Table Of ContentBehavioral Treatment
of Alcohol Problems
INDIVIDUALIZED THERAPY AND
CONTROLLED DRINKING
THE PLENUM BEHAVIOR THERAPY SERIES
Series Editor: Nathan H. Azrin
THE TOKEN ECONOMY: A Review and Evaluation
By Alan E. Kazdin
COGNITIVE-BEHAVIOR MODIFICATION: An Integrative Approach
By Donald H. Meichenbaum
BEHAVIORAL TREATMENT OF ALCOHOL PROBLEMS
Individualized Therapy and Controlled Drinking
By Mark B. Sobell and Linda C. Sobell
Behavioral Treatlllent
of Alcohol Problems
INDIVIDUALIZED THERAPY AND
CONTROLLED DRINKING
Mark B. Sobell
Vanderbilt University
Nashville, Tennessee
and Linda C. Sobell
Dede Wallace Center
and
Vanderbilt University
Nashville, Tennessee
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Sobell, Mark B
Behavioral treatment of alcohol problems.
(The Plenum behavior therapy series)
Includes index.
1. Alcoholism. 2. Behavior therapy. I. Sobell, Linda C., joint author. II. Title.
(DNLM: 1. Behavior therapy. 2. Alcoholism-Therapy. WM274 S677bj
RC565.S6 616.8'61'06 77-12381
ISBN-13:978-1-4613-3966-3 e-ISBN-13:978-1-4613-3964-9
DOl: 10.1007/978-1-4613-3964-9
First Printing - January 1978
Second Printing - July 1980
© 1978 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1978
A Division of Plenum Publishing Corporation
227 West 17th Street, New York, N.Y. 10011
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
To
"Cas" and Circumstance
Preface
Ideas about the nature of alcohol problems have been undergoing
dramatic change over the past several years. This book summarizes
the clinical research we have conducted over the past eight years;
research which has evoked controversy and which, we hope, will be
evaluated as having been influential in the development of a scientific
approach to the clinical treatment of alcohol problems. Although we
reference many studies from the general behavioral literature on
alcohol problems, we make no pretense of presenting a thorough
review of that literature. By and large, this book focuses on the
research we have conducted, the rationale for that approach, and a
detailed discussion of methods and results which cannot be presented
in journal articles.
The book begins by giving the reader a perspective on traditional
concepts in the alcohol field, and why those concepts are now being
challenged. Within that conceptual framework, we then trace the
development and sophistication of our clinical research, presenting
for the first time in a single work a complete consideration of the
rationale, methods, and results of the study of Individualized Be
havior Therapy (IBT) for alcoholics. Following a discussion of many
of the more subtle aspects of that study and its results, we describe
how IBT can be used in an outpatient setting-the setting in which
we have conducted clinical research for the last six years. We feel that
this book has given us an opportunity to present a more thorough and
integrated exposition of the IBT study and related clinical research
than has been possible in scientific journals. Similarly, it has allowed
us a much greater opportunity for speculation and thought sharing
VII
Vlll Preface
about the methodology, techniques, and results than previously has
been possible.
We see this book as useful for two audiences: individuals who
have an interest in behavior therapy, and those who are interested in
the treatment and treatment outcome evaluation of alcohol problems.
We believe that many of the experiences associated with developing
behavioral treatment approaches to drinking problems have sig
nificance for behavior therapy in general. Finally, recognizing that
the treatment of individuals with alcohol problems has met with little
success in the past, we see the IBT study and related research as
providing those in the alcohol field with techniques and guidelines for
approaching and evaluating alcohol problems in a more systematic
and pragmatic manner.
Mark B. Sobell
Linda C. Sobell
Nashville, Tennessee
Acknowledgments
Over the past eight years, we have received assistance, support, and
inspiration from a great many individuals and our employers. More
over, many of the studies described in this book were conducted in
collaboration with other investigators. We would particularly like to
thank the following people: Claudia Armstrong, Timothy B. Baker,
Joseph V. Brady, Sebastian Casalaina, William Christelman, Kenneth
C. Mills, Natalie Olsen, Fred Samuels, and Drexel B. Sheahan. We
are also greatly indebted to Nancy Crow, who repeatedly typed the
manuscript without complaint, and to Stephen A. Maisto, who per
formed the multiple regression analyses reported in Chapter 7. Lastly,
we have benefited greatly from the editorial suggestions of Nathan H.
Azrin and Seymour Weingarten.
M. B.S.
L. C. S.
IX
Contents
CHAPTER 1
The Nature of Alcohol Problems 1
Traditional Concepts of Alcohol Problems ............... 1
Alcoholics Anonymous ............................ 2
Jellinek's Disease Concept of Alcoholism ............ 3
A Conceptual Reformulation ........................... 9
Differences between Traditional and Empirically Derived
Concepts ....................................... 12
Conclusion ........................................... 14
CHAPTER 2
Alternatives to Abstinence: A Departure from Tradition . 15
"Once an Alcoholic, Always an Alcoholic!": Tradition
Contradicted ................................... 15
A New Look at an Old Problem ........................ 17
Individualized Behavior Therapy (IBT): A Nontraditional
Approach ...................................... 20
Traditionalists Respond to the Mounting Evidence ....... 22
Nonproblem Drinking Outcomes: Unexpected
Consequences .................................. 28
Conclusions and Cautions against Misinterpretation 28
XI
Contents
XII
CHAPTER 3
The Functional Analysis of Drinking Behavior . . . .. . .. .. 31
A Functional Analysis Model of Drinking Decisions ....... 33
What Constitutes a Drinking Problem ................... 37
A Detailed Consideration of the Model .................. 38
Implications: Strategies for Intervention ................ 40
Further Considerations ................................ 44
CHAPTER 4
The Early Patton Studies: An Empirical Foundation 47
The Research Setting, Circa 1969 ....................... 47
Baseline Drinking Behavior .................... ....... 50
Videotape Self-Confrontation: A Demonstration of the
Value of Scientific Method in Clinical Research .... 65
Modifying Drinking Behavior .......................... 69
Reinterpreting the Adage: "First Drink, Then Drunk" .... 73
Evidence for a Learning Deficiency ..................... 77
Integrating the Early Research ......................... 78
CHAPTER 5
Individualized Behavior Therapy (IBT): A Broad-
Spectrum Behavioral Approach .................. 81
Experimental Design .................................. 82
Subjects .......................................... 82
Assignment to Experimental Conditions ............. 83
Treatment Procedures ................................ 87
Facilities ......................................... 87
Overview ........................................ 88
Modification of the Drinking Response-Avoidance
Contingencies .................................. 89
Videotaped Drinking: Sessions 1 and 2 .............. 91
Education: Session 3 .............................. 92
Videotape Replay: Sessions 4 and 5 ................. 93
Analogue Failure Experience: Session 6 ............. 93
Problem Solving Skills Training: Sessions 7 through 16. 94
Videotape Contrast and Summary: Session 17 ....... 103
