Relapse to drinking represents a common and major problem in alcoholism treatment. Although many treatment procedures result in temporary modification of drinking behavior, a majority of cases relapse within 6-12 months. The proposed project is a programmatic series of three studies assessing the treatment efficacy of two approaches to relapse suppression. One builds upon promising findings that covert sensitization (CS) effectively suppresses drinking and other addictive behaviors, and that its outcome is predictable from the extent of established conditioned aversion. The second approach is based on cognitive-behavioral (CB) procedures. Both approaches are quite amenable to administration by trained paraprofessional personnel in outpatient settings, an advantage both in terms of cost-effectiveness and of applicability to present service delivery systems. The present studies are designed to determine the additive effectiveness of CS and CB as components of alcoholism treatment and aftercare, and to elucidate the mechanisms of efficacy and predictors of favorable outcome associated with these treatment procedures. Study 1, the first of three clinical trials, addresses a seldom studied but instructive aspect of relapse potentials: persistent urges to drink during prolonged periods of abstinence. CS appears to be a promising approach for suppressing such urges, and thus to diminishing relapse probability. Abstinent alcoholics will participate in a controlled trial of CS interventions. Study 2 evaluates the impact of adding CS and CB procedures to representative inpatient alcoholism treatment programs, testing them against a self-monitoring control. Study 3 translates these interventions and the findings of Studies 1-2 into an aftercare context, in an experimental comparison of posttreatment CS and CB with untreated and self-monitoring controls. Together these studies will provide clear information about the effectiveness of CS and CB as adjunctive interventions within current alcoholism treatment practices. Data will also be obtained regarding the mechanisms of efficacy of and the individual difference predictors of therapeutic benefit from these procedures.
