AN EARLY COUNSELLING INTERVENTION PROGRAM FOR PROBLEM DRINKERS CONTRASTING GROUP AND INDIVIDUAL DELIVERY FORMATS by DOUGLAS R. ADAMS B.A., University of British Columbia, 1972 M.A., University of British Columbia, 1978 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF THE DOCTOR OF EDUCATION in THE FACULTY OF GRADUATE STUDIES • in the Department of COUNSELLING PSYCHOLOGY THE UNIVERSITY OF BRITISH COLUMBIA 1990 (§) Douglas Ronald Adams, 1990 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of C o u n s e l l i n g Psychology The University of British Columbia Vancouver, Canada D a t e a r ^-i i i n , lgqn DE-6 (2788) ABSTRACT I t i s h y p o t h e s i z e d t h a t group t r e a t m e n t may be more e f f e c t i v e t h a n an i n d i v i d u a l t r e a t m e n t f o r m a t . The p u r p o s e o f t h i s s t u d y was t o a d d r e s s s e v e r a l d e f i c i e n c i e s o f p r e v i o u s r e s e a r c h i n c o n t r a s t i n g group and i n d i v i d u a l t r e a t m e n t d e l i v e r y formats and t o a s s e s s t h e d i f f e r e n t i a l e f f e c t i v e n e s s o f t h e s e two f o r m a t s . The t r e a t m e n t a r e a c h o s e n was t h a t o f e a r l y p r o b l e m d r i n k e r t r e a t m e n t as i t was r e l a t i v e l y easy t o c o n t r o l t r e a t m e n t c o n t e n t a c r o s s t r e a t m e n t formats s i n c e d e t a i l e d c o n t e n t manuals and t h e o r y have been w e l l d e v e l o p e d i n t h i s a r e a . S u b j e c t s were s e l e c t e d from t h o s e r e s p o n d e n t s t o a media a d v e r t i s e m e n t who p a s s e d s e v e r a l s c r e e n i n g c r i t e r i a and were a l t e r n a t e l y a s s i g n e d t o a group o r i n d i v i d u a l f o r m a t . A l a c k o f t h e r e q u i s i t e number o f s u b j e c t s r e q u i r e d some s p e c i f i c d e s i g n changes . E a c h t r e a t m e n t c o n d i t i o n was g i v e n a s t r u c t u r e d e i g h t - w e e k t r e a t m e n t program o f once p e r week meet ings o f s e v e n t y - f i v e m i n u t e s e a c h o r a w a i t - l i s t c o n t r o l c o n d i t i o n . S t a t i s t i c a l c o n t r a s t s were t h e n p e r f o r m e d on t h e f o l l o w i n g v a r i a b l e s : t o t a l d r i n k u n i t s p e r week, maximum d r i n k u n i t s p e r d a y , P r o f i l e o f Mood S t a t e s -a measure o f c u r r e n t a f f e c t i v e s t a t e , Weissman S o c i a l A d j u s t m e n t S c a l e - a measure o f s o c i a l f u n c t i o n i n g l e v e l , and a g e n e r a l p r o b l e m c h e c k l i s t . Data u n i t s were g a t h e r e d \ I p r e - t r e a t m e n t , week ly d u r i n g t r e a t m e n t f o r d r i n k u n i t s , a t p o s t - t r e a t m e n t f o l l o w - u p , and a t s i x months f o l l o w i n g t h e end o f t r e a t m e n t . The o t h e r d a t a were g a t h e r e d p r e - t r e a t m e n t , p o s t - t r e a t m e n t , and a t t h e s i x - m o n t h f o l l o w - u p . R e s u l t s o f t h e d a t a m a n i p u l a t i o n s i n d i c a t e d t h a t the t r e a t m e n t i n t e r v e n t i o n was a s s o c i a t e d w i t h g r e a t