To keep the alcoholic in out‐patient treatment A differentiated approach through treatment contracts

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Abstract
Eight-two alcoholics were offered a 2-year outpatient program characterized by stressing the patient''s own decisions both in joining the program and the choice of objectives and methods, by repeated feedbacks through treatment evaluations, and by relapse prevention. The 58 patients who accepted were more often married than the others. All but eight completed the program. The most important treatment components were ranked by the patients. Individual counselling was ranked highest, followed by evaluation of contract with therapist, disulfiram and biofeedback by means of gamma-GT. Patients with alcohol dependence more often preferred insturmental components, such as disulfiram and gamma-GT, while the others more often preferred psychological components, such as individual counselling and contract evaluations. Preference of psychological components was not found to be related to degree of personality disturbances. It is suggested that to effectively keep the patients in treatment in the present programme depends on the combination of patient''s active engagement, continuous feedback and individualized treatment objectives.

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