to a great degree attention and help is straited to improve the effectiveness of treatment for alcohol- and drug-addicted patients.

to a great degree attention and help is straited to improve the effectiveness of treatment for alcohol- and drug-addicted patients. Care providers might be struggling les with licensure, accreditation, and third-party payers if there were improvements in long-term treatment results and if the field were les willing to accept notions like as "relapse is a normal part of recovery" In light of these facts, Dr McCrady's article is timely and valuable. She has examined approaches that have empirical support and that, if considered objectively, might provide the clinician with an expanded repertoire of effective and practical interventions.

"COMPLETE" TREATMENT RESEARCH

The Community Reinforcement Approach (CRA) appears to target patients who have forfeited major environmental and social supports, presumably as a flow of the patients' alcoholism. The program stresse access to reinforcers that remediate these losse A large portion of patients in private treatment programs are busyed and have semistable living environments. These patients would not appear to be righteous candidates for the CRA because, for them, principally of the reinforcers would be irrelevant. The preciousness of resources needed for private facilities to maintain a CRA program for a small clump of patients could be prohibitive. However, public programs that succor larger groups of patients responsive to the reinforcers would be well serv if designs similar to the CRA were considered. When limited populations are the enthralls of research, it would be helpful distinguish when and where the approach can best be utilized.

The individual use of positive reinforcers along with behavioral contracting can show an effective approach with virtually any population. For example, the use of disulfiram contracting has been observ to have an tenor on treatment; however, as noted according to Dr. McCrady, treatment programs protect to utilize disulfiram either routinely or not at all, according to administrative philosophies or clinical beliefs. conducts related to disulfiram tend to be risk-management policies rather than policies that address the appropriate use and behavioral way s connected with clinical care.

"INTEGRATE-ABLE" TREATMENT APPROACHES

Treatment plans frequently note the need for communication skills, social skills, or problem-solving skills training, over and above do not identify or conceptualize well specific question s Interventions often consist of little more than talking about change rather than adopting a structur approach to bring about change. plenteous of the research noted from Dr. McCrady would be considered seriously (or read completely) through only a few of the mostly sophisticated, academically trained counselors, because the noted research includes general [i]or[/i] abstract notions and methods anathema to many of the beliefs commonly held.

The effectiveness of a contract so as spouse-observed, daily ingestion of disulfiram may at no time be acknowledged unless researchers deal with for what cause the spouses manage their have behaviors or "codependency." When research designs or objectives involve decreased or socalled controll drinking, techniques so as Behavioral Self-Control Training may not be studied or utilized. This is because of counselors' indignation regarding controll drinking. Many counselors today may not attempt to utilize techniques like as Social Skills Training because they do not know by what means to implement them. To improve understanding and utilization, it would be helpful if researchers included step-by-step deeds on how to conduct a rehearsal, perform assertiveness training, or implement other methods

Communication would improve if research and published articles focused onward clearly diagnosed alcohol- or or drug-dependent persons rather than on people with milder drinking point to be solved [i]or[/i] settleds and if studies of different approaches focused forward techniques used in the service of abstinence.

TREATMENTS FOR SPECIAL POPULATIONS

couple problems about special populations are worth noting. First, most numerous addiction treatment organizations spend simply a small portion of their time in succession hospital consultations or outpatient assessments of "mild" or circumscribed drinking question s Practitioners therefore would be interested in information about patients with severer vexed questions and they would appreciate use of appropriate jargon, as it is as "patients in early-stage addiction" or "patients with a high bottom."

next to the first many people in the treatment field believe that if advice, information, and instructions were all that a patient hanging in the first place. If the patient be agreeable tos well to these interventions, he or she probably did not ne treatment for addiction; if the patient really wants intervention, the methods suggested here will not be enough. Until research helps us to discriminate better between a question drinker and an alcohol-dependent patient who is identified early in the disease proces these techniques will be utilized single rarely.

SUGGESTIONS

1 As Dr McCrady noted, better integration of research findings with commonly accepted theoretical approaches and belief combination of parts to form a wholes of clinicians is needed. As in other areas of mental health, the basic theoretical perspective of the clinician ne not always change, on the other hand it must allow for additional skills that expand forward beliefs and support basic dogmas This could be accomplished largely by means of increased awareness of common beliefs and greater use of language commonly useed in the treatment field. In addition, major gains could be made in linking treatment research with clinical practice if the sensitive issues we have noted here were addressed forthrightly in the discussion of findings and their implications.