Spring 2009 COURSE SYLLABUS Rutgers University Graduate Psychology ASSESSMENT AND TREATMENT OF ALCOHOL ABUSE AND ALCOHOLISM 18:821:630:01

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1 Spring 2009 COURSE SYLLABUS Rutgers University Graduate Psychology ASSESSMENT AND TREATMENT OF ALCOHOL ABUSE AND ALCOHOLISM 18:821:630:01 Tuesdays 9:15 a.m. 12:00 p.m. Center of Alcohol Studies, Room 219 Instructor: Elizabeth Epstein, Ph.D. Offices and Contact information: Brinkley & Adele Smithers Hall, #354, Ext , or Course Goals: To provide a graduate level overview of theoretical models, research, and clinical techniques related to the assessment, diagnosis and treatment of substance abuse, dependence, and related problems. Emphasis will be on alcohol but other drugs will be discussed as well. Course Requirements: There are four major course requirements: 1. Readings and Class Participation (25%): Readings are assigned each week. You are expected to do all of the reading. Readings generally include one chapter from the text and two to four supplementary articles each week. Most classes will begin with a brief individual or group exercise related to the readings, which will then serve as a springboard for discussion. I encourage active class participation, which should include asking questions, relating presentations to the readings, and generally playing with the ideas and materials. In addition to discussion of readings, most classes will include some kind of active learning exercise, so be prepared to role play, engage in small group discussions, etc. If you have to miss a class, please let me know. 2. Paper Outline (25% of grade): You are asked to NOT to write a review paper related to issues in the conceptualization, assessment or treatment of alcohol problems. However, you are asked to prepare a DETAILED OUTLINE of such a paper; this would be a scholarly paper, drawing on empirical and theoretical literature. The paper would pose a major question, and attempt to answer this question through reference to the literature. The paper would not draw much upon your clinical or experiential knowledge about alcohol problems. The paper would be about pages (exclusive of references), and written strictly in accordance with APA style. A list of ideas for paper topics appears in this syllabus, but is meant only to stimulate your thinking. You do not have to select a topic from this list. You may elect to have your outline distributed to everyone in the class, but this will not be required. Paper outline topics should be decided upon and cleared with me by February 17, I strongly suggest you give me a draft outline to read within two weeks of that date. I will read and return it within a week. The final outlines are due on April 28, Clinical Experience (25% of grade): Each student should have a clinical experience to complement the academic aspects of the course. There are several alternative experiences that could satisfy this requirement: 1

2 a. a. Self-help group observation. There are several different self-help groups for persons with substance use disorders and for their family members. Alcohol-related groups include: Alcoholics Anonymous, S.M.A.R.T., Moderation Management, Women for Sobriety, and Al-Anon. You may attend self-help group meetings as an alternative clinical experience. You must attend at least 3 meetings of three different types of self-help groups, in order to obtain a good picture of the structure and function of these groups. At least one has to be AA, one NA, and one additional one of your choice (the third can be an additional AA or NA meeting but in a different town than the first one you attended). b. Intoxicated Driver Resource Centers. Persons in New Jersey who are arrested for Driving While Intoxicated (DWI) must attend a weekend long educational program at an Intoxicated Driver Resource Center (IDRC). You may attend one of these programs to learn about the structure, function and content of these programs. c. c. Interviews with persons with drinking problems. You may conduct an interview with a person who have resolved a previous drinking problem. You should spend at least two hours interviewing the person and cover the following topics (at a minimum): development of the problem, signs and symptoms, how the problem was recognized, unsuccessful attempts at change, how successful change was effected, and perspectives on how the person's life is different. d. d. Involvement/observation of an Employee Assistance Program (EAP). A major source of clinical referrals is the workplace. You may contact a local EAP to develop an experience in an EAP setting. If you elect this experience, you should seek opportunities to observe/be involved with supervisor training or assessment and triage of individual employees. You should also review the full written EAP policy of the organization. e. e. Other clinical experiences. If you have an alternative idea for a clinically relevant experience, please discuss it with me. For all clinically relevant experiences, you are required to write up a 5 page summary of the experience. The format for the write-up will vary with the type of experience, but should include (1) objective information, (2) your subjective appraisal of the person, program, or experience, and (3) how you assess the relationship between what you observed or experienced and the theoretical/research literature on the topic. These write-ups are due when you complete the clinical experience, or by March 24 at the latest. 4.Personal change project (25% of grade): A good way to learn about the specific treatment interventions in the alcohol field is to apply them to your own behavior. For the personal change project, you will be required to do the following: (1) Select a behavior of your own that you would like to change. This behavior might be a consummatory behavior (e.g. cigarettes, food in general or certain classes of food, caffeine), or another behavior that you would like to decrease (e. g. television watching, sedentary activities). Selecting a behavior that you would like to increase typically does not work well for this assignment, because is too dissimilar to the need to stop/decrease drinking. (2) You may elect different levels of self-disclosure about the self-change target. The default is that you tell no one what your target behavior is. You may elect to tell me 2

