Clinical Case Studies in the Behavioral Treatment of Alcoholism

311 Pages·1982·8.68 MB·English

by  Peter M. Miller (auth.)

Clinical Case Studies in
the Behavioral Treatment
of Alcoholism
Clinical Case Studies in
the Behavioral Treatment
of Alcoholism
Edited by
WILLIAM M. HAY
and
PETER E. NATHAN
Rutgers University
New Brunswick, New Jersey
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Main entry under title:
Clinical case studies in the behavioral treatment of alcoholism.
Includes bibliographical references and index.
Contents: Behavioral treatment of binge drinking / Peter M. Miller-Behavioral
treatment of alcoholism / Mark S. Goldman and Diane K. Klisz-When is a book a
treatment?: bibliography for problem drinkers / William R. MilIer-[etc.]
1. Alcoholism-Treatment-Case studies. 2. Behavior therapy-Case studies. I.
Hay, William M., 1947. . II. Nathan, Peter E. [DNLM: 1. Behavior therapy-Case
studies. 2. Alcoholism-Therapy-Case studies. WM 274 C644]
RC565.C487 1982 616.86'106 82·18048
ISBN -13:978-1-4613-3417-0 e-ISBN -13:978-1-4613-3415-6
DOl: 10.1007/978-1-4613-3415-6
©1982 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1982
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical. photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
For our fathers
WILLIAM G. HAY, Jr.
EMIL NATHAN, Jr.
Contributors
Glenn R. Caddy, Department of Psychology, Nova University, Fort Lauderdale,
Florida
Tony Cellucci, North Carolina Weslyan College, Rocky Mount, North Carolina
Mark S. Goldman, Department of Psychology, Wayne State University, Detroit,
Michigan
William M. Hay, Alcohol Behavior Research Laboratory, Rutgers-The State
University, New Brunswick, New Jersey
Ray J. Hodgson, Addiction Research Unit, Institute of Psychiatry, Maudsley
Hospital, London England
Diane K. Klisz, Department of Psychology, Wayne State University, Detroit,
Michigan
Barbara S. McCrady, Problem Drinkers Project, Butler Hospital, Providence,
Rhode Island
Peter M. Miller, Sea Pines Behavioral Institute, Hilton Head Island, South Carolina
William R. Miller, Department of Psychology, University of New Mexico,
Albuquerque, New Mexico
Peter E. Nathan, Alcohol Behavior Research Laboratory, Rutgers-The State
University, New Brunswick, New Jersey
vii
viii CONTRIBUTORS
Ted D. Nirenberg, Veterans Administration Medical Center, Davis Park,
Providence, Rhode Island
Nora E. Noel, Problem Drinkers Project, Butler Hospital, Providence, Rhode
Island
E. Mansell Pattison, Department of Psychiatry, Medical College of Georgia,
Augusta, Georgia
Howard J. Rankin, Addiction Research Unit, Institute of Psychiatry, Maudsley
Hospital, London England
Linda C. Sobell, Clinical Institute, Addiction Research Foundation, and
University of Toronto, Toronto, Ontario, Canada
Mark B. Sobell, Clinical Institute, Addiction Research Foundation, and
University of Toronto, Toronto, Ontario, Canada
Roger E. Vogler, Department of Psychology, Pomona College, Pomona, California
Preface
There is no shortage of books on behavioral research, on behavioral research
on alcoholism, or on behavioral research on alcoholism treatment. Most of
the authors of chapters in this book have been involved in the writing of
these books. The books and their authors have played an important role in
the dramatic increase in the influence of behavioral approaches to one of our
society's most troubling human problems.
There are not many books, though, which detail the longitudinal course
of the behavioral therapies, none doing so for behavior therapy with al
coholics and problem drinkers. That this book now appears, then, is a first,
made more valuable by the fact that the chapter's authors are both research
ers and clinicians, willing and able to combine respect for empirical data
with clinical sensitivity and compassion, concern, and commitment for their
patients.
The chapters in this book reveal important commonalities and telling
divergencies in technique, strategy, and treatment tactics. Despite a common
perspective on etiology and treatment, the authors of the chapters in this
book diverge in criteria for deciding on treatment goal, choice of initial
intervention target, the specifics of techniques used, and follow-up proce
dures. Common to all, though, is an openness to innovation, a pragmatic
appreciation of approaches that work, and a sincere respect for the patient
and his or her fundamental desire for a healthy, happier, and more produc
tive life.
