_] A Clinical Study of LSD Treatment in Alcoholisnl

Transcription

1 ,r Y ) l _ (196g) LSD18S3 d 1 Amer.J.Psychat. I;_, _] A Clncal Study of LSD Treatment n Alcoholsnl BY ARNOLD LUD_VIG I.D._.IEHO_IE LEVINE_ 3I.I)._ LOUIS STARK9 AND ROB}_HT LAZAR One hundred seventy-sx male alcoholc cotc drug addcts, t was noted that the patents partcpated n a controlled nvest- applcaton of a specalzed therapeutc gaton o/ the dfferental elffcacy of three technque known as "hypnodelc therapy" LSD treatment procedures and a "no produced sgnfcantly greater atttude therapy," or mleu treatment, condton, change and symptom relef compared to Half of each group was also assgned to other control treatment condtons(10). It dsulfram after dscharge from the hosptal was felt that the combned, snmltaneous use to determne whether any of these tech- of hypnoss along wth the admnstraton of nques could be enhanced by ts use. LSD enabled therapsts to control, structure, Although sgnfcant mprovement was and channel the resultng drug reacton shown wthn all treatment groups as better than could be acheved by ordnary measured by a number of clncal assess- nterpersonal psychosocal technques(5, 7, merts n the post-treatment and follow-up 11). In ths manner, patents could be perods, no one treatment condton proved prevented from drftng nto "mental orbt" to be superor. The authors conch,.de that the and could be forced to focus on and resolve drantatc clams for the effcacy of LSD ther current problems by attemptng to treatment n alcoholsm are unjustfed, understand ther psychologcal geness. Snce t was not possble to do a follow-up I evaluaton of these patents after hosptal HIS REPORT represents the culmnaton release, a defntve apprasal of ths tech of a three-year nvestgaton des_ned_ nque could not be made. to determne: a) whether there would be In order to pursue these ntal studes, a dfferental effectveness among three exper- large-scale controlled follow-up study wth mental LSD treatment condtons and a alcoholc patents was conducted. The control treatment condton and b) whether hypnodelc treatment technque was to be the effectveness of any of these technques compared wth two other LSD technques as could be enhanced by placng the patents well as wth a "no therapy" condton. Also, on dsulfram (Antabuse) subsequent to to maxmze the possblty for abstnence hosptal dscharge, from alcohol followng hosptal dscharge, In prevous work wth hosptalzed nar- the addtonal technque of dsulfram admnstraton was ncorporated nto the treat- Read at the 124th annual meetng of the ment study desgn. Not only would study Amercan Psychatrc Assocaton, Boston, Mass., patents receve one or another of the ex- May 13-17, pcrmental treatments but upon hosptal re- Dr. Ludwg s drector of educaton and research. Mendota State Hosptal, 301 Troy Dr., lease a selected sample would receve the Madson, Ws " Dr. Levne s chef, drug dsulfram as well. Psychopharmacology Research Branch, Natonal Insttute of Mental Health: Mr. Stark s research It was hypotheszed that patents expertassocate, Mendota State Hosptal: and Mr. Lazar s encng a favorable response to any of the research scentst, Bometrcs Laboratory, George expermental LSD treatment condtons Washngton Unversty. Ths work was supported by Publc Health would be more motvated to stay on Servce grant MH from the Natonal dsulfram, should t be assgned to them, Insttute of Mental Health. The lysergc acd dethylamde for ths study and therefore would do better than patents was suppled by Sandoz Pharmaceutcals and the n the same treatment condton who were dsulfram (Antabuse) was suppled by Ayerst Laboratores. not gven ths drug. Amer. J. Psychat. 126: 1, July 1969 [97]

