Journal of Studies on Alcohol, Vol. 3•, No.

1, 1975

A Reviewof Psychologically
Oriented
Treatment of Alcoholism

II. The Relative Effectiveness of Different Treatment

Approachesand the Effectivenessof Treatment
versus No Treatment •

Chad D. Emrick, Ph.D.

SVMMa•tY.A review o1•384 studiesolt pstjchologicall•t

orientedalcoholismtreat-
mentshowed
thatdilyerences
• treatment
methods
did notsignificantl•t
affectlong-
term outcome.Mean abstinencerates did not differ betweentreated and untreated
alcoholics,
but more treatedthan nontreatedalcoholics
improved,suggesting that
formaltreatmentat leastincreases
an alcoholic's
chancesof reducinghis drinking
problem.

NTHIS
SECOND
inaseries
of
reports
onalarge-scale
review
of studiesevaluatingoutcomefollowingpsychologically
ented treatmentof alcoholism,
ori-
126 studiesreportedin 168
publicationshavebeenadded (1-6, 8, 10-40, 42, 43, 46-55, 58-69,
71-86, 89-99, 101-104, 106-139, 141-153, 155, 156, 157, 159-163,
165-181) to the 271 alreadyreviewed (41). These new reports
were collectedwhile updatingthe review through 1973. In the
process
of updating,I foundnot only recentresearchbut a number
• Basedon researchsubmittedin partial fulfillment of the requirementsfor the
degreeof Doctor of Philosophy(41) under the ExecutiveCommitteeof the Gradu-
ate Schoolof Arts and Sciences,Columbia University, New York.
aAssistantProfessorof Clinical Psychology,University of ColoradoMedical Cen-
ter, 4200 East 9th Ave., Denver, CO 80220.
ACK•OWLEDCMENTs.--This researchwas supportedin part by General Research
Assistance Grant 501-RR 05357 from the U.S. Public Health Service. In addition
to thosepreviouslyacknowledged(41), I expressmy appreciationto Lynn Maletz
and BernieceHindmarshfor their considerablehelp in updating the review and
to Donald W. Stilsonwho offered invaluableassistancein analyzingthe data. I
am grateful to Bertha Merriwether,Patty Polskyand Carol Emrick for their help
in preparing this manuscript.
Receivedfor publication:23 September1974.
88
 REVIEV• OF ALCOHOLIS1V[
TREAT1VIENT 89

of previously
unanalyzedstudieswhichappearedduringthe original
1952-1971review period. Thus, the additionalstudiesserve not
only to updatethis work but to renderit considerably
more ex-
haustive.
Both proceduresfor researchingthe literature and the nature
of the 119 studiesevaluating3 or more alcoholicsare similar to
the procedures andstudiesdescribed in the first paper (41). The
remaining7 studies(19, 47, 119, 120, 138, 165, 169) were not
analyzedbecausethey were single-case reports.
Thispaperwill presentfindingsdealingwith the followingques-
tionsaskedof the literature: (1) Whether an alcoholicincreased
his chancesof improvingin any dimensionby having one treat-
ment rather than another;(2) Whether the likelihoodof improve-
ment in drinkingwas iust as strongor strongerwith no formal
treatment.