Our major debt, then, is to our colleagues and friends who have joined
us in preparing this book. As on other occasions, we owe them our thanks
for participating with us in an enterprise we all feel is a worthwhile one. As
well, we would like to thank our colleagues at the Alcohol Behavior Research
Laboratory and the Graduate School of Applied and Professional Psycholo-
ix
x PREFACE
gy, who continue to offer us the kind of intellectual and emotional suste
nance that makes this kind of work so enjoyable as well. Barbara Honig
typed much of this book with her usual mixture of gentle grumbling and
good grace. And the National Institute on Alcohol Abuse and Alcoholism
supported salaries, supplies, and scribes for a number of those whose chap
ters appear in this book, including its editors.
PETER E. NATHAN
WILLIAM M. HAY
Contents
Summary of Cases Presented . . . . . . . . . . . . . . . . . . . . .. Inside front cover
PART I. CONTEMPORARY BEHAVIORAL
ASSESSMENT AND TREATMENT PROCEDURES 1
Chapter 1. Behavioral Treatment of Binge Drinking .................... 3
PETER M. MILLER
1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3
2. Reason for Referral ..................................... 4
3. History of Drinking Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4
4. Current Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5
5. Assessment Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 6
6. Treatment Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8
7. Treatment Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 9
8. Treatment Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 16
9. Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19
Commentary ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 20
10. References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21
Chapter 2. Behavioral Treatment of Alcoholism: The Unvarnished Story. . .. 23
MARK S. GOLDMAN AND DIANE K. Kusz
1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 23
2. Mrs. J. ............................................... 32
Commentary .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 46
3. References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 47
xi
xii CONTENTS
Chapter 3. When Is a Book a Treatment? Bibliotherapy for Problem
Drinkers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 49
WILUAM R. MILLER
1. Introduction ...................... '. . . . . . . . . . . . . . . . . . . .. 49
2. Controlled Drinking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 49
3. Bibliotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 50
4. Differential Diagnosis .................................. 52
5. Case One: Leah. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 54
6. Case Two: Richard .................................... , 60
7. Discussion. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. 64
Commentary ................................................. 67
8. References. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. 69
Chapter 4. Behavioral Treatment of Outpatient Problem Drinkers: Five
Clinical Case Studies ......................................... , 73
NORA E. NOEL, LINDA C SOBELL, ToNY CELLUCCI, TED D. NIRENBERG, AND
MARK B. SOBELL
1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 73
2. Case No.1 (Therapist L. C S.) .......................... , 77
3. Case No.2 (Therapist T. D. N.) . . . . . . . . . . . . . . . . . . . . . . . . .. 83
4. Case No.3 (Therapist M. B. S.) ......................... , 88
5. Case No.4 (Therapist N. E. N.) . . . . . . . . . . . . . . . . . . . . . . . . .. 92
6. Case No. 5 (Therapist T. C) ............................ , 96
7. Concluding Comments ................................ , 99
Commentary ................................................ 100
8. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 102
PART II. RELATIONSHIPS BETWEEN MARITAL
DISCORD AND ALCOHOL ABUSE .................. 105
Chapter 5. Louise: The Real and the Ideal..... . . . . . . . . . . . . . . . . . . . .. 107
PETER E. NATHAN
1. The Setting .......................................... 107
2. Behavioral Assessment, Including Drinking History. . . . . . .. 108
3. Louise at the Beginning of Treatment. . . . . . . . . . . . . . . . . . .. 114
4. The Eight-Session Contract. . . . . . . . . . . . . . . . . . . . .. . . . . . . .. 116
5. The Contract That Worked. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121
6. Louise: The Real and the Ideal. . . . . . . . . . . . . . . . . . . . . . . . .. 122