Contingent reinforcement of lowered blood-alcohol levels in an outpatient chronic alcoholic

Recently. the proposition that alcohol abuse is an operant behavior and thus functionally related to its consequences has been investigated under experimental conditions. In controlled laboratory settings, in which inpatient chronic alcoholics are allowed access to alcoholic beverages, alcohol consumption has been markedly altered via operant strategies. Monetary rewards (Cohen et al., 1971), the opportunity to participate in an enriched environment (Cohen et al., 1971). and visits to a girlfriend (Bigelow et al., 1973) have been used as reinforcers for decreased drinking.Other investigators (Sulzer, 1965; Miller, 1972: Hunt and Azrin, 1973) have successfully applied similar contingency management techniques to alcoholics in the natural environment. However, failure to control for the influence of extraneous therapeutic variables (e.g., attention-placebo factors, job counseling) together with reliance on self-report measures of drinking behavior seriously limit the conclusiveness of these results. Objective assessment is particularly essential with operant techniques since consequent events must be systematically scheduled upon the occurrence or non-occurrence of drinking. Documentation of drinking in the natural environment is a difficult task since the alcoholic frequently consumes alcohol when he is alone. In lieu of direct observation, blood alcohol concentrations are an obvious means of objective assessment. Such data are most conveniently obtained via breath tests similar to the ones that law enforcement officers utilize to identify intoxicated motorists.The purpose of the present study was to investigate the influence of reinforcement contingencies on lowering blood alcohol concentrations obtained in an alcoholic's natural environment.