DIFFERENCES IN OUTCOME BETWEEN RANDOMLY ASSIGNED

OR ADEQUATELY
MATCHEDTREATMENTGROUPS
Evidence for the relative effectiveness of different treatment
approaches can be found in studiesof patientseither randomly
assignedto two or more treatmentgroupsor matchedon charac-
teristicsknownto relateto outcome.Thesestudiesyield interpret-
able data on treatmenteffectsbecausethey controla powerful
determinant of outcome,viz., patient-characterizing
variables?Any
observeddifferencescan be attributedto divergentapproaches as
appliedby the therapeuticagentsinvolved.
Procedure.Amongthe 384 studiesreviewed,72 randomlyassigned
patientsto 2 or more treatmentgroupsor matchedthem on important
variables(5, 13, 20, 21, 25, 34, 35, 37, 40, 46, 51, 53, 55, 66, 79, 82, 84,
91-95, 99, 101, 108, 125, 135, 136, 142, 151, 152, 159, 160, 161, 166, 168,
172, 177, 178) [5, 6, 9, 18, 19, 23, 27, 46, 51, 52, 55, 56, 59, 69, 61, 67,
68, 80, 81, 82, 96, 102,105,106,115,116,126,,128,137,139, 141, 144,
146, 148, 149, 151, 153, 159, 192, 201, 208, 219, 230, 239, 248, 249, 250,
259, 260, 268, 272, 282, 286, 289, 291, 296, 301, 310].4 This body of re-
searchwas screenedfor all outcomedifferencessignificantat the .05
level or better.In studieswhereiust somegroupswere randomlyas-
signedor matched,resultspertainingonly to the appropriatelyformed
groupswere considered (20, 21, 55, 66, 91-95, 101, 151) [23, 46, 55, 56,
8A later paper will review data on the relationships
betweentreatmentoutcome
and a broad range of patient characteristics.
• Entriesin squarebracketsrefer to bibliographic
itemsin the first paper of this
series(41).
90 c.D. va•rPaC•

126, 139, 151,239, 282, 289, 291]. When specificresultsas well as the
methodsusedto obtainthem were reported,the formerwere checked
for accuracy,the latter for their appropriateness.
Computational errors
were foundin 2 reports(101, 142). In severalother casesinappropriate
methodswere detectedsuch as not using Fisher'sexact method for
computing P valueswhenthe datarequiredit (166) [82] and applying
Yates'correctionwhen the data did not [137, 192]. In 2 cases[5, 137,
192] a 1-tailedtest was performedwhen a 2-tailed test would have
beenmoreappropriate.In 2 other studies(108) [102, 146], certainpa-
tients(e.g., rapid drop-outsand thoselostto follow-upor otherwisenot
directlyevaluated)were not properlyexcludedfrom the calculationof
outcomerates,and in another(166) a patientwas inappropriately ex-
cludedfrom i groupbefore determiningrates.Finally, patientsin a
nonrandomly assignedgroupwere inappropriately combinedwith those
in a randomlyassigned groupbeforecomparingthe latter with another
properlyformed group [291].
Conclusions regardingrelativetreatmenteffectswere limited to dif-
ferences found more than 6 months after termination of treatment in
at least50• of patientsin all groupsbeing compared.This procedure
was adoptedbecausemany researchers have reporteda high drinking
relapserate duringthe first 6 monthsafter treatment[e.g.,50, 106, 148,
178,288]. Once6 monthsto a year have passed,time betweentreatment
and follow-updoesnot significantlyinfluencethe statisticalpatterning
of outcomein groupsof patients(e.g., 13) [18, 19, 59, 151, 223, 288].
By limiting this analysisto differencesfound more than 6 months
after treatment, conclusionscould be based on stabilized data. The
wisdom of this procedureis supportedby severalstudiesfinding sig-
nificant differences in treatment outcome at evaluations 6 months or
lessafter terminationbut no suchresultsat later follow-ups[106, 137,
141, 148, 149, 159, 192]. Apparently,the initial benefitsof one approach
were wiped out, leaving patientshaving that treatment no better off
than other patientsmore than 6 monthsafter termination.

