ee us i s are trd. Plea ke eaert ge bry ins Broadening the Base of Treatment Paall s. ent ed ting filesetbeen acci for Alcohol Problems al typhave ginay orim he ors m terr Report of a Study by a Committee of the k, not froographic Division oIf NMSeTnItaTlU HTeEal tOh Fan Md EBDehIaCvIioNrEal Medicine op oy er bme t p ao ps original ed, and he ain m tret oe ed frat bnnot ea es crer, c L filwev Mo Xh m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri NWataioshnianlg Atocna, dDe.mCy. 1P9r9e0ss ee us ii s are trd. Plea eakerte National Academy Press 2101 Constitution Avenue, NW Washington, DC 20418 ge bry ins NbeOrsT aIrCeE d:r Tawhen pfrroomjec tth teh acto uisn tchiels soufb tjheec tN oaf ttihoinsa rle Apocratd wemasy a opfp Srocvieendc besy, tthhee GNoavtieornnainl gA cBaodaermd yo fo tfh Ee nNgaintieoenrainl gR, easneda rtchhe CInosutintcuitle, wofh Moseed miceinme-. Paall The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. s. ent This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee con- ed ting filesetbeen acci sTfceiohssntesigi nIorgnen sssots ifiit noum ntteeah mleo cfbe hMxeararsemt edoirifn c ratiehntsieeop Nnow naoastsfii bocpinholaialtilryc tA eytro cme adbda eeit ntmae nr1ys 9a op7dfe0v r Sitbsaceyiirn et inthnoceg e tN hst,oea t tfthiheoeden N eahrlaea tAali logcthnoa advolee fAmr tnhcymea o depfenu mtSb acylnii ceod.n f Iic tEnes sn to hgtwoiisn n,ee tneihnlreiiisnt tIig and,ts iitavsintteiud nit gnethu iaeidcs eIhtsnne stduitf nimytduieentermg b obiofse stMrhus e etoshdf eoi tcfAhi nemc eaae.dpdepicmraoylp 'crsia a1rt8ee,6 p3ro- ginal typay have hLrTeohisblee rA awarbcrouhyrs,k oea ofna nCnd d woe ndAhugilccrchaeo tshtishoo iCnlsi. sapmtua bloolfigc taihnteigo D-nin eip-sP abruatmbseleidcn awt toiaofs n Hp Deeraaflottharm anedd pHuurmsuaann tS teor vCicoenst.ract No. ADM-281-87-003 with the National Institute on Alco- orim Institute of Medicine (U.S.) he ors Broadening the base of treatment for alcohol problems : report of a study by a committee of the Institute of Medicine, Division of m terr Mental Health and Behavioral Medicine. k, not froographic p“c“CoC. ncootmnmetn.rmtasci.ttt eneo .f oAr DthMe -S2t8u1d-y8 7of-0 T0r3e awtmithe ntht ea nNda Rtieohnaabl iIlnitsattiitounte S oenr vAiclceos hfoolr AAblcuosheo alnisdm A alncdo hAollcisomho ol fA thbeu sDe”e-p-aPr.t mfoelnlot wofin Hg etaalbthle aonfd op oy Human Services”--T.p. verso. er bme t Includes bibliographical references. p paso ISBN 0-309-04038-8 he original ained, and 1ta[hDn. edAN SAlLctuMlocdho:yo h1 looi.sf la miTslcm-ro-eT ha(rUtomel.aiSestmmn.)t -e Ia-IntnIht.d- e-T rCRaitoeplehny.ag. brWeilsiMstae st2i.o 72n4. SAI5el8rcv5oibhccoe]sli cfos-r- ARelchoahboilliitsamti oann-d- CAolncoghreosls A. Ib. uIsnes.t iItIu.t Ne oatfi oMneadl iIcnisnteit u(Ute. So.n) .A Clocomhmoli tAtebeu fsoer m tret RC565.I4893 1990 ed froat be nnot 3Dfo6Nr2 LL.2iM9b'r2/aD-r-yLd Cco2f 0Congress es creer, ca 90-5C70IP2 ML filowev FSiercsot nPdr iPnrtiinngti,n Ag,p Ariul g1u9s9t0 1991 Xh Third Printing, March 1995 m g, ed fromattin CProipnyterdig ihnt t©he 1 U99n0it ebdy Sthtaet eNs aotifo Anaml eAriccaademy of Sciences en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri ee us iii s are trd. Plea eakerte This book is dedicated to the memory of E. MANSELL PATTISON, M.D. 1933-1989 in recognition of his ge bry ins many contributions to the treatment of alcohol pro1b9le8m7-s1; 9a8n8d to the memory of SARAH CAITLIN GLASER Paall s. ent ed ting filesetbeen acci al typhave ginay orim he ors m terr k, not froographic op oy er bme t p ao ps