3 individually, or the class as a whole. (3) Each week, through April 21, we will cover one week of a typical cognitive-behavioral treatment program for alcohol abuse/dependence, and you will apply the intervention to your own target behavior and report on the results the following week. (4) You will be expected to keep an ongoing record of the target behavior, and to graph the behavior each week. (5) You will be expected to engage in simple behavioral homework assignments (e. g. completing a decision matrix about the pros and cons of changing the behavior, conducting a functional analysis of variables controlling the behavior). (6) In class, I would hope that you will discuss your reactions to the various interventions. You will be graded on compliance with assignments, not on your success in self change. Spring, 2009 ASSESSMENT AND TREATMENT OF ALCOHOL ABUSE AND ALCOHOLISM The assigned texts for the course are: 1. McCrady, B. S. & Epstein, E. E. (1999). Addictions: A comprehensive guidebook. NY: Oxford University Press. ISBN13: ISBN10: McCrady, B.S., & Epstein, E.E. (2008). Treatments That Work: Couples Therapy for Alcohol Use Problems. A cognitive-behavioral Treatment Program. Therapist Guide. NY: Oxford University Press. ISBN13: ISBN10: McCrady, B.S., & Epstein, E.E. (2008). Treatments That Work: Couples Therapy for Alcohol Use Problems. A Cognitive Behavioral Treatment Program. Workbook.. NY: Oxford University Press.mcrady ISBN13: ISBN10: All readings will be available at the GSAPP or library website 3

4 WEEKLY SYLLABUS January 20 Class 1 What is the course all about? What s expected? What is alcohol? What are its effects? How common is drinking? What is a drinking problem? How common are drinking problems? How are alcohol use disorders different from Drug Addiction? > McCrady, B. S. (2008). Alcohol use disorders. In: D. H. Barlow (Ed.), Clinical handbook of psychological disorders, fourth edition. NY: Guilford Press. McCrady & Epstein, Chapter 4: Moak, D. H., & Anton, R. F., Alcohol January 27 Class 2 What happens to drinking problems over time? Course of treated and untreated alcohol problems Guest Lecture: Amy Cohn, Ph.D. McCrady & Epstein, Chapter 2: Finney, J. W., Moos, R. H., & Timko, C. The course of treated and untreated substance use disorders: Remission and resolution, relapse and mortality. Finn, P. R., Sharkansky, E. J., Brandt, K. M., & Turcotte, N. (2000). The effects of familial risk, personality, and expectancies on alcohol use and abuse. Journal of Abnormal Psychology, 109(1), Tucker, J. A. (2003). Natural resolution of alcohol-related problems. In M. Galanter (Ed.), Recent developments in alcoholism, Volume 16: Research on alcoholism treatment (pp ). NY, NY: Kluwer Academic/Plenum Publishers. **Tucker, J. A., Vuchinich, R. E., & Rippens, P. D. (2004). A factor analytic study of influences on patterns of help-seeking among treated and untreated alcohol dependent persons. Journal of Substance Abuse Treatment, 26, February 3 Class 3 How do we understand motivation? How does change occur? Motivational Interviewing Guest Lecture: Michelle Drapkin, Ph.D. McCrady & Epstein, Chapter 13: Yahne, C. E. & Miller, W. R. Enhancing motivation for treatment and change. Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71,

