The long-term goal of this research program is to reduce relapse among alcohol abusers by determining more effective treatment interventions. The theoretical framework guiding this work is based on: 1) a coping skills model of relapse derived from social learning theory, 2) models of classically conditioned reactivity to alcohol stimuli, and 3) an assumption that matching patients to treatment of the basis of key individual difference variables will enhance treatment efficacy.
Specific aims of this study are to test the effectiveness, separately and combined, of two forms of intervention: family social skills training derived from social learning theory, and cue exposure with response prevention derived from respondent learning theory. Another major aim is to examine a treatment-matching hypothesis by determining whether individual differences in cue reactivity and coping skills interact with the treatments to provide differential outcome. A 2 X 2 stratified randomized design will be used with one factor being family social skills training and the other factor being cue exposure treatment. Each cell will be stratified on initial cue reactivity to ensure an equal number of low an high cue reactors in each condition. This will also allow later cue reactivity X cue exposure analyses to test one matching hypothesis. The control for the social skills training will be a discussion group and the control for the cue exposure treatment sessions will involve films and reading. All treatments and controls will be added to standard inpatient alcoholism treatment. This design will allow us to investigate the effects of each treatment alone and in combination as compared to standard inpatient treatment while controlling for time and expectancy. Assessment includes multiple measures of alcohol use including 6, 12, and 18 month follow-up interviews, measures of coping skills and cue reactivity previously developed in this laboratory, and measures of family and psychosocial functioning. These assessments will allow evaluation of treatment effects and relapse, retrospective investigation of additional matching hypotheses, and evaluation of the role of various prognostic and mediating variables.
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