e r improvement on a l c o h o l consumpt ions t h a n a w a i t - l i s t c o n t r o l g r o u p , b u t t h a t group t r e a t m e n t was n o t a s s o c i a t e d w i t h g r e a t e r t r e a t m e n t g a i n s t h a n t h e i n d i v i d u a l format on any m e a s u r e s . These r e s u l t s a r e g i v e n t o be t e n t a t i v e g i v e n s e v e r a l m a j o r l i m i t a t i o n s o f t h i s s t u d y w h i c h a r e d i s c u s s e d . The r e s e a r c h was found t o be r e l e v a n t i n t h e a r e a o f t r e a t m e n t p l a n n i n g , and i s i n t e r p r e t e d as p r o v i d i n g a more t h e o r e t i c a l l y m e a n i n g f u l c o n t r a s t o f t h e two formats t h a n p r e v i o u s l y a c h i e v e d due t o g r e a t e r e x p e r i m e n t a l c o n t r o l o f p o s s i b l y c o n f o u n d i n g v a r i a b l e s . A u s e f u l i n i t i a l t e s t was p e r f o r m e d o f a t r e a t m e n t program d e v e l o p e d f o r t h i s s t u d y w h i c h shows p r o m i s e f o r h e l p i n g p r o b l e m d r i n k e r s . I t i s a l s o s u g g e s t e d t h a t t h i s r e s e a r c h p r o v i d e s some i m p o r t a n t c o n c l u s i o n s f o r t h e c o n t r a s t o f g r o u p and i n d i v i d u a l f o r m a t s i n p s y c h o l o g i c a l i n t e r v e n t i o n s g e n e r a l l y . F u t u r e d i r e c t i o n s a r e s u g g e s t e d . TABLE OF CONTENTS A b s t r a c t H T a b l e o f C o n t e n t s '- , V « L i s t o f T a b l e s , . . , VI.. » » t L i s t o f F i g u r e s V"L C h a p t e r 1 I n t r o d u c t i o n 1 C h a p t e r 2 L i t e r a t u r e Review 5 S e v e r i t y o f Problems 5 Review o f R e l e v a n t D r i n k R e d u c t i o n T r e a t m e n t S t u d i e s 8 C o n t r a s t s o f Group and I n d i v i d u a l T r e a t m e n t o f P r e - A l c o h o l i c s 18 Summary and C o n c l u s i o n s from t h e L i t e r a t u r e on Groups f o r Prob lem D r i n k e r s 28 A r e a s o f H e a l t h R e q u i r i n g Assessment i n I n t e r v e n t i o n s w i t h Prob lem D r i n k e r s 3 0 Added Impact o f t h e Group Treatment F o r m a t : S o c i a l P s y c h o l o g i c a l R e s e a r c h 3 3 Models o f Group I n f l u e n c e 3 4 Models P r o p o s e d by S o c i a l P s y c h o l o g y t o U n d e r s t a n d Group I n f l u e n c e 47 A p p l i e d S o c i a l P s y c h o l o g y and Group I n f l u e n c e s . . . 52 Group v e r s u s I n d i v i d u a l Format 57 T h e r a p e u t i c F a c t o r s and Group T r e a t m e n t . 60 F a c t o r s U n i q u e t o I n d i v i d u a l Treatment 71 Summary o f R e l e v a n t F i n d i n g s 75 C o n c l u s i o n 81 Purpose and H y p o t h e s i s 82 C h a p t e r 3 Methodo logy 85 Overv iew 85 E x p e r i m e n t a l D e s i g n 8 5 S u b j e c t s 88 P o p u l a t i o n Samples 88 R e c r u i t m e n t and S e l e c t i o n 88 T h e r a p i s t s 90 P r o c e d u r e 9 0 Trea tment C o n d i t i o n s 9 0 Review o f D e s i g n 92 C o n t a c t and S e l e c t i o n o f C l i e n t s . 92 Random Ass ignment 9 4 C o l l a t e r a l V e r i f i c a t i o n by S i g n i f i c a n t O t h e r s 94 I V D e s i g n A d j u s t m e n t s . . . . . 