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.

1 The Nature of Alcohol Problems.- Traditional Concepts of Alcohol Problems.- A Conceptual Reformulation.- Differences between Traditional and Empirically Derived Concepts.- Conclusion.- 2 Alternatives to Abstinence: A Departure from Tradition.- "Once an Alcoholic, Always an Alcoholic!": Tradition Contradicted.- A New Look at an Old Problem.- Individualized Behavior Therapy (IBT): A Nontraditional Approach.- Traditionalists Respond to the Mounting Evidence.- Nonproblem Drinking Outcomes: Unexpected Consequences.- Conclusions and Cautions against Misinterpretation.- 3 The Functional Analysis of Drinking Behavior.- A Functional Analysis Model of Drinking Decisions.- What Constitutes a Drinking Problem.- A Detailed Consideration of the Model.- Implications: Strategies for Intervention.- Further Considerations.- 4 The Early Patton Studies: An Empirical Foundation.- The Research Setting, Circa 1969.- Baseline Drinking Behavior.- Videotape Self-Confrontation: A Demonstration of the Value of Scientific Method in Clinical Research.- Modifying Drinking Behavior.- Reinterpreting the Adage: "First Drink, Then Drunk".- Evidence for a Learning Deficiency.- Integrating the Early Research.- 5 Individualized Behavior Therapy (IBT): A Broad-Spectrum Behavioral Approach.- Experimental Design.- Treatment Procedures.- 6 IBT: Emergence of New Treatment Evaluation Measures and Procedures.- IBT Follow-Up Procedures.- IBT Outcome Measures: Drinking Behavior.- IBT Adjunctive Outcome Measures of Life Health.- Summary Measures of IBT Outcome.- Length of Follow-Up: How Long is Long Enough?.- A Look Back at IBT Follow-Up And a Look Ahead.- On the Use of Self-Reported Data.- Concluding Comments.- 7 IBT: Results.- Within-Treatment Results.- Follow-Up Results.- Predictors of TreatmentOutcome.- Summary of IBT Results.- 8 IBT: Interpretation of Results.- Follow-Up Procedures and the Interpretation of Outcome Variables.- The Value of Multiple Measures of Outcome.- Controlled Drinking as an Outcome.- Other Considerations.- A Final Analysis.- 9 IBT in Retrospect.- Specific Treatment Components.- Control Group Assignments.- Controlled Drinking from the Subjects' Viewpoint.- Follow-Up as Continued Care.- Reflections on a Large-Scale Clinical Research Project.- 10 IBT in Private Practice and Outpatient Programs.- Differences between Inpatient and Outpatient Treatment.- General Considerations.- Outpatient Behavioral Treatment Methods.- Concluding Comments.- References and Selected Readings.