2 4! 60 LSD TREATMENT IN ALCOHOLISM LUI: { Proeedure sutable canddates, durng whch standard-, zed explanatons of the program were gven ther :,',t The entre npatent treatment phase was and voluntary wrtten consent secured. Of as conducted at the Alcoholc Treatment the 254 patents referred, 195 (76.77 pat. Center (ATC) of Mendota State ttosptal, percent) of the patents volunteered. For bad Male alcoholc patents were referred to ths varous reasons, 19 patents were dropped wt: 30-bed center by the hosptal admsson from the program before ther treatment; met: '_, wards to partcpate n the one-month therefore, 176 patents (69.29 percent of ther npatent mleu therapy program. Ths the patents ntervewed) actually were trea hghlystructuredntensveprogramconsst- treated, sh { ed of fve therapeutc communty meetngs Durng ths ntervew, patents were n- told per week, small group therapy, lectures on the causes and effects of alcoholsm, AA formed that they would be offered one of four major treatment condtons on one just F, meetngs, work assgnments, and recreaton- occason, as well as the possblty of LSII al and occupatonal therapy, as well as recevng dsulfram for one year (suppled web_ opportuntes for ndvdual counselng and free) just pror to and followng hosptal ses_ rehabltatonplannng, dscharge. In order to reduce patent bas sess towardther assgnedtreatmentcondton, app_ " Patent Selecton and Recrutment whch ncluded the later possblty of pat_ All patents who met the followng dsulfram, patents were told that all root, crtera were consdered as canddates for treatments were equally effectve and that day the study: 1) between the ages of 21 and the partcular treatment they receved would ob_ 55; 2) up to four prevous admssons to be chosen especally for them on the bass of took Mendota State Hosptal for alcoholsm; 3) ther pretreatment psychologcaltestng and seda_ no overt psychoss; 4) no evdence of clncal ntervews. In actualty, both the whey, serous neurologcal or physcal dsablty; treatment condtons and therapsts were of t! 5) contact wth a responsble relatve (who assgned randomly to the patents, be f, was not over 70 years old) wthn one year; In addton patents were told that they revc and 6) resdence wthn a specfed geo- would receve an extensve pretreatment and now. graphcal area. Selected demographc char- post-treatment npatent evaluaton and be l. acterstcs of the total study sample (N = expected to return to the hosptal for the LSI) 176) maybe found n fgure 1. scheduled follow-up vsts and evaluatons, pra.:, An ntal ntervew was held wth all They were further nformed that a responsble relatvewouldbe contactedpror to notk was Fgure1 treatment and at the sx- and 12-month attcr } SelectedBemographc Characterstcs of thetotalstudy ntervals Sample(N=176) followng hosptal release, nto of : '_" PERCENTAGE Treatment Procedure orc_ ; A snglestandardzedpreparatorysesson pr_3 _... _._,_ was held for each patent. Ths sesson, Hyp o _... _... lastngapproxmaelytwo hours, was rough... _ ly dvded nto two parts. The frst hour and f, _ I,o_,_E_0..._,o, a ton half gatherngrelevant was devoted to psychatrc to the followng nforma- psw "... _ areas: a) chefcomplants,b) past hstory tere,... (especallyfamly and martal), c) self- ther I Smgle _N! cone... _'-_'a,_.,_ descrpton, d) hstory of alcohol consump- sml......ii ton, e) psychosocal hstory, and f) treatmentexpectatons.on the _,ssof ths Patkl)... _._.<. nformaton, therapsts were to formulate dos:: HIGHSCHOOLEDUCATION... _' the major problem areas that would be dealt and OCCUPATION u..._:_t_, wth durng the expermental treatment Alfl; s... _%gl sesson, treat _ [98] Amer. J. Psychat. 126: 1, July 1969 Am, :t

3 ._e_,._,_,,o.,,_.t_._/ _,_._... _1SM LUDWIG, LEVINE, STARK, AND LAZAR 61 ;ard- After ths nformaton was obtaned, the patents were told they would have to solve ::ven therapst gathered certan other data, such ther problems themselves wth the ad of Of as measures of patent suggestblty. The ths drug. Once the sesson began, therapsts :;.77 patents were then told the 5, would be called were not to engage n any dalogue wth For back for ther gpecfc treatment sesson patents except for offerng them brcf sup- ;,ped wthn the next few days. It s mportant to port f patents began to appear anxous or,.ent; menton that at ths pont nether the pancky.! of therapst nor the patent knew whch No therapy, or mleu therapy (MT), _eere treatment would be admnstered. To dmn- condton. Patents assgned to ths condton sh the possblty of bas, therapsts were were requred to spend an equvalent n- told whch treatment they were to conduct amount of tme n the treatment room n _:.of just pror to the actual treatment sesson. "contemplaton and medtaton" by themone For all treatment condtons nvolvng selves. They were asked to do an "honest of LSD, the patent receved 3/xg. per kg. body personal nventory," wrte down the reasons :led weght of LSD at the begnnng of the for ther problems, and make constructve qtal sesson. Regardless of the condton, all plans for the future. Snce no actve or!_as sessons occurred n the mornng and lasted specfc form of psychotherapy or drug on, _ approxmately three hours. Followng ths therapy was admnstered durng these of patents were brought to an observaton sessons, we have vewed them as a all room where they remaned throughout the representaton of the basc mleu treatment _hat day and overnght. Specally traned nurses program of the ATC.,uld observed them frequently durng ths tme, Followng each of the four therapy : of took _tal sgns, admnstered nghttme condtons, patents had an opportunty to and sedaton, and offered supportve therapy "work through" any resdual problems n the when ndcated. Snce detaled descrptons ther ongong formal group therapy program cere of the three LSD treatment condtons may at the ATC. Snce all patents were exposed be found elsewhere(4, 10, 11), only a bref to a smlar hosptal mleu both pror to and hey revew of these procedures wll be gven followng ther expermental therapy experand now. ence, t was assumedthat any dfferences be Hypnodelc therapy condton (hypnoss-t- noted among the three LSD and no therapy the LSD + psychotherapy). After the appro- control condtons could be attrbuted to the ms. prate dosage of LSD was gven, a hyp- specfc treatments nvolved. ns- notc nducton, lastng 30 to 45 mnutes, Dsulfram assgnment. Pror to hosptal to was performed. Durng the nducton, an release (after post-treatment npatent eval-,ath attempt was made to brng the patent uaton), patents were nformed whether or nto as deep a trance as possble. At the end not they would receve dsulfram. Selecton of the nducton, an actve, dynamcally to receve ths drug was determned on a orented psychotherapy was begun wth the random bass, ensurng that one-half the on prmary focus on major problem areas, patents wthn each of the four major on, Hypnotc control was perodcally renforced treatment groups would be assgned. Those _:h- through approprate suggestons and tech- selected were told that evaluatons ndcated :nd nques, the drug wouldbe most helpfulfor them. _m- Psychedelc therapy condton (LSD-F They were strongly encouraged to take a ng psychotherapy). The patents were admns- fxed, prescrbed dosage every day, nstruct- ; :)ry.'iftered LSD and told to begn talkng about ther problems. As n the hypnodelc ed on the dangers of mbbng alcohol whle on dsulfram, gven a dsulfram dentfca- :P- condton, therapsts began to engage n a ton card for ther wallets, and started on the f) smlar form of actve psychotherapy, Drug therapy condton (LSD alone). drug four days pror to hosptal dscharge. They were gven a sx-month supply' of the hs Patents were smply gven the approprate drug (renewable for another sx months)and : ate dosage of LSD and were nstructed to relax nstructed to take one 0.5 gram tablet pcr :alt and begn thnkng about ther problem.,;, day. Although the practce of some cln- :nt Although the therapsts remaned n the cans s to gve a test dose of alcohol to treatment room throughout the sesson, patents treated wth dsulfram to establsh 69 Amer. J. Psychat. 126: 1, July 1969 [99]?!