95 S t a t i s t i c a l C o n s i d e r a t i o n s . . . . 96 M a t e r i a l s 99 The T r e a t m e n t Program 99 S c r e e n i n g Measures 118 Dependent Measures 120 A l c o h o l Consumpt ion 120 L i f e S a t i s f a c t i o n Q u e s t i o n n a i r e 121 P r o f i l e o f Mood S t a t e s 122 Weissman S o c i a l Adjus tment S c a l e 123 C h a p t e r 4 R e s u l t s 125 S e c t i o n One: D e s c r i p t i v e S t a t i s t i c s 125 S e c t i o n Two: P o s t - T e s t S t a t i s t i c a l C o n t r a s t s . . . . 138 ( i ) C o n t r a s t s T e s t i n g H y p o t h e s i s One 139 ( i i ) C o n t r a s t s T e s t i n g H y p o t h e s i s T w o . . . . . . . 148 C h a p t e r 5 D i s c u s s i o n . 162 Review o f Hypotheses and C o n c l u s i o n s 162 H y p o t h e s i s One 163 H y p o t h e s i s Two 164 L i m i t a t i o n s o f t h i s S t u d y 166 I m p l i c a t i o n s o f t h i s S tudy f o r C o u n s e l i n g T r e a t m e n t Formats 176 I m p l i c a t i o n s o f t h i s S tudy f o r F u t u r e R e s e a r c h 179 S u g g e s t i o n s f o r F u t u r e R e s e a r c h 182 Summary 18 6 B i b l i o g r a p h y 188 A p p e n d i x A M e d i c a l S c r e e n i n g 201 A p p e n d i x B A d v e r t i s e m e n t 204 A p p e n d i x C C l i e n t Consent Form 205 Append ix D The V a l i d i t y o f S e l f - R e p o r t Data 206 A p p e n d i x E C l i e n t S e l f - M o n i t o r i n g C a r d . . . 221 A p p e n d i x F M i c h i g a n A l c o h o l i s m S c r e e n i n g T e s t 222 Append ix G The L i f e S a t i s f a c t i o n Q u e s t i o n n a i r e . . . . 2 2 4 A p p e n d i x H The P r o f i l e o f Mood S t a t e s 22 6 A p p e n d i x I S o c i a l Adjus tment S c a l e - S e l f R e p o r t . . . . 227 V L I S T OF TABLES T a b l e 1 C h a r a c t e r i s t i c s o f C l i e n t s i n Group and I n d i v i d u a l T r e a t m e n t : H y p o t h e s i s 1. S o c i a l and Demographic 12 6 T a b l e 2 C h a r a c t e r i s t i c s o f C l i e n t s i n Group and I n d i v i d u a l T r e a t m e n t : H y p o t h e s i s 1. A l c o h o l Consumpt ion and R e l a t e d P r e - T e s t Measures 12 8 T a b l e 3 C h a r a c t e r i s t i c s o f C l i e n t s i n Treatment and W a i t - L i s t G r o u p s : H y p o t h e s i s 2. S o c i a l and Demographic 131 T a b l e 4 C h a r a c t e r i s t i c s o f C l i e n t s i n Treatment and W a i t - L i s t G r o u p s . H y p o t h e s i s 2. A l c o h o l Consumption and R e l a t e d P r e - t e s t Measures 13 2 T a b l e 5 Nominal Demographic Data f o r E n t i r e S tudy Sample 134 T a b l e 6 R a t i o Demographic Data f o r E n t i r e Study Sample 134 t T a b l e 7 H y p o t h e s i s One: P o s t - t e s t A n a l y s i s o f C o v a r i a n c e Compar i sons t o A s s e s s S i m i l a r i t y o f S u b - g r o u p s 14 0 T a b l e 8 H y p o t h e s i s One: P o s t - t e s t A n a l y s i s o f C o v a r i a n c e Compar i sons t o A s s e s s S i m i l a r i t y o f S u b - g r o u p s p r e v i o u s l y W a i t - l i s t e d and n o t P r e v i o u s l y W a i t - l i s t e d o f the I n d i v i d u a l Trea tment C o n d i t i o n 14 2 T a b l e 9(a) M a j o r C o n t r a s t s o f H y p o t h e s i s One: A n a l y s i s o f C o v a r i a n c e C o n t r a s t s Between Group T r e a t m e n t and I n d i v i d u a l T r e a t m e n t . P o s t - t e s t 144 T a b l e 9(b) M a j o r C o n t r a s t s Between Group Trea tment and I n d i v i d u a l T r e a t m e n t . S i x Month F o l l o w - u p . . . . 