5 Prochaska, J. O. & DiClemente, C. C. (2005). The transtheoretical approach.. J. C. Norcross & M. R. Goldfried, (Eds). Handbook of psychotherapy integration (2nd ed.) (pp ). New York, NY: Oxford University Press. February 10 Class 4 Where do pharmacotherapies fit? What about dual diagnosis patients? Guest Lecture: Jill Williams, M.D. McCrady & Epstein, Chapter 25, pages : Rosenthal, R. N., & Westreich, L., Treatment of persons with dual diagnoses of substance use disorder and other psychological problems. Anton, R. F., O'Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D.,Donovan, D. M., Gastfriend, D. R., Hosking, J. D., Johnson, B. A., LoCastro,J. S., Longabaugh, R., Mason, B. J., Mattson, M. E., Miller, W. R.,Pettinati, H. M., Randall, C. L., Swift, R., Weiss, R. Williams, L. D., Zweben, A.(2006). Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A Randomized Controlled Trial. JAMA: Journal of the American Medical Association, 295, Johnson, B.A., Rosenthal, N., Capece, J.A. et al. (2007). Topiramate for treating alcohol dependence: A randomized controlled trial. JAMA, 298 (14), February 17 Class 5 Are all alcoholics alike? What makes alcohol problems so complicated? Epstein, E.E. (2002). Classification of Alcohol Use Disorders. In N. Heather Babor, T. F., Hofmann, M., DelBoca, F. K., Hesselbrock, V., Meyer, R. E., Dolinsky, Z. S., & Rounsaville, B. (1992). Types of alcoholics. 1. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry, 49, Epstein, E. E., Labouvie, E., McCrady, B. S., Jensen, N. K., & Hayaki, J. (2002). A multisite study of alcohol subtypes: Classification and overlap of unidimensional and multidimensional typologies. Addiction, 97, National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2002). Alcohol and minorities: An Update. Alcohol Alert No. 55. Rockville, MD: NIAAA. Ball, S., A, Jaffe, A. J., Crouse-Artus, M. S., Rounsaville, B. J., & O'Malley, S. S. (2000). Multidimensional subtypes and treatment outcome In first-time DWI offenders. Addictive Behaviors., 25, February 24 Class 6 5

6 What tools can help a clinician identify a person with a drinking problem? What interviewing approaches are effective and valid? Green, K., Worden, B., Menges, D., & McCrady, B.S. (2008). Alcohol use disorders. In J. Hunsley & E. Mash (Eds.) A Guide to Assessments that Work. New York: Oxford U. Press. McCrady, B.S., & Epstein, E.E. (2008). Chapter on Assessment. Treatments That Work: Couples Therapy for Alcohol Use Problems. A cognitive-behavioral Treatment Program. Therapist Guide. NY: Oxford University Press. Fleming, M. F. (2003). Screening for at-risk, problem, and dependent alcohol use. In: R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives, Third Edition (pp ).Boston: Allyn & Bacon. Makela, K. (2004). Studies of the reliability and validity of the Addiction Severity Index. Addiction, 99, Allen, J. P. & Litten, R. Z. (2001). The role of laboratory tests in alcoholism treatment. Journal of Substance Abuse Treatment, 20, Blume, A. W., Morera, O. F., & de la Cruz, B. G. (2005). Assessment of addictive behaviors in ethnic-minority cultures. In: D. M Donovan & G.A. Marlatt (Eds.), Assessment of addictive behaviors, Second edition. NY: Guilford Press. March 3 Class 7 What kinds of help are available? How successful is treatment? Miller, W. R., Walters, S. T., & Bennett, M. E. (2001). How effective is alcoholism treatment in the United States? Journal of Studies on Alcohol, 62, Miller,W. & Wilbourne,P. ( 2002) Mesa Grande: a methodological analysis Of clinical trials of treatments for alcohol disorders. Addiction, 97, Morgenstern, J. & Longabaugh, R. (2000). Cognitive-behavioral treatment for alcohol dependence: A review of evidence for its hypothesized mechanisms of action. Addiction, 95, Mensinger, j.l., Lynch, K.G., TenHave, T.R., & McKay, J. R. (2007). Mediators of telephonebased continuing care for alcohol and cocaine dependence. JCCP, 75(5), Litt, M. D., Kadden, R. M., Cooney, N. L., & Kabela, E. (2003). Coping skills and treatment outcomes in cognitive-behavioral and interactional group therapy for alcoholism. 6

