Psychotherapeutic Approach

Alcoholism Clin & Exp Res

Appel

et al. 1991

The importance of psychiatric symptomatology for the treatment course of alcoholics was analyzed in a long-term outpatient treatment study. Seventy-two patients, 60 men and 12 women, were personally interviewed during treatment and after 3 years. Before treatment psychiatric symptoms were rated according to the Comprehensive Psychopathological Rating Scale (CPRS). Women had significantly higher scores than men. Men with many symptoms and women had more psychological benefits from drinking and a more impaired personality structure than men with few symptoms. Men with many symptoms also had a lower level of social functioning. The severity of abuse did not differ between the three groups. Men with many symptoms had a less favorable outcome between 25 and 36 months after start of treatment than men with few symptoms and women. Among men who completed treatment, those with many symptoms showed a less successful course after 6 months and during the 3rd year after start of treatment, while differences after 3 months and during later stages of treatment were less pronounced. It is suggested that before start of treatment a psychiatric evaluation should be performed including psychiatric diagnosis, personality analysis, and an assessment of psychological benefits from drinking.

Psychiatric Symptoms in Alcoholics Attending Outpatient Treatment

Alcoholism Clin & Exp Res

Appel

et al. 1991

To keep the alcoholic in out‐patient treatment A differentiated approach through treatment contracts

1986

Acta Psychiatr Scand

Eighty-two alcoholics were offered a 2-year out-patient programme characterized by stressing the patients' own decisions both in joining the programme and in the choice of objectives and methods, by repeated feedbacks through treatment evaluations, and by relapse prevention. The 58 patients who accepted were more often married than the others. All but eight completed the programme. The most important treatment components were ranked by the patients. Individual counselling was ranked highest, followed by evaluations of contract with therapist, disulfiram and biofeedback by means of gamma-GT. Patients with alcohol dependence more often preferred instrumental components, such as disulfiram and gamma-GT, while the others more often preferred psychological components, such as individual counselling and contract evaluations. Preference of psychological components was not found to be related to degree of personality disturbances. It is suggested that to effectively keep the patients in treatment in the present programme depends on the combination of patients' active engagement, continuous feedback and individualized treatment objectives.

Early and late improvement in a two‐year out‐patient alcoholic treatment programme

1986

Acta Psychiatr Scand

The process of improvement was studied in a 2-year out-patient programme for alcoholics. The drop-out rate was 16%. The analysis was based on recurrent evaluations of treatment contracts including both drinking pattern and psycho-social treatment objectives. Background data were related to the alcohol adjustment during the first but not during the second year of treatment. Subjects with favourable background characteristics showed an early improvement of drinking pattern but few psycho-social changes. In contrast, subjects whose improvement in drinking behaviour occurred during the second year of treatment showed improvement in their psycho-social adjustment already during the first year. All subjects with an early stable improvement were type 1 alcoholics according to the Cloninger-Bohman typology while the majority of those who improved during the later part of the treatment period were type 2 alcoholics.