145 T a b l e 10 H y p o t h e s i s Two: P o s t - T e s t A n a l y s i s o f C o v a r i a n c e Compar i sons t o A s s e s s S i m i l a r i t y o f S u b - g r o u p s (w i th t h o s e p r e v i o u s l y on W a i t - l i s t d e l e t e d ) . Group One and Group Two o f t h e Group T r e a t m e n t C o n d i t i o n 150 T a b l e 11 P o s t - t e s t A n a l y s i s o f C o v a r i a n c e t o A s s e s s S i m i l a r i t y o f S u b - g r o u p s , Group Trea tment and I n d i v i d u a l T r e a t m e n t S u b j e c t s 152 T a b l e 12 M a j o r C o n t r a s t s o f H y p o t h e s i s Two: A n a l y s i s o f C o v a r i a n c e C o n t r a s t s Between T r e a t e d and W a i t - l i s t C o n t r o l S u b j e c t s (w i th s u b j e c t s p r e v i o u s l y on W a i t - l i s t d e l e t e d from t h e t r e a t e d s u b j e c t p o o l ) 154 T a b l e 13(a) Means and S t a n d a r d D e v i a t i o n s f o r t h e T h r e e C o n d i t i o n s on P o s t - t r e a t m e n t Weekly A l c o h o l Consumpt ion 156 T a b l e 13(b) A n a l y s i s o f V a r i a n c e f o r t h e T h r e e C o n d i t i o n s on P o s t - T r e a t m e n t Weekly Consumption 157 T a b l e 13(c) O r t h o g o n a l C o n t r a s t s o f C o n d i t i o n s on P o s t -Trea tment Weekly Consumption 157 T a b l e 14(a) Means and S t a n d a r d D e v i a t i o n s f o r t h e T h r e e C o n d i t i o n s on P o s t - t r e a t m e n t Peak Day A l c o h o l , Consumpt ion 158 T a b l e 14(b) A n a l y s i s o f V a r i a n c e f o r t h e T h r e e C o n d i t i o n s on P o s t - T r e a t m e n t Peak Day A l c o h o l Consumpt ion 158 T a b l e 14(c) O r t h o g o n a l C o n t r a s t s o f C o n d i t i o n s on P o s t -Trea tment Peak Day Consumption 159 VII L I S T OF FIGURES Page F i g u r e 1 H i s t o r i c a l D e s c r i p t i o n o f t h e O v e r a l l P r o c e d u r e 98 F i g u r e 2 I n t e r v e n t i o n s U t i l i z e d and When These Were Used 103 F i g u r e 3 Weekly consumpt ion 147 VHI CHAPTER 1 AN EARLY COUNSELLING INTERVENTION PROGRAM FOR PROBLEM DRINKERS CONTRASTING GROUP AND INDIVIDUAL DELIVERY FORMATS The f i e l d o f c o u n s e l i n g p s y c h o l o g y s e t s as i t s aim the p r o m o t i o n o f h e a l t h , w e l l - b e i n g , and p e r s o n a l development so t h a t each i n d i v i d u a l may r e a c h h i s o r h e r own p o t e n t i a l ( E r i k s o n and W h i t e l y , 1980; Ivey and Simek-Downing, 1980) . A major impediment t o a l i f e o f h e a l t h , w e l l - b e i n g and a c t u a l i z e d p o t e n t i a l i s t h e i n t e r f e r e n c e o f a d d i c t i o n s , one o f the most w i d e - s p r e a d and d e s t r u c t i v e o f which i n v o l v e s o v e r c o n s u m p t i o n