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 has also virtually ignored the role of the posttreatment environment, and study of interactions between treatment setting, extended outpatient/aftercare treatment, and patient characteristics has been minimal or nonexistent. The present project is designed to address methodological limitations in this research and further our knowledge of setting X aftercare duration X patient characteristic interactions. Male alcoholics seeking clinical services for alcoholism will be randomly assigned to either a 21-day comprehensive inpatient treatment program, a 21 - day intense outpatient treatment program equated in content and intensity, or a standard, less intense, outpatient treatment. Upon completion of primary treatment, subject treatment groups will again be randomly assigned to aftercare/extended outpatient treatment of either six or twelve month duration. Overall treatment outcome and relapse rates will be evaluated for the different treatment/aftercare 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 18 month follow- up upon completion of aftercare/extended outpatient treatment; (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.
