State Hospitals and Alcoholism; A Nation-Wide Survey of Treatment Techniques and Results

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Abstract
A questionnaire was sent to the medical directors of 231 state mental hospitals throughout the USA. The 74% returns provided a broad picture of present-day care of alcoholics in state hospitals. These hospitals, admitting an average of 272 alcoholics a year, had an average census of 66 alcoholics who stayed an average of 8.1 weeks. There was considerable difference in enthusiasm in accepting alcoholic patients with the Pacific coast states showing the least, and the Southeast and Southwest the greatest. Special ward units averaging 56 beds were in use in 31% of the hospitals and another 20% had special treatment programs without separate ward areas. Alcoholics Anonymous was utilized in 88% of the hospitals while group psychotherapy, drug therapy and individual psychotherapy were each used in over half. The estimated over-all rate of improvement was 60% at discharge, 39% up to a year after discharge and 33% for periods over a year after discharge. There was no significant difference between hospitals with special interest or units and those which accepted these patients reluctantly. Lack of adequate aftercare is probably a leading cause of poor results. A rationale for the treatment of alcoholics in state hospitals is offered. Abstinence is ensured, forcing the patient to turn to people for sustenance. A massive confrontation of the alcoholic with his system of rationalization constitutes a therapeutic assault on his mechanism of denial. The disappointed rage of the alcoholic is diffused over the team instead of being directed at a single therapist and thus allows the therapeutic team to accept these patients more comfortably. There remains a great need to improve inpatient services for alcoholics and even greater need to provide more adequate aftercare. Community resources already available need to be better coordinated and more fully utilized.