7 Journal of Consulting and Clinical Psychology, 71(1), Moggi, F., Ouimette, P. C., Finney, J. W., & Moos, R. H. (1999). Effectiveness of treatment for substance abuse and dependence for dual Diagnosis patients: A model of treatment factors associated with one year outcomes. Journal of Studies on Alcohol, 60, March 10 Class 8 How should a clinician plan for treatment? What goals should be set? What variables are most important in matching clients with approaches to treatment? McCrady & Epstein, Chapter 12: Kadden, R. M. & Skerker, P. M. Treatment decision making and goal setting. Sobell, M. B., & Sobell, L. C. (2000). Stepped care as a heuristic Approach to the treatment of alcohol problems. Journal of Consulting and Clinical Psychology, 68(4), ASAM Criteria Longabaugh, R. & Wirtz, P. W. (2001). Project MATCH hypotheses: Results and causal chain analyses. Project MATCH Monograph Series, Volume 8. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism Rosenberg, H. (1993). Prediction of controlled drinking by alcoholics and problem drinkers. Psychological Bulletin, 113, Rychtarik, R. G., Connors, G. J., Whitney, R. B., McGillicuddy, N. B., Fitterling, J. M., & Wirtz, P. W. (2000). Treatment settings for persons With alcoholism: Evidence for matching clients to inpatient versus outpatient care. Journal of Consulting and Clinical Psychology, 68, March 17 Spring Break: No class 7

8 March 24 Class 9 What treatments have come from Behavioral and Cognitive Theory McCrady & Epstein, Chapter 14: Carroll, K. M. Behavioral and cognitive behavioral treatments. McCrady, B.S., & Epstein, E.E. (2008). Treatments That Work: Couples Therapy for Alcohol Use Problems. A cognitive-behavioral Treatment Program. Therapist Guide. NY: Oxford University Press. McCrady, B.S., & Epstein, E.E. (2008). Treatments That Work: Couples Therapy for Alcohol Use Problems. A Cognitive Behavioral Treatment Program. Workbook.. NY: Oxford University Press.mcrady *Witkiewitz, K. & Marlatt, G. A. (2004). Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist, 59, Monti, P. M. & Rohsenow, D. J. (2003). Coping skills training and cue exposure treatment. In: R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches. Effective alternatives, third edition (pps ). Boston: Allyn & Bacon. March 31 Class 10 Are there treatments available for persons with less severe problems? READINGS **Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P., & Marlatt, G. A.(2001). Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91, Fleming, M. F., Mundt, M. P., French, M. T., Manwell, L. B., Stauffacher, E. A., & Barry, K. L. (2002). Brief physician advice for problem drinkers: Long-term efficacy and benefit-cost analysis. Alcoholism: Clinical & Experimental Research, 26, Marlatt, G. A., Baer, J. S., Kivlahan, D. R., Dimeff, L. A., Larimer, M. E., Quigley, L. A., Somers, L. M., & Williams, E. (1998). Screening and brief intervention for high risk college student drinkers: Results from a 2 year follow up assessment. Journal of Consulting and Clinical Psychology,66, **O'Leary, T. & Monti, P. M. (2004). Motivational enhancement and other brief interventions for adolescent substance abuse: Foundations, applications and evaluations. Addiction, 99 (suppl.), *Woodall, W. G., Kunitz, S. J., Zhao, H., Wheeler, D. R; Westerberg, V., & Davis, J. (2004). The prevention paradox, traffic safety, and driving-while-intoxicated treatment. American Journal of Preventive Medicine, 27,

