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during the follow-up period as those subjects who had received a conventional abstinence oriented treatment programme. Information at follow-up was collected from the subjects themselves, from at least two friends or relatives and from hospital and prison records.
The findings of the Polich study cited earlier (Polich et al. 1981) produced evidence that people with a previous diagnosis of alcoholism were able, in some cases, to drink in a harm free manner at a subsequent time. Their data demonstrated that, of those subjects who showed improvement at follow-up, subjects with a low severity of dependence at first contact were more likely to be successful at controlling their drinking at follow-up (they had fewer relapses if they pursued a moderation goal than if they pursued an abstinence goal), and those with high severity were more likely to be successful with an abstinence goal (they had more relapses if they tried to drink in a controlled manner).
Two studies which are suggestive of the relationship between dependence and drinking outcomes were reported in 1984 with one follow-up reported in 1987. Sanchez-Craig and her colleagues (Sanchez-Craig et al. 1984) recruited 70 “early stage problem drinkers” with short histories of problem drinking and an absence of physical or cognitive impairment and randomly assigned them to a short term out-patient treatment which involved either a controlled drinking or an abstinence goal. Two year follow-up of drinking showed the two groups to be indistinguishable and the majority of successful outcomes in each group involved moderate drinking. Conversely, Foy and his colleagues (Foy et al. 1984) randomly assigned “veterans who are chronic alcoholics” to a behavioural treatment that had either an abstinence or a controlled drinking goal. At 5-6 years follow-up, outcomes for the two groups were virtually the same. The majority of good outcomes for both groups involved abstinence (Rychtarik et al. 1987). As Sanchez-Craig and her colleagues used different measures of dependence (namely the Alcohol Dependence Scale described in Chapter 3) to those used by Foy and his colleagues (who used an unspecified symptom checklist), it is not possible to draw firm conclusions about the relationship between levels of dependence and drinking outcomes, but these studies are suggestive of the ability of low dependence individuals to drink in moderation regardless of treatment goal and the ability of high dependence individuals more successfully to achieve total abstinence regardless of treatment goal. Thus, not only do these studies establish that treatment goals other than total abstinence are possible, but further they suggest that the degree of severity of dependence may predict the success of different drinking goals. Further evidence on the predictive validity of the dependence syndrome construct is discussed below.
Questionnaires measuring the syndrome (discussed in Chapter 3) have either been substance specific or required a change in wording, as in the case of the Severity of Dependence Scale (SDS)
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