' (Ewing, 1972, p, 9), Actually, the subjects could be described as highly recalcitrant to traditional treatment and of generally poor prognosis.…”

“…For instance, in 1972 Ewing stated that 'no effort is made to invoke dynamic psychotherapeutic methods, although some patients continue in therapy with other psychiatrists while in the program' (p. 10). A year later, Ewing and Rouse (1973) modified this description slightly: 'No attempt was made to develop formal group psychotherapy in these sessions but undoubtedly communications of a therapeutic nature occurred' (p. 70). However, in their more recent report the authors stated: 'We included group therapy, couples therapy, modeling and other techniques to be described, because we wanted to make our therapy as powerful as possible so that it might have the greatest chance of success' (Ewing and Rouse, 1976, p. 124).…”

“…Caddy (1979) has elsewhere assailed Ewing and Rouse's use of blood alcohol concentration discrimination training in the absence of a thorough behavioral counseling program as an inappropriate use of the Lovibond and Caddy (1970) methodology and apt to have little influence on drinking behavior. Furthermore, the nature of treatment sessions apparently changed over the course of the study: several such changes were described by Ewing (1972) and Ewing and Rouse (1973).…”

Propositions for Professional Understanding and Treatment of the Alcoholic Patient: An Overview

“…Pendery et al (1982) has offered evidence that the conclusions reached by the Sobells failed to fit the facts of followup. It should be noted that Ewing's and Rouse's (1976) work Failure of an Experimental Treatment Program to Inculcate Controlled Drinking in Alcoholics revealed that none of their experimental subjectsalcoholicscould return to social drinking. Ewing (1979), in his guest editorial article, noted that gamma alcoholics eventually lost control (referring to his work of 1976), then added, &dquo;It is possible, of course, that a program of devoted and regular monitoring and self-scrutiny (equivalent to a long-term and deep commitment to A.A.) might have prevented the relapses.…”