Treatment contracts in an inpatient alcoholism treatment setting.

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Abstract
Inpatients (100) of an alcoholism program (mean age 46; 43 women) were assigned to 1 of 4 treatment contract conditions (no explicit contract, patient-authored, mutually authored or staff-authored) and were evaluated at 3, 6 and 12 mo. after discharge to determine the effect of contract condition on aftercare participation and treatment outcome. Characteristics of patients and staff members that might make 1 type of contract or another preferable were also examined. Before discharge each patient and his treatment coordinator completed questionnaires assessing their satisfaction with the type of contract assigned and, if they were not satisfied, what they would have preferred. Although both patients and staff members preferred mutually authored contracts, the less input staff members had in preparing the contract, the better the treatment outcome and the more likely patients were to participate in aftercare. Patient characteristics had no bearing on contract effectiveness. Staff members tended to favor contracts involving less active intervention for patients with a poor prognosis. They leaned toward less intervention the more experience they had had with the no-contract condition. Allowing patients to take some responsibility for their own recovery may be an important factor in treatment.

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