Research comparing the relative efficacy of inpatient and outpatient treatment for alcoholism is not very current and fails to stand up well under close methodological scrutiny. This research also has virtually ignored the role of the posttreatment environment, and study of interactions between treatment setting, aftercare attendance, and patient characteristics has been minimal or nonexistent. Partial (two-year) funding previously was awarded to initiate and document the feasibility of a study (currently ongoing) designed to address these methodological limitations. The present competing continuation application requests funding to complete the project (essentially the follow-up and data analysis). In the ongoing investigation, male and female alcoholics seeking clinical services for alcoholism are being randomly assigned to either a 28-day comprehensive inpatient program, a 28-day intense outpatient treatment program equated in content and intensity, or a 28-day standard, less intense, outpatient treatment. Upon completion of primary treatment subjects in all conditions receive six months of aftercare. Overall treatment outcome and relapse rates will be evaluated for the different setting and intensity conditions. In addition, variables or clusters of variables which best predict treatment response and posttreatment functioning will be evaluated. Importantly, the study incorporates methodological advances over previous work in this area. These advances include: (a) treatment protocols closely modeled after contemporary methods; (b) procedures for the maintenance of outpatient/aftercare attendance and assurance of the integrity of the treatment conditions; (c) comprehensive assessment of patient characteristics; (d) assessment of expectancy and therapist effects; (e) aggressive 12-month follow-up upon completion of aftercare; (f) outcome assessment by staff blind to subject-group assignment; (g) quantifiable measures of drinking behavior; and (h) inclusion of multiple sources for verification of self-report and outcome classification.
