Outpatient treatment of the problem drinker: strategies for attaining abstinence

The initial phase of outpatient alcohol treatment is often the most difficult, since the patient must cease drinking--a change he has typically been unable to accomplish in the past. This paper describes a model of treatment which emphasizes that well-intentioned attempted solution behaviors by the patient and his family frequently serve to perpetuate the very drinking behavior they intend to eliminate. "Second order," illogical interventions can be a powerful clinical method for overcoming this vicious cycle of repetitive abusive drinking. The model is family oriented and conceptualizes cessation of drinking (in the motivated patient) as a product of undoing the commonsensical but ineffective attempts of the patient and his family. Two case studies are offered, illustrating the techniques.