RESULTS AND DISCUSSION

Thirty-onestudiesreportedno differences betweengroups(13,

25, 34, 82, 94, 95, 99, 101, 166, 172) [5, 9, 18, 19, 23, 27, 46, 52, 55,
56, 59, 60, 61, 80, 81, 96, 105, 126, 139, 144, 151, 219, 230, 259, 260,
272, 286, 289, 310]. The remainderfound significantdifferences,
but in all except5 studies(136, 159, 160, 161) [67, 208, 282, 291],
the resultswereobservedat evaluations madeduringtreatmentor
at most6 monthsafter terminationof all therapyfor at leastI of
the 2 groupsbeingcompared(5, 37, 40, 46, 51, 53, 66, 79, 84, 125,
135, 142, 152, 159, 160, 161, 168, 177, 178) [6, 51, 68, 82, 106, 115,
116, 128, 137, 141, 148, 149, 153, 159, 192, 201, 248, 249, 250, 268];
orthedifferences
pertained
to onetherapykeepingpatientsin treat-
 REVIEW OF ALCOHOLIS1VfTREATMENT 91

ment longerthan another(5, 20, 21, 35, 37, 55, 91, 92, 93, 108, 142,
151) [6, 82, 102, 146, 239, 296, 301]; or were found by chance
amongnumerous comparisons [51, 106,'148,250]; or did not reflect
better outcomefor either group (177, 178). Thus, in the vast ma-
iorityof cases,
significant resultswereshort-term,
due to chanceor
not directlyrelatedto life adiustment.
Table I presentsthe few significantlong-termdifferencesthat
were found. Their most strikingcharacteristicis that all appear to
have derived,at least in part, from someaspectof one treatment
plan being relatively harmful by retarding improvementrather
than from one approachbeing relatively beneficial.Description
of the studiesreportingthesedifferencesshouldsubstantiatethis
point.
In the studyby Tomsovicand Edwards[282], patientsvolun-
teeredto receivelysergidehalfwaythrougha 90-dayprogramand
were told they might or might not receivethe drug. On the 45th
day a coinwas flipped;half receivedthe drug,the otherhalf did
not. At 1-year follow-upmore of the nonschizophrenic patients
not receivinglysergidewere drinking than similar patientswho
had receivedlysergide(p (.05). Moreover,more of the forme•
tendedto drink than nonschizophrenic patientswho had not vol-
unteeredfor lysergidebut had been treated in the regular pro-
gram (p (.10). Tomsovicand Edwards suggested,and I agree,
that disappointment of the patientsdeprivedthe drug causedthe
relativefailure of the nonlysergidevolunteergroup.
In Vogleret al.'sstudy[291] of electricalaversiveconditioning,
patientsin one group received"sham conditioning."They were
askedto drink at a bar locatedon the hospitalward and told they
might or might not be shockedwhile drinking,thoughthey never
were. Patientsin anothergroup,labeled "pseudoconditioning," re-
ceivedshocksonlyrandomlyupondrinking;and thosein two other
groupswere shockedcontingenton drinking. It is important to
realizethat both sham-and pseudoconditioning groupswere aware
of the sensiblemannerin which other patientsreceivedshocks.At
8-monthfollow-up,more contingentlyshockedpatientswere ab-
stinentthan thosein the shamconditioninggroup (p (.05) and
the contingently shocked patientswaitedmoredaysafter discharge
beforedrinkingthan did the sham-and pseudoconditioning groups
combined(p (.05). It seemsthat the unshockedand noncontin-
gentlyshockedpatientsexperienced treatmentfor what it was-a
9• c. r•. •,M•CK

