This application addresses the serious national debate concerning the feasibility and cost-effectiveness of inpatient versus outpatient alcoholism treatment programs. The application further seeks to focus this debate on the special problems of caring for the rural alcoholic, problems created by restricted access to transportation and by low population density which jeopardizes the viability of outpatient group meetings. The study will define the prognostic indicators that make outpatient care. Resolution of this debate has immense fiscal and therapeutic implications for the development of treatment resources for the 20,000,000 alcoholics of our country. The experimental design will compare inpatient versus outpatient residency during an intensive alcoholism treatment of 7-14 days. Two study groups (inpatient and outpatient) will participate in identical treatment programs from 8 AM until 5 PM daily. The outpatient group will reside at home evenings and commute to the hospital treatment center for daystime care: the inpatient group will stay in the hospital full time. A control group will be simulated using a limited treatment model of 2-3 days of hospital detoxification followed by referral to Alcoholics Anonymous. Outcome assessments will be performed at 6 intervals over the 2 years following treatment. The comprehensive telephone and personal interviews will use nationally recognized evaluation instruments to assure comparability of this study with other well designed alcoholism treatment programs. Multivariant, regression analysis will be used to identify differences in outcomes among the three groups.
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