o f a l c o h o l . S i n c e c o u n s e l i n g p s y c h o l o g y seeks t o a s s i s t p e o p l e i n overcoming problems so t h a t they may l i v e more complete l i v e s , i t seems i m p o r t a n t t h a t the f i e l d t u r n i t s a t t e n t i o n s t o the problem o f o v e r c o n s u m p t i o n o f a l c o h o l . Many t r e a t m e n t d e s i g n s and modes o f d e l i v e r y have been sugges ted t o a s s i s t prob lem d r i n k -e r s . However, t h e d i f f i c u l t y i s t h a t t h e r e a r e no 1 c l e a r i n d i c a t i o n s o f which d e s i g n s and modes w i l l be t h e most e f f e c t i v e . The c u r r e n t s t u d y has been c o n s t r u c t e d t o e x p l o r e t h i s p r o b l e m more f u l l y and i n v e s t i g a t e s the compara-t i v e e f f e c t i v e n e s s o f group and i n d i v i d u a l c o u n s e l i n g t r e a t m e n t s f o r problem d r i n k e r s . A d e f i n i t i v e s t u d y i n t h e a r e a c o u l d have an impact on t h e d e s i g n and d e l i v -e r y o f f u t u r e t r e a t m e n t f o r m a t s . S t r u c t u r e d t r e a t m e n t programs based on c o g n i t i v e b e h a v i o r a l p r i n c i p l e s have r e c e n t l y been d e v e l o p e d and have p r o v e n t o be s u c c e s s f u l i n t h e a r e a s o f we ight c o n t r o l , .smoking c e s s a t i o n , and a l c o h o l consumpt ion r e d u c t i o n . P r i o r t o the development o f s t r u c t u r e d t r e a t m e n t s , s t u d i e s c o n t r a s t i n g group and i n d i v i d u a l format were p l a g u e d by m e t h o d o l o g i c a l p r o b l e m s , t h e most p e r s i s t e n t o f which was the i n a b i l i t y t o s e p a r a t e format and c o n t e n t . As a r e s u l t , group and i n d i v i d u a l t r e a t m e n t s i n p r e v i o u s c o n t r a s t s d i f f e r e d i n b o t h format and c o n t e n t , making i t i m p o s s i b l e t o i s o l a t e format as a v a r i a b l e . The development o f s t r u c t u r e d t r e a t m e n t s has e n a b l e d the c o n t r o l o f c o n t e n t . 2 C o n s e q u e n t l y , a r e t u r n t o t h e q u e s t i o n o f the compara-t i v e impact o f group and i n d i v i d u a l formats becomes s i g n i f i c a n t a t t h i s t i m e . Some c u r r e n t s u g g e s t i o n s a r e t h a t group and i n d i v i d u a l formats are e q u a l l y e f f e c t i v e . However, p r o p o n e n t s o f group methods ( e . g . Yalom, 1975; N a t a l i and C v i t i k o v i c , 1977) would argue t h a t group d e l i v e r y adds u n i q u e and p o w e r f u l f e a t u r e s r e s u l t i n g i n a g r e a t e r and more e n d u r i n g t r e a t m e n t impac t . In a d d i -t i o n , s o c i a l p s y c h o l o g i s t s ( e . g . A s c h , 1952) p r o v i d e d a t a which i m p l i e s t h a t a group format c o u l d be more i m p a c t f u l t h a n an i n d i v i d u a l f o r m a t . R e s e a r c h t o date on the c o m p a r a t i v e e f f i c a c y o f group v e r s u s i n d i v i d u a l t r e a t m e n t p r e s e n t a t i o n i n the a l c o h o l consumpt ion r e d u c t i o n a r e a i s r e l e v