iiii

o,ii
 REVIEW' OF ALCOHOLISM TREATI•ENT 93

sham.Feelingabused,they may havemorefrequentlyreturnedto

drinkingthan they would have had they not had the experience.
In the study by Ends and Page [67], client-centeredgroup
therapypatientshad significantlybetter drinking outcomethan
learning-theory and social-discussiongroups(p < .01 and p < .05,
respectively).Also,patientsreceivinganalyticgroup therapy sur-
passedthe learning-theory groupin abstinence(p < .05). In ac-
countingfor the pooroutcomeof the social-discussion group,Ends
and Pageremarked '"that groupmeetingsin which the therapist
is not actively'therapeutic' haveno therapeuticvaluefor mostof
the participants,and resultin minimalchanges,but changesthat
are not constructiveand generallyharmful."The relative failure
of the learning-theory groupwas explainedas follows:"learning-
theorytherapyashereconceived and applieddoesnot demonstrate
anytherapeutic usefulnessby reversing any of the deleterious
proc-
esseswhich occurredspontaneously in the controlgroup. . . but
rathertendsto acceleratesuchprocesses." Thus, as with Tomsovic
and Edwards,Ends and Pagereasonedthat the long-termdiffer-
encesthey observedstemmedfrom some treatmentsbeing rela-
tivelyharmful,not beneficial.
In the studyby Pittmanand Tate (136) [208] all patientswere
askedat intakeif they couldstay in the hospital3 or moreweeks
if requestedto do so.Thosewho agreedwere randomlyassigned
to one of two groups.In one, patients were asked to leave after
7 to 10 days,and were not offeredaftercarebut were encouraged
to attend AlcoholicsAnonymousmeetings.Patientsin the other
grouphad a chanceto stay 3 to 6 weeksand at dischargewere
encouraged to returnfor aftercare.At follow-up,moreof the longer-
term groupwere sociallystable (p < .05) and had changedresi-
dence(p < .05). It seemsunlikelythat patientshavingthe extra
therapyreceivedunusuallybeneficialtreatment.Rather,thosenot
havingit probablyfelt reiectedat being askedto leavewith no
offer of additionalcare, particularlywhen their fellow patients
were gettingmore therapy.
Finally, in the studyby Sobelland Sobell(159, 160, 161), each
patientwas interviewedby severalstaff membersto assess whether
total abstinenceor controlleddrinkingwould be the appropriate
treatmentgoal. Followingthis, a coin was flipped to determine
whetherthe patientwouldmerelyenterthe conventional inpatient
programto work towardhis goal or would receivebehaviorther-
9• c.D.

apy adjunctivelyto the program.Oneyear after completionof all

treatment,patientsin the groupreceivingbehaviortherapywith
controlleddrinkingas the goal had more often "functionedwell"
in drinkingbehaviorduringmostof the year thanhad thosemerely
treatedin the conventionalprogramwith the goal of controlled
drinking(p (.01). Also,the formerhad spentfewer daysdrunk
or institutionalized
for alcohol-related
reasons(p (.005) and had
moreoftenimprovedin "generaladiustment to interpersonal
rela-
tionshipsand stressfulsituations"(p (.05). These differences
may well rest in the feelingsof reiectionmembersof the non-
behavior-therapygroupexperiencedwhen they lost the coin toss.
Resultsof a lengthy2-yearfollow-upinterviewrevealedthat 405•
of this groupfelt permanentlyreiectedand another205•initially
experiencedreiection but thenfelt better.Only 13.35felt "good"
or "okay"aboutnot beingselected for the experimental
treatment,
26.75•claimingindifference.
5 Thus,a clearmaiorityof patientsfelt
deprivedof specializedtreatmentand resentedthe deprivation.
Feelingreiected,they may haveimprovedlessthan they would
have,had they not had the experience.
The resultsof thesefive studiessuggestthat someelementsin
the treatmentenvironmentharm alcoholicsby eliciting thoughts
and feelingsof disappointment, abuse,neglector reiection.This
aversivestate functionsas an antecedentto further drinking, re-
sultingin fewer patientsimprovingthan would improveif they
had had anothertreatment.Giventhe possibilityof administering
iatrogenictreatment,therapistsshould diligently guard against
harming alcoholicsthrough inappropriateinterventions.
Althoughiatrogenyseemsto be a centralfactorin the long-term
differencesfound in this review, it is quite possiblethat the dif-
ferenceswere partly due to one treatmenthavingunusuallybene-
ficial, long-lastingeffects. However, since the studiesfailed to
controlfor patients'negativeexperiences, this possibilitycould
not be documented.Whether or not long-termbeneficialeffects
will ever be demonstrated, the weight of presentevidenceis over-
whelminglyagainsttechniquevariablesbeing powerful determi-
nantsof long-termoutcome,whateverthe valence.It would seem
that continuedeffortsto developtechniques havinguniquelyposi-
tive posttreatment outcomewill bear little fruit. A wiserexpendi-
ture of resources might be in the area of developingstrategiesto
Personalcommunicationwith Linda Sobell, 10 September1974.
 lIEVIEW OF ALCOHOLIS1V[
TREAT1VIENT 95

