The proposed research is a prospective follow-up study of alcoholic patients after inpatient treatment and is aimed at identifying the determinants of alcoholic relapse. The conceptual framework guiding this work is derived from behavioral-economic theories of choice. This approach directs a focus on identifying the molar environmental contexts in which alcohol consumption emerges from among the set of available activities as the most preferred activity, as during a relapse episode. Based on the conceptualization and previous and current research, the proposed project will concentrate on measuring four classes of variables as they exist in the subjects natural environments: (1) alcohol consumption, (2) life event occurrences, (3) money income, and (4) income expenditures to commodity classes, especially alcohol consumption. Research during the current award period developed interview procedures for measuring these variables for a 12 month pretreatment interval, and self-monitoring procedures for measuring them during the follow-up period after treatment. Data indicate that the variables can be measured with adequate reliability and accuracy. In the proposed project, these procedures will be implemented with at least 60 male alcoholics who receive inpatient treatment at a VA Medical Center. Interviews regarding the 12 month pretreatment interval will be conducted while subjects are hospitalized, and they will then be followed for 12 months after discharge. Data for the first 6 months of the posttreatment period will be collected through subject self-monitoring, and data for the second 6 months of the interval will be collected in interviews after the 12th month. Data from this project will provide a detailed description of stability and change over time in subjects' alcohol consumption and their allocation of resources to valued activites under different environmental conditions. The general hypothesis is that relapse after treatment will be associated with the reinstatement of those environmental contexts that produced the highest levels of alcohol consumption during the pretreatment interval. The procedures will have direct clinical applicability regarding assessment of alcoholic patients and individualization of treatment plans.
