The aftermath of heresy: a response to Pendery et al.'s (1982) critique of "Individualized Behavior Therapy for Alcoholics"

A point-by-point response is presented to Pendery et al.'s (1982) critique of the study “Individualized Behavior Therapy for Alcoholics (IBTA)”. Two independent, external investigations have critically examined the original records from the IBTA study. The IBTA study compared two different techniques for treating poor-prognosis, chronic alcoholic state hospital patients. It was found that a broad-spectrum behavioral treatment oriented to controlled drinking was a more effective treatment than was the standard hospital treatment program based on conventional wisdom. The Pendery et al. critique gave the appearance of being a refutation by presenting findings for only one group of Ss in a comparative study. In this response, it is shown that the experimental and control Ss were justifiably classified as gamma alcoholics, that Ss were randomly assigned to groups, and that the two groups were comparable in terms of pretreatment characteristics. Moreover, as regards the originally reported 2-yr treatment outcome findings, it is shown that Pendery et al, reported no specific events which were not already documented in the original study records which formed the basis for publications about the IBTA study. Finally, even in terms of long-term outcomes, i.e. mortality rates 10–11 yr after treatment, the experimentally-treated group (20% mortality) continued to fare better than the traditionally-treated group (30% mortality). Ironically, rather than Pendery et al.'s report being a refutation of the original published accounts of the IBTA study, it is concluded that the data reported by Pendery el al. actually strengthen the validity of the original publications. The attack on the IBTA study can be meaningfully viewed as a reflection of the scientific revolution presently underway in the alcohol field. The central impetus for conceptual change in the alcohol field, however, derives less from controlled-drinking research than from the lack of empirical support for conventional wisdom. Ideas are changing because the traditional view no longer inspires progress.     

A comparison of a brief and long version of the Situational Confidence Questionnaire

Assessing confidence to resist drinking in high risk situations is an important part of behavioral treatments for alcohol problems. The present study assessed the reliability and validity of the original 100-item Situational Confidence Questionnaire (SCQ) and of an 8-item brief version (BSCQ). Using a visual analog scale, the BSCQ asked respondents to report their confidence to resist urges to drink heavily using the original eight SCQ subscales (e.g., pleasant times with others, social pressure). Data were collected from 120 adult problem drinkers who voluntarily entered an outpatient alcohol treatment program. The comparability of the BSCQ and the SCQ-100 was evaluated through intraclass correlations between the eight subscales and comparison of both instruments' underlying factor structures. Correlation coefficients for the subscales ranged from 0.56 to 0.80. Both instruments showed similar, but not identical factor structures. The present results indicate that the BSCQ provides comparable information to the SCQ-100. Limitations, as well as the clinical advantages, of using the BSCQ over longer versions are discussed.     

An Institution for Change: Developing a Family Day Unit

This paper describes the theory and structure of a day unit designed to intervene in the systems of families who present with severe or multiple problems to agencies attempting to help them, but who are difficult to engage in a therapeutic pact and unresponsive to attempts at outpatient therapy. An analysis of these families is offered in terms of the relations between internal and external boundaries and difficulties in making transitions in the daily contexts of life. The principles of the unit are described in terms of the creation of an artificial extended family, the intensification of sequence and patterns of interaction, and the making and traversing of boundaries. Particular attention is paid to the function of agency interventions in family patterns and to redefining the relationship between family and agencies.     

Test-retest reliability of retrospective self-reports in three populations of alcohol abusers

The reliability of alcohol abusers' retrospective self-reports was evaluated using a time-line follow-back interview technique. Independent groups of male subjects were interviewed in three different treatment settings (outpatient,n=12; inpatient,n=12; residential,n=12) on two separate occasions to assess the test-retest reliability of their self-reports of daily drinking and related events occurring 1 year prior to treatment. Correlational and scatterplot analyses generally showed a high correlation and low discrepancy between the two sets of interview responses for all groups. However, since some population differences were found in the reliability of reports for some variables, further research is needed to delineate the conditions under which reliable and valid retrospective self-reports can be obtained from different populations of alcohol abusers.This research was supported, in part, by Grant No. AA07072 from the National Institute on Alcohol Abuse and Alcoholism to Vanderbilt University.