Inpatient treatment of alcoholism: a behavioral approach

After detoxification has been completed (if needed), a comprehensive assessment of the individual patient's drinking and other problems is the first step in inpatient behavioral treatment of alcoholism. On the basis of the assessment results, treatment is planned and delivered in an individualized manner to achieve three major goals. The first goal of treatment is to facilitate and consolidate the patient's commitment to change by carefully reviewing the evidence from the assessment of negative consequences of the patient's drinking. Alcohol education about the long-term negative consequences of drinking and the use of a decision matrix to clarify the patient's reasons for not drinking also are useful in this regard. The second goal is to stabilize the change in the drinking that occurred when the patient decided to enter the inpatient treatment program. Aversion therapy to decrease desire for alcohol, teaching alternative skills to deal with likely precipitants of renewed alcohol use, and strengthening behaviors incompatible with alcohol abuse all can be used to help maintain abstinence. Antabuse (including behavioral contracting procedures to increase compliance with this drug), along with psychotropic medication for additional psychopathology, are pharmacological interventions that often can be used to stabilize change. A final very important goal is the careful planning of aftercare and post-discharge life to help maintain the changes started during inpatient treatment. A case is presented to illustrate the above notions.