a n t but f l a w e d . Two hypotheses were i n v e s t i g a t e d i n the p r e s e n t s t u d y . The p r i m a r y h y p o t h e s i s examined i n t h i s s t u d y i s t h a t a group format i s more e f f e c t i v e t h a n an i n d i v i d u a l f o r m a t , showing g r e a t e r change on the t a r g e t 3 b e h a v i o r o f d r i n k r e d u c t i o n . T h i s h y p o t h e s i s i s based on a s o c i a l l e a r n i n g model o f group communicat ion and t r e a t m e n t . A second h y p o t h e s i s i s t h a t t r e a t m e n t u t i l i z i n g a s t r u c t u r e d p s y c h o e d u c a t i o n a l program i s s u p e r i o r t o n o - t r e a t m e n t . The hypotheses were t e s t e d u s i n g a s t r u c t u r e d t r e a t m e n t program f o r problem d r i n k e r s , the g o a l o f w h i c h was t o r e d u c e the consumption o f a l c o h o l . The e f f i c a c y o f the hypotheses were a s se s sed by c o n t r a s t i n g d r i n k consumpt ion f i g u r e s between group , i n d i v i d u a l , and w a i t - l i s t c o n d i t i o n s as a major c o n t r a s t , and o t h e r h e a l t h r e l a t e d measures as a minor c o n t r a s t . 4 CHAPTER 2 LITERATURE REVIEW S e v e r i t y o f D r i n k i n g Problems The e p i d e m i c n a t u r e o f a l c o h o l problems has been w e l l documented. I t has been e s t i m a t e d t h a t s e v e n -t y - f i v e p e r c e n t o f a d u l t Canadians consume a l c o h o l , and t h a t one i n t e n o f these i s a problem d r i n k e r whose o v e r - i n v o l v e m e n t w i t h d r i n k i n g i s c a u s i n g o n - g o i n g problems 2 R ° 3 ° 4 In t h i s second d e s i g n a l l s u b j e c t s were randomly a s s i g n e d t o one o f two c o n d i t i o n s . The f i r s t c o n d i t i o n r e c e i v e d t r e a t m e n t w h i l e the second s e r v e d as a w a i t l i s t c o n t r o l c o n d i t i o n . Measures were t h e n c o l l e c t e d f o r a l l s u b j e c t s a t t h e p o s t - c o n d i t i o n p o s i t i o n . 86 The purpose o f a c o n t r o l c o n d i t i o n i n t h e above d e s i g n s was t o p r o v i d e an independent assessment o f the s t a b i l i t y o f a t a r g e t b e h a v i o r when an i n t e r v e n t i o n d i r e c t e d toward t h a t b e h a v i o r i s not g i v e n . W h i l e c o n t r o l groups a r e a f r e q u e n t demand o f r i g o r o u s r e s e a r c h i t has been p o i n t e d out on o c c a s i o n t h a t t h e y may be u n n e c e s s a r y g i v e n the e x t r e m e l y common f i n d i n g o f b e h a v i o r a l s t a b i l i t y . Campbel l and S t a n l e y (1963) recommend t h e s e d e s i g n s as t r u e e x p e r i m e n t a l d e s i g n s . In t h e use o f t h i s d e s i g n t h e y recommend t h a t g a i n - s c o r e s , t h e changes between the p r e - t e s t measure and the p o s t - t e s t measure , be a v o i d e d as t h i s may a r t i f i c i a l l y s u p p o r t a s i g n i f i c a n t d i f f e r e n c e , p a r t i c u l a r l y i f t h e g a i n o f t h e c o n t r o l c o n d i t i o n i s n e a r s i g n i f i c a n c e . R a t h e r t h e y sugges t t h a