original ed, and he ain m tret oe ed frat bnnot ea es crer, c L filwev Mo Xh m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri ee us iv s are trd. Plea ke eaert ge bry ins Paall s. ent ed ting filesetbeen acci al typhave ginay orim he ors m terr k, not froographic op oy er bme t p ao ps original ed, and he ain m tret oe ed frat bnnot ea es crer, c L filwev Mo Xh m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri ee us v s are trd. Plea ke eaert ge bry ins Committee for the Study of Treatment and Rehabilitation Services for Alcoholism and Paall Alcohol Abuse s. ent ed ting filesetbeen acci RTHOOBBMEaRtAtTlSe DCF.r. eSBePkA,A BMROiKcRhS, i,g PMaHn..DD..,,+* PCrhofaeisrs, oPr reosfi dPesnytc hEomloegryit,u sD eapnadr tSmeenniot ro fC Posnyscuhltiaantrty, ,W U.nKiv. eKrseiltlyo gogf CFoounnndeacttiiocunt, original typmay have ROBHoEfe RMaTlti hnW nCe.e sBnotLteaUr, ,M MFai,n rMmnei.aDnpg.o,t olPinsH,, .CMDoi.n,n nAneescsstooitccauiatte Professor of Pediatrics and Maternal and Child Health, University he ors CHAD D. EMRICK, PH.D., Assistant Clinical Professor of Clinical Psychology in Psychiatry, University of m terr Colorado Health Sciences Center, Denver, Colorado k, not froographic JEIDMW PFAeRnRAnDsNy ClvGEaOKniT,a MTH.SE.WIL.,, CM.E.D.A.,. PP.,H P.rDes.,i dPenrot,f eJismso rF raonf cePks yacnhdi aAtrsys,o cJiaetfefes,r sIonnc ., MNoedrwicaallk ,C Coolnlengeec,t icPuhtiladelphia, op er bome ty MERCWenYteNr fRor. HGeRaEltEhN RLeIsCeaKrc, hP, HK.aDis.,e*r +P eVrmicaen Pernetsei,d Peonrtt l(aRneds,e Oarrcehg)o, nKaiser Foundation Hospitals, and Director, p ao ps DAVID C. LEWIS, M.D., Professor of Medicine and Community Health, Donald G. Millar Professor of Alcohol original ed, and aSncdh oAold,d Picrotivoind eSntcued,i eRsh, oadned IDsliarnedctor, Center for Alcohol and Addiction Studies, Brown University Medical he ain G. ALAN MARLATT, PH.D., Professor of Psychology, University of Washington, Seattle, Washington m tret THOMAS F. MCGOVERN, ED.D., C.A.D.A.C., Associate Professor of Psychiatry, Department of Psychiatry, oe ed frat bnnot MARSKou Vth.w PeAstU ILnsYti,t uPtHe .fDor., *A d# dRicotbiveret DDi.s eEaisleerss, TPreoxfaess sToerc ohf U Hneiavletrhs iCtya rHe eMalathn aSgceimenecnets aCnedn Etecro, nLoumbbicosc, kP, rToefexsassor ea of Public Management and Economics, and Executive Director, Leonard Davis Institute of Health es crer, c Economics, University of Pennsylvania, Philadelphia, Pennsylvania L filwev BARBARA ROSS-LEE, D.O., Professor and Chairman, Department of Family Medicine, College of XMho Osteopathic Medicine, Michigan State University, East Lansing, Michigan. m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri ee us vi s are trd. Plea eakerte HARVEY A. SKINNER, PH.D., Professor and Chairman, Department of Behavioural Science, Faculty of ge bry ins MCaendaidciane, University of Toronto, and Senior Scientist Addiction Research Foundation, Toronto, Ontario, s. Paallent CYNTHIA P. TURNURE, PH.D., Executive Director, Chemical Dependency Program Division, Minnesota ed Department of Human Services, Saint Paul, Minnesota ting filesetbeen acci ROGSWEcRahso hDoilnA goLtfoE nM WedAicLiKneE, Ra,n Md .CDh.,i ePf,r oAfedsdsiocrt ioofn sP sTyrcehaitamtreyn ta nCde nBteehr,a vVioetrearla Sncs ieAnfcfeasi,r sU Mnievdeircsaitly Coefn Wtera,s hSienagtttolen, al typhave CONSTANCE M. WEISNER, M.S.W., DR. P.H., Senior Scientist, Alcohol Research Group, Institute of ginay Epidemiology and Behavioral Medicine, Medical Research Institute of San Francisco Pacific Medical orim Center, and Lecturer, School