involvealcoholicsin therapy,any kind of therapy,sinceall ap-

proaches seemgenerallyhelpfulto the majorityof patients(41).
Also,rather than seekan outstandingtreatment,therapistsmight
give attentionto matchingeach alcoholicwith the setting and
approachwhich meshesbest with his views on the causes,nature
and treatmentof alcoholism(134). Suchendeavorsshouldadvance
the field of alcoholismtreatmentmore than further proliferation
of techniquesused to help alcoholicsonce they are involved in
therapy.

DRINKING OUTCOME IN TREATED VERSUS NONTREATED

OR MINIMALLY TREATED ALCOHOLICS

Oneway to assess psychotherapeuticeffectsis to comparechange

ratesof formally treated patientswith thoseof alcoholicshaving
no formal treatment. 6 If improvementfollowing formal psycho-
therapy is found to surpassimprovementwithout therapy, it can
be concludedthat treatmenthelpsmorethan it hurts,otherthings
beingequal.If changeis the samewith or withouttherapy,treat-
ment probablyhas no consistently harmful or beneficialeffects;
and if no-therapyimprovementrates surpassthosefrom therapy,
treatmentprobablyharms alcoholicsby preventingor retarding
improvement.In an effort to weigh therapy effectsagainstno
therapy,an analysiswas undertakento comparedrinkingoutcome
of treatedand untreatedalcoholics.In reportingthis analysis,im-
provementfollowingno treatmentwill simply be referred to as
no-treatmentimprovement.Although improvementwithout ther-
apy has typically been referredto as spontaneous remission(57,
88, 164) [15],thismodeof reference
is avoidedbecausethe adjec-
tive "spontaneous"suggests
that changeoccurringwithouttherapy
arisesnaturally from life's circumstances
and conditionswhile
changewithin therapyfollowsa 'differentprocess.In fact, there
is no evidenceto suggestthat changeprocessesdiffer inside and
outside of treatment.

Procedure.One way to assess

changein drinkingbehavioramong
untreated alcoholicsis to analyze data from studiesof alcoholicsre-
ceivingno treatment(7, 9, 56, 57, 105, 140, 158). Anotherway is to
6For the purposesof brevity, nonformallytreated alcoholicswill be referred to at
timesas nontreatedor untreatedalcoholics. It is to be understoodthat theseadjec-
tivesrefer only to absenceof formaltreatment,not to completelack of therapeutic
experience(e.g., on a job, at home, or alone).
96 c.D. EM•RICK