t t h e p r e - t e s t s c o r e s be u t i l i z e d t o form b l o c k s o r t h a t they be used as c o v a r i a t e s f o r the p o s t - t e s t s c o r e c o m p a r i s o n s , as i n the c u r r e n t s t u d y . W h i l e the d e s i g n u t i l i z e d a common s u b j e c t p o o l , the i n c l u s i o n o f some s u b j e c t s i n more t h a n one c o n d i t i o n n e c e s s i t a t e d t h e d i v i s i o n o f the d e s i g n s and s t a t i s t i c a l a n a l y s e s i n t o the s e p a r a t e h y p o t h e s i s . T h i s w i l l be d i s -c u s s e d more f u l l y below i n t h e p r o c e d u r e s s e c t i o n . 87 S u b j e c t s P o p u l a t i o n s and Samples The t a r g e t p o p u l a t i o n o f t h i s s t u d y was e a r l y s tage p r o b l e m d r i n k e r s . The a c c e s s i b l e p o p u l a t i o n c o n s i s t e d o f e a r l y s t a g e prob lem d r i n k e r s i n a m o d e r a t e l y s i z e d c i t y . The a c t u a l sample c o n s i s t e d o f v o l u n t e e r s f o r t r e a t m e n t a t a c o n t r o l l e d d r i n k i n g c l i n i c who responded t o a newspaper a d v e r t i s e m e n t f o r t h i s c l i n i c and met s e v e r a l s c r e e n i n g c r i t e r i a . R e c r u i t m e n t and S e l e c t i o n S u b j e c t s were s creened b r i e f l y d u r i n g an i n i t i a l t e l e p h o n e i n t e r v i e w , d u r i n g a f a c e - t o - f a c e i n t e r v i e w , and a f t e r r e c e i p t o f a m e d i c a l r e p o r t ( M e d i c a l S c r e e n i n g ; A p p e n d i x A ) . The purpose o f the s c r e e n i n g was t o d i v e r t from t h e s e t r e a t m e n t s any i n d i v i d u a l s who: (1) had m e d i c a l c o n t r a i n d i c a t i o n s t o c o n t i n u e d but reduced a l c o h o l consump-t i o n : (2) appeared t o have more s e v e r e o r e x t e n s i v e p r o b -lems i n t h e a r e a s o f c a r e e r , s o c i a l i n t e g r a t i o n , o r r e l a -t i o n s h i p due t o . a l c o h o l problems ( s e v e r a l j o b l o s s e s , f r i e n d s h i p d i s i n t e g r a t i o n s , or m a r i t a l d i s r u p t i o n due t o 88 a l c o h o l i n v o l v e m e n t ) : (3) appeared t o be p h y s i o l o g i c a l l y a d d i c t e d t o a l c o h o l from the amount o f consumption r e p o r t e d ( i . e . 60 o r more d r i n k s p e r week): (4) had a l e n g t h y d u r a t i o n o f d r i n k i n g problem (ten y e a r s o r more) : o r (5) had p r e v i o u s and u n s u c c e s s f u l t r e a t m e n t s f o r a l c o h o l c o n -sumpt ion problems ( e s p e c i a l l y i n p a t i e n t t r e a t m e n t s ) . A p p r o x i m a t e l y h a l f o f the t o t a l number o f s u b j e c t s t o t h e program were d i v e r t e d a t the t e l e p h o n e i n t e r v i e w o r f a i l e d t o a t t e n d s c r e e n i n g appo in tments . Two i n d i v i d u a l s were d i v e r t e d from t r e a t m e n t i n t h i s program as t h e r e s u l t o f a f a c e - t o - f a c e i n t e r v i e w o r m e d i c a l a d v i c e . One was r e f e r r e d t o an a b s t i n e n c e program and one t o a p s y c h i a t r i s t . F i n a l l y ,