9 April 7 Class 12 What is AA? How does it work? Are there treatments based on AA principles? Guest Lecture: James Langenbucher, Ph.D. Class requirement: attend at least one AA meeting prior to this class McCrady & Epstein, Chapter 15: Sheehan, T. & Owen, P. The disease model. McCrady & Epstein, Chapter 17: Nowinski, J. Selfà â â help groups foraddictions. Longabaugh, R., Wirtz, P. W., Zweben, A., & Stout, R. L. (1998). Network support for drinking, Alcoholics Anonymous and long term matching effects. Addiction, 93, Morgenstern, J., Bux, D., Labouvie, E., Blanchard, K. A., & Morgan, T. J.(2002). Examining mechanisms of action in 12-step treatment: The role of 12-step cognitions. Journal of Studies on Alcohol, 63, April 14 April 14 Class 12 Forensic Assessment of Substance use Guest Lecture: James Langenbucher, Ph.D. April 21 Class 13 What do we know about marital and family therapies? > McCrady, B.S., & Epstein, E.E. (2008). Treatments That Work: Couples Therapy for Alcohol Use Problems. A cognitive-behavioral Treatment Program. Therapist Guide. NY: Oxford University Press. McCrady, B.S., & Epstein, E.E. (2008). Treatments That Work: Couples Therapy for Alcohol Use Problems. A Cognitive Behavioral Treatment Program. Workbook.. NY: Oxford University Press. Epstein, E.E. & McCrady, B.S. (2002). Couple therapy in the treatment of alcoholism. In A.S. Gurman and N. Jacobson (Eds.) Clinical Handbook of Marital Therapy, 3rd Edition (pps ). New York: Guilford Publications. Miller, W. R., Meyers, R. J., & Tonigan, J. S. (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, April 28 Class 14 Neurobiology and Genetics of Addiction 9

10 Guest Lecture: Jennifer Buckman, Ph.D.> May 5 Class 15 Mechanisms of Behavioral Change in Addictions Treatment Movie: Addiction. HBO Morgenstern, J. (2007). Perspectives and future directions. Alcoholism: Clinical and Experimental Research, supplement to Vol. 31 (10), 87S-90S. Willenbring, M.L. (2007). A broader view of change in drinking behavior. Alcoholism: Clinical and Experimental Research, supplement to Vol. 31 (10). 84S-86S. Huebner, R.B., & Tonigan, J.S. (2007). The search for mechanisms of behavior change in evidence-based behavioral treatments for alcohol use disorders: Overview. Alcoholism: Clinical and Experimental Research, supplement to Vol. 31 (10). 1S-3S. National Institute on Alcohol Abuse and Alcoholism (2006a). Mechanisms of behavior change in the treatment of alcohol use disorders. Funding Opportunity Announcement RFA- AA Bethesda, MD: NIAAA. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2006b). Mechanisms of Behavior Change Research Initiative: Strategic Research Plan. Report prepared by the Mechanisms of Behavior Change (MOBC) Trans-disciplinary Research Team for the Extramural Advisory Board, NIAAA National Advisory Council on Alcohol Abuse and Alcoholism. Bethesda, MD. 10

11 Suggested Paper Outline Topics: This list suggests some possible questions for your papers. If you select one of these topics, don't feel obligated to address every issue that I listed under the topic. 1. Discuss the treatment of an underserved group, such as women, Blacks, Hispanics, gays or lesbians, or the homeless. Discuss research about alcohol problems in this group, as well as suggested approaches to treatment and data about effectiveness. 2. Review research on alcoholism and other psychiatric disorders. Consider issues related to prevalence, differential diagnosis, treatment and long term outcome. 3. Examine issues related to mandatory treatment of alcohol and drug use problems. Consider such questions as prevalence of mandatory treatment, evidence of its effectiveness, for whom it is most and least appropriate. Also consider legal and ethical issues. 4. Examine whether the outcomes for alcoholism are different with and without treatment. Consider both drinking and quality of life issues. 5. Discuss different models of the nature of alcohol problems, empirical evidence related to these models, the values and limitations of these models for planning of services, and your own conclusions about what model you prefer. 6. Discuss models for treatment of persons who have problems with both alcohol and other drugs. Are there models with empirical support? What are the outcomes? 7. Consider different models for conceptualizing the behavior of members of alcoholics' families (e.g. coping models, disease models). What empirical support exists for different models? Are there research data supporting treatments derived from these models? 8. What environmental and person variables predict help-seeking for alcohol problems? How do these variables interact? 9. Discuss alcohol use and abuse in work environments. Are particular work environments, occupations, or organizational structures associated with greater or lesser alcohol problems? What types of workplace interventions or programs appear most effective in dealing with alcohol problems? 10. Discuss the controlled drinking controversy. What key issues informed the controversy at the beginning? How has discussion of controlled or moderated drinking evolved in the United States? Are perspectives different in other countries'? 11. Discuss harm reduction. What are key elements in the model? How does harm reduction apply to alcohol problems? What are advantages and disadvantages of a harm reduction approach? What is the scientific/research base for harm reduction? 12. Discuss treatment planning and patient-treatment matching how does the evidence guide clinical practice? 11

