The Use Made of Treatment: an Alternative Approach to the Evaluation of Alcoholism Services

Abstract

Despite much evaluative research on alcoholism services, the effectiveness of treatment is still an unsettled matter. The inconclusive results of empirical studies comparing different methods and extensive statistical analysis of their findings do not point a clear way forward for future evaluative efforts. Using a sample of follow-up data from an evaluation study of three residential units (not considered here) this report sets out to demonstrate that dynamics in individual drinking patterns make surveys of studies which have applied different outcome criteria very unreliable. The feasibility of the single controlled study in evaluation is also questioned and attributed to the inappropriate use of a “quality control” model. An alternative approach which avoids the methodological and practical difficulties of the conventional design examines the use made of treatment by clients. A more realistic account based on individual cases is urged which recognizes that seeking help for a drink problem is only one of a number of ways in which the treatment episode fits into the lives of problem drinkers. Some observational evidence is presented and a reinterpretation of Costello' successful and unsuccessful treatment groupings is made in support of a treatment-use approach to evaluation.