Larry E. Beutler - US grants

Alcoholism is a major public health problem that affects families as well as individuals. Alcoholism treatments have typically focused upon the drinking behaviors of the identified patient and only secondarily have attempted to alter patterns of family interactions. Literature of the past decade, however, has suggested for some subtypes of alcoholics, drinking may reflect and be perpetuated by a disturbance of the family system. Two alcoholics subtypes are most relevant to this issue. The first subtype consists od internalizing or neurotiform drinkers whose drinking may be supported by the family system. Among these alcoholics, drinking may reduce family tension and divert attention away from family problems. The second subtype consists of externalizing or characterological alcoholics, whose drinking behaviors represent a pattern of impulsive behavior that supercedes the influence of the family system. This latter subtype represents an individual problem and, unlike the former, drinking tends to disrupt interpersonal relationships rather than attenuate their intensity. On the basis of these characterizations, it is hypothesized that differential rates of effectiveness will be observed among these two subtypes of alcoholics when behavioral focused and family systems-focused treatments are compared. The current projects represents a revision of a previous submission, the focus of which is to test two treatment models on patients representing these two subtypes of alcoholics. Changes and additions are indicated by bold type.

DESCRIPTION: (Applicant's Abstract) Cocaine abuse represents a serious and growing problem in American society. Effective treatments are needed that both address problems of drug use and abuse and that adequately address concomitant and frequently observed depression in this group. This stage 1 research proposal is a preliminary step toward conducting a large scale, randomized clinical trial comparison of a treatment that selectively combines effective procedures from several different treatment approaches. Specifically, Prescriptive Therapy (PT) uses subject distress level, externalizing coping style, and resistance tendencies to individualize treatment and guide the selection of interventions drawn from supportive counseling, cognitive therapy, and experimental treatment models. In anticipation of the larger study, PT will be refined and contrasted with two manualized treatments, Cognitive Therapy (CT) and Supportive/Self-Directed Therapy (S/SD) through four preparatory phases. In Phase 1, we will select instruments and refine the rules of applying Prescriptive Therapy and the contrasting interventions. In Phase 2, we will test procedures for selecting and training therapists in the three treatment procedures. In Phase 3, we will select a sample of patients presenting with cocaine abuse and mild to moderate dysphoria within the depressive spectrum. This phase will be used to answer questions of subject availability and representativeness as well as to select participants in the final phase of the current project. In Phase 4, we will pilot test the ability to deliver the modified PT, CT, and S/SD treatments to co-morbid, cocaine abusing and depressed patients.