12 SUPPLEMENTAL BOOKS OF PARTICULAR INTEREST *Alcoholics Anonymous World Services (1980). Alcoholics Anonymous. NY: Author. AA World Services (1978). Twelve Steps and Twelve Traditions. NY: Author.. (2007). Assessing alcohol problems. A guide for clinicians and researchers. NIAAA Treatment Handbook Series #4. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism. Bishop, F. M. (2001). Managing additions. Cognitive, emotive, and behavioral techniques. Northvale, NJ; Jason Aronson, Inc. Non-Fiction Novels Bouroughs, Augustin Dry A Million Little Pieces Drinking: A Love Story Beautiful Boy Sober for Good Movies: Clean and Sober When a Man Loves a Woman Days of Wine and Roses Dimef, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief alcohol screening and intervention for college students A harm reduction approach. NY: Guilford Press. *Ellis, A. & Velten, E. (1992). When AA doesn't work for you. Rational steps to quitting alcohol. Fort Lee, NJ: Barricade Books, Ins. Fingarette, H. (1988). Heavy drinking. The myth of alcoholism as a disease. Berkeley, CA: University of California Press. Gomberg, E. S. L. & Nirenberg, T. D. (1993). Women and substance abuse. Norwood, NJ: Ablex Publishing. 12

13 Hester, R. K. & Miller, W. R. (2003). Handbook of alcoholism treatment approaches Effective alternatives. Third edition. Boston: Allyn and Bacon. Kurtz, E. Not-God - A history of Alcoholics Anonymous. Center City, MN: Hazelden Educational Services. Institute of Medicine (1989). Prevention and treatment of alcohol problems: Research opportunities. Washington, DC: National Academy Press. Institute of Medicine (1990). Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press. Kadden, R., Carroll, K., Donovan, D., Cooney, N., Monti, P., Abrams, D., Litt, M., & Hester, R. (1995). Cognitive-behavioral coping skills therapy manual. A clinical research guide for therapists treating individuals with alcohol abuse and dependence. [Project MATCH Monograph Series.] Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Marlatt, G. Alan (1998). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York, NY: The Guilford Press. Meyers, R. J. & Smith, J. E. (1995). Clinical guide to alcohol treatment: The Community Reinforcement Approach. NY: Guilford Press. McCrady, B. S. & Miller, W. R. (1993). Research on Alcoholics Anonymous Opportunities and alternatives. New Brunswick, NJ: Rutgers Center of Alcohol Studies. Miller, W. R. & Rollnick, S. (2002). Motivational interviewing, Preparing people for change addictive behavior (second edition). NY: Guilford Press. Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, r. G. (1995). Motivation enhancement therapy manua.l A clinical research guide for therapists treating individuals with alcohol abuse and dependence. [Project MATCH Monograph Series.] Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Monti, P., Abrams, D., Cooney, N. & Kadden, R. (2002). Treating alcohol dependence: A coping skills training guide (second edition). NY: Guilford Press. Nowinski, J., Baker, S. & Carroll, K. (1995). Twelve step facilitation therapy manual. A clinical research guide for therapists treating individuals with alcohol abuse and dependence. [Project MATCH Monograph Series.] Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Peele, S. (1995). The diseasing of America: How we allowed recovery zealots and the treatment industry to convince us we are out of control. Lexington, MA: Lexington Books. 13

14 Rotgers, F., Morgenstern, J., & Walters, S. T. (2003). Treating substance abuse. Theory and technique, second edition. NY: Guilford Press. Sobell, M. B. & Sobell, L. C. (1993). Problem drinkers. Guided self-change treatment. NY: Guilford Press. *Tate, P. (1993). Alcohol. How to give it up and be glad you did. Altamonte Springs, FL: Rational Self-Help Press. United States Department of Health and Human Services (1993). Eighth Special Report to the U.S. Congress on Alcohol and Health. Washington, DC: US Government Printing Office. 14