approximate the no-treatmentconditionby analyzingoutcomedata

reportedin studiesof alcoholics havingsomebut onlyminimalformal
therapy(6, 87, 94, 95, 121, 128) [20, 45, 47, 49, 84, 110, 126,223, 233,
279,301].Althoughsuchdataare contaminated by individualshavingat
least one treatment contact,contaminationcan be minimized by lim-
iting observations
to thosebasedon patientshavinglessthan five out-
patientsessions
or 2 weeks'inpatienttreatment.It is doubtfulthat many
patientsare more than minimallyaffectedby this amountof treatment.
Procedures for collecting,
classifying
andcullingbothno- andminimal-
treatmentdata were essentiallyidenticalto thosedescribedin the first
paperof thisseries(41). All categorizable
datawereuseclto calculate
abstinentand total-improved ratesin both minimallytreatedand un-
treatedalcoholics.
7 The no- and minimal-treatment
rateswere compared;
and sinceno significantdifferences
were found,the data were pooled
within eachcategory.Thesepooleddata were comparedwith abstinent
and total-improvedrates in formally treated alcoholicsevaluated6
months or more after termination of all treatment. These treatment rates
were chosenfor their comparabilityto the no- and minimal-treatment
rates which were basedsolely on follow-upscoveringa period of at
least 6 months.
To determine whether an association existed between treatment
amount and drinking outcomet tests were performed.A relationship
was assumedto exist if test resultswere significantat the .05 level or
better. Once an association was found, its predictivepower was meas-
ured by ,o2 for t-test resultsand by ;t• and ;tB for resultsof the chi-
squareanalysis(70): •2shows the proportionof variancein drinking
outcomerates that can be accountedfor by variance in the amount
of treatmentpatientshavehad; ;tA measures how muchmoreaccurately
treatment amount can be predicted by knowing whether or not an
alcoholichas improved; and ;tB measuresreductionof prediction er-
ror in the oppositedirection. These adjunctivemeasureswere taken
to shedlight on the practicalimportanceof associations, it beingdecided
that a ,o2, ;tA or ;t• value of more than .10 was needed before a rela-
tionshipcould be consideredof any practical importance.

RESULTS AND DISCUSSION'

As shown in Table 2, 13%of nontreated alcoholicswere abstinent

and 41%were at leastsomewhatimproved,and 21%of minimally
treated alcoholicswere abstinent and 43% somewhatimproved.
There were no statisticallyor practicallysignificantdifferencesbe-
tweenthe no- and minimal-treatment rates.The precisionof these
findingsmust be taken with somecautionsincethey were based
7 SeeEmrick (41) for a descriptionof the abstinentand total-improvedcategories.
These categorieswere the only ones used in this analysisbecausethey alone con-
tained observations from two or more no-treatment as well as two or more minimal-
treatment groups.
 REVIEW OF ALCOHOLISM TREATMENT 97

TABLE2.--Drinking OutcomeFollowingNo Treatment Comparedwith Outcome

after Minimal Treatment
OUTCOME PER GROUP a OUTCOME PER PATIENT a
Amount of Mean N in
Treatment Groups b % SD t we N Category % Xa k• kz
ABSTINENT
None 3 12.9 16.9 .61 ß0 1231 165 13.4 0.44 c .0 .0
Minimal 2 20.6 3.6 36 7 19.4

TOTAL IMPROVED
None 2 40.8 1.7 .25 .0 584 243 41.6 0.05 .0 .0
Minimal 3 42.6 9.7 50 20 40.0

a w•ø: the proportion of variance in outcomeaccountedfor by variance in the amount of treatment. XA --

the proportional reduction in probability of error when predicting the amount of treatment a subject had by
knowing whether or not he met an outcomecategory.ka -• the proportional reduction of error for predicting
whether a subject met an outcome category by specifying how much treatment contact he had.
b Numbers vary with amount of treatment depending on how many groups had data fitting the amount.
e Yates' correction was used in computing this chi square.

on varyingdatafromiusta few studiesandpatientvariableswere

not controlledin makingthe no- vs minimal-treatmentcomparisons.
Nevertheless,
theresultssuggestthat (1) manyalcoholics
candrink
lessor stopaltogetherwith no or minimal treatmentand (2) un-
treated alcoholicschange as much as those receiving minimal
treatment.