of Public Health, University of California at Berkeley, California he ors m terr ok, not fropographic SFHRTEEURDDMEYAR NSICT IKA. D FBIFE. GSELNAHSEARU, SM, P.DH..,D F..,R A.Css.Po.c(iCat)e, SSttuuddyy DDiirreeccttoorr oy er bme t LEAH MAZADE, Editor apo BARBARA A. KELLEY, Project Secretary ps original ed, and FERLAEDINREIC L ASOWLSOOMNO, ANd, mMi.nDis.,t rDatiirveec tSoer,c rDeitvarisyi,o Dn iovfi sMioenn otafl M Heenatlathl Haneda lBthe ahnadvi Boreahl aMvieodriacli Mneedicine he ain m tret oe ed frat bnnot ea es crer, c L filwev Mo Xh m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri *+# LMLiieaamiissoobnne,,r ,CC Ionomsmtimmtuiitttettee oeef ft Moo rI etddheienc tiSinfueyb sRtaensecaer Achb Ouspep Corotvuenriatigees Sfotur dthye Prevention and Treatment of Alcohol-Related Problems ee us CONTENTS vii s are trd. Plea ke eaert ge bry ins Contents Paall s. ent ed ting filesetbeen acci al typhave originmay Section I: An Overview of the Study he ors Introduction and Summary 1 m terr Chapter 1 — Our Vision 13 k, not froographic ChSaepctetiro 2n —II: SomWeh Fatu ins dbaeminegn ttraela tQedu?estions 23 op er bome ty CChhaapptteerr 43 —— WWhhoat pisro tvreidaetms etrneta?tment? 4928 p ao ps Chapter 5 — Does treatment work? 142 original ed, and CChhaapptteerr 67 —— IIss ttrreeaattmmeenntt navecaeilsasbalrey?? 115623 he ain Chapter 8 — Who pays for treatment? 183 m tret oe ed frat bnnot CShaepcttieorn 9 I —II: AspTehcet sc oomf Tmruenaittmy reonlte 2 11 ea Chapter 10 — Assessment 242 es crer, c Chapter 11 — Matching 279 L filwev Chapter 12 — Determining Outcome 313 XMho Chapter 13 — Implementing the vision 329 m g, en recomposed frog-specific formattinn. CCCChhhhSaaaappppectttteeeetirrrro 1111n4756 I V————: SpeACPPcooonippan ouulc vllPlaaueottsriipvioooiunnenlsswsa ddt aiaeenonffdniidnn s reed eiddecn fobb iTmnyyri msfteiutoarenuntncmcsdttiaueotnrniaotaln lc schhaarraaccteterrisistitcicss 3333 45895719 eno the original work has bation of and other typesettiding styles, for attributiauthoritative version CCChhhaaaSpppettteeecrrrti 112o980n V———: AspCPTeahocyestit sne evgofo fff eloFucritt niitovhaneenn octerfisen sfagitnmanencit nsgy sptoelmicy 444 056654 epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri ee us CONTENTS viii s are trd. Plea ke eaert ge bry ins ChSapectetiro 2n1 V —I: GuLideiandge rtshhei pOngoing Effort 4 85 s. Paallent Acknowledgements, 505 ed Appendixes: ting filesetbeen acci ABC... ITMnrteeemartnmbaeterinos tno Mafl toRhdeea vTliiateisweks :oF fPo rTrocrceeesastsm aenndt aOnudt cRoemheabilitation Services for Alcoholism and 555501071 al typhave Alcohol Abuse, by M. Grant and E. B. Ritson ginay D. Coercion in Alcohol Treatment, by C. M. Weisner 579 orim Index 611 he ors m terr k, not froographic op oy er bme t p ao ps original ed, and he ain m tret oe ed frat bnnot ea es crer, c L filwev Mo Xh m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri ee us ix s are trd. Plea ke eaert ge bry ins Broadening the Base of Treatment Paall s. ent ed ting filesetbeen acci for Alcohol Problems al typhave ginay orim he ors m terr k, not froographic op oy er bme t p ao ps original ed, and he ain m tret oe ed frat bnnot ea es crer, c L filwev Mo Xh m g, ed fromattin en recomposg-specific forn. eno the original work has bation of and other typesettiding styles, for attributiauthoritative version epresentaks, hean as the digital rord breblicatio e: This new e lengths, won of this pu PDF filnal; linnt versi About this to the origiuse the pri
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