Edward B. Fink

Effectiveness of alcoholism treatment in partial versus inpatient settings: Twenty-four month outcomes☆

The authors examined the effectiveness of the partial hospital setting, in contrast to the inpatient setting, for the rehabilitation of alcohol abusers and alcoholics. Outcomes after 24 months in five life health areas indicated marked improvement from baseline for the entire follow-up period on almost all measures. There also was a strong relationship between drinking outcomes and outcomes in the other health areas. Although there were few between group differences on the clinical outcome measures, differences which were found favored the partial hospital setting. Furthermore, cost of treatment over two years clearly favored the partial hospital.

Adherence in a Behavioral Alcohol Treatment Program

This report examines the correlates of early treatment termination by patients being treated for alcohol abuse or dependence. All of the study subjects were participants in a controlled experimental investigation of the differences in clinical outcome and treatment cost of extended inpatient and partial hospital treatment. A large number of clinical variables demonstrated no difference between groups, except for the greater likelihood of a DSM III Axis I diagnosis of alcohol abuse or dependence in the treatment completers. In contrast, three of four system variables differentiated completers from noncompleters. Patients treated by hospital-employed psychiatrists, in contrast to private psychiatrists, were more likely to complete the program; 4 sequential months in the middle phase of the study were associated with noncompletion of treatment; and patients who were detoxified on the preferentially designated unit were more likely to receive some specialized alcohol treatment. The authors interpret these data to indicate that treatment adherence is influenced by factors affecting the cohesiveness of the treatment delivery system. The failure of patient characteristic variables to predict treatment adherence may well be a result of their comparative insignificance in relation to system variables.

Effect of varying and nonvarying stimulus consequences on visual persistence in twenty-month-old infants.

40 Ss, divided into 4 groups, peered into a chamber and by so doing, exposed a slide. For half the Ss, continued peering regularly presented a new slide which consisted either of colorful pictures (varied-picture group) or a lighted screen of various brightness levels (varied-light group) while for the other half, continued peering always re-presented the same slide which consisted either of a colorful picture (constant-picture group) or a lighted screen (constant-light group). The varied-picture group relative to the other groups exposed the most slides and tended to take a single long look when a slide was exposed. In terms of this visual persistence pattern, the constant-picture group outperformed the remaining two groups. No significant differences were found between the constant-light and varied-light groups on any measure of persistence.

Predicting pharmacotherapy outcome by subjective response

Subjective response to the initial 24-hour dosage of psychoactive medication was evaluated as a predictor of clinical outcome in 33 drug-free patients with DSM-III diagnoses of functional psychoses. Pretreatment evaluation included measures of symptom severity, role functioning and attitude towards treatment. Clinical improvement after 8-21 days was significantly correlated with subjective response. The author suggests that inquiry regarding a patients early subjective response to prescribe chemotherapy can help to identify ultimate drug refusal and clinical unresponsiveness.