Althoughmany alcoholicsimprovewithout treatment,the focus

of concernhere is whether or not more alcoholicsimprove with
treatmentthan without. As shownin Table 3, the per-groupab-
stinence rates did not differ between treated and nontreated or
minimallytreatedalcoholics;
and althoughper-subiectabstinence
rateswere positivelyrelated to treatmentamount,the association
was of no practicalsignificance.
On the otherhand, both per-group
and per-subiecttotal-improvedrates were positivelyand prac-
tically related to treatmentamount.Thirty-sixpercentof the vari-
ance in the per-grouprates can be accountedfor by whether or
not alcoholics had morethan minimaltreatment,and the probabil-
ity of makingan error in predictingan alcoholic'soutcomestatus
is reduced10.5%by specifyingwhether or not he had more than
minimal treatment.Again, theseresultsmust be taken with some
reservationsincevery few minimal- and no-treatmentdata were
involvedand patient characteristicswere not controlled.Nonethe-
less,the findingssuggestthat alcoholicsare, in a practicalsense,as
likely to stop drinkingcompletelyfor 6 monthsor longer when
 98 ½. •. •.•vm•c•

TABLE3.-Drinking OutcomeFollowing TreatmentComparedwith Outcome

a•ter No or Minimal Treatment
OUTCOME PER GROUP a OUTCOME PER PATIENT a
.4mount of Mean N in
Treatmen• Groups
b % SD t o• N Category% X• Xa X•
ABSTINENT
None or
minimal 5 15.9 12.8 1.25 .011 1267 172 13.6 103.0• .0 .0
More than
minimal 45 24.5 16.3 3037 851 28.0

TOTAL IMPBOVED
None or
minimal 5 41.9 7.0 4.64• .363 634 263 41.5 89.1• .0 .105
More than
minimal • 31 65.1 19.6 1774 1119 63.1

a See Table 2 footnote a.

b Numbers vary with amount of treatment depending on how many groups had data fitting the amount.
e It is interesting to note that percentages of total improvement among treated alcoholics are similar to
those Landis (100) reported among alcoholics treated in state mental hospitals in 1933. According to Landis,
60% of patients were dischargedas recoveredor improved within a year of admission, an unremarkable per-
centage since patients were clearly involved in formal treatment. This point would not have to be made if
it were not for the fact that Landis's data for neurotifs were misused by Eysenck (44) as an index of •m-
provemerit without treatment. Actually, Landis's data for both neurotics and alcoholics refer to patients dis-
charged from state mental hospitals and are thus indices of improvement following formal treatment. See
Bergin [15] for a detailed discussion of this issue.
• P < .001.

theyhaveno or minimaltreatmentas whenthey havemorethan

minimal treatment. On the other hand, treatment seemsto increase
an alcoholic's chancesof at least reducinghis drinkingproblem.
It is comfortingto find that many alcoholics improvewithout
formaltreatment,sincefew of them get treatedfor their alcohol-
ism?The sizabletotal-improved ratesfor nontreatedand minimally
treated alcoholicscontradictthe pessimistic statementby Eysenck
and Beech (45) that "spontaneous remission[of alcoholand re-
lated problems]is theoreticallyexpectedto be almostentirely
absent,and clinicalexperiencecertainlysuggests that lack of treat-
ment would almostalwaysmean absenceof improvement." Also,
the mean no- and minimal-treatmenttotal-improvedrate of 41.9•o
is not far from the median improvementrate of about 305 Bergin
[15]foundin neuroticsubiects whohadnoor onlyminimaltherapy.
Apparently,alcoholism is not the onlypsychologicaldisorderwhich
sometimesimproveswithout treatment.
8 Shepherd(154) reportedthat in 1965 a mere 2000 alcoholicsamong an estimated
100,000 used extensivestate-operatedalcoholismfacilities in Connecticut.
 REVIEW OF ALCOHOLISM TREATMENT 99

Treatmentagenciesshouldfeel not onlycomforted but heartened

to seesomeindicationthat treatmentis effectivein helping alco-
holicsimprove.Clearly the sizableexpenditureof human and fi-
nancial resources for alcoholism treatment has not been in vain.
Thisand the first paperof the series(41) havefocusedprimarily
on questionsrelated to variousaspectsof alcoholismtreatment.
The next article will, amongother things,addressthe following
two issuesregardingevaluation,not of treatment,but of the stud-
iesthemselves: (1) The adequacyof reportingof the studies;(2)
The qualityof their design.
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