4 _ 62" LSD TREATMENT1N ALCOtIOLISM _, TABLE 1 BascFactoralResearchDesgn DISULFIRAM THERAPY MILIEU HYPHODELC PSYCHEDELIC DRUG ALONE TOTAL No ! Yes ,_ Total } an aversve condtonng stuaton, not donen thsexpernaent, ths was acterstcs--the Calforna Psychologcal In- ventory (CPI) (3) and the Psychatrc EvaluatonProfle(PEP)(6). ThePEPsa Expermental Desgn self-report nventory composed of Sx fac- Forty-four patents were assgned n a tors, four of whch are drectly nterpretable fxed random order to each treatment n terms of mprovement or deteroraton n _ condton, wth half of each group recevng the patent's psychologcal health. These._ dsulfram Table 1 shows just pror the basc to and factoral after dscharge, research four Dstrust, factors Optmsm, are desgnated and Competence. as Dstress, _" desgn employed for ths study. Scores may vary between 0 and 100, wth hgh scores ndcatng more llness on the Therapsts Dstress and Dstrust factors, whle hgh _ Thrteen psychatrsts partcpated as scores ndcate more health on the Optmsm,:_ therapsts n the study. In an attempt to and Competence factors. control the varable of therapeutc skll 2. Observable to or reportable behavor-- _ avod basng treatment results, each thera- the Breathatyzer(1, 2) and the Drnkng patents n each of the treatment condtons, s a hghly relable and senstve nstrument pst Therefore was each assgned therapst an was equal responsble number for of Follow-up for determnng Form blood (DFF). alcohol The level Breathalyzer from a patents---each patent recevng one of the ment cannot be used to evaluate drnkng four expermental treatment condton, s and behavor durng the nterval between followone-half ether of the one patents or two recevng blocksdsulfram, of eght sample ups, t of produces expred vrtually ar. Although ncontrovertble the nstru- I treatng _ It s mportant to menton that all evdence for sobrety or nebraton at the,! partcpatng therapsts were traned by the tme breath samples are obtaned. The prncpal nvestgator n the technques of Drnkng Follow-up Form was devsed to hypnoss and the admnstraton of LSD obtan from patents nformaton regardng pror to the project. Extensve readng ther drnkng behavor on a month-tomateral was assgned and demonstraton month bass.! sessons were arranged. The therapsts dd 3. Socal adjustment--the Behavor Rat- hypnotzed receveasa part doseofof thelsd tranng nor procedure, were they constructed ng Scale (BRS)(9), to permt Ths evaluaton ratng of scale patent was ] socaladjustmentn sx generalareas: a) Evaluaton Instruments home nterpersonal relatonshps, b) socal I In order to evaluate treatment outcome nterpersonal relatonshps, c) personal so- _ adequately, measures assessng the patent's cal responsbltes, d) employment, e) stcs were employed along wth lneasures Scores for each area can be combned to symptomatology evaluatng observable and personalty behavor and character- socal drnkng form a total pattern, adjustment and f) score. legalanadjustment. equvalent of evaluatng these areas s gven elsewhere relatves. Follow-up personnel admnstered I adjustment. (8). The specfc The ratonale nstruments for the employed necessty n form ths scale of by ths conductng scale was a 30- admnstered to 45-mnute to ths study to evaluate treatment effcacy structured ntervew. On the bass of the were asfollows: patent's answers, ratngs were made for 1. Symptomatology and personalty char- each subscale. The best possble adjustment [100] Amer. J. Psychat. 126: 1, July 1969

5 ISM LUDWIG, LEVINE, STARK, AND LAZAR 63 would be represented by a score of 24 and were accepted nto the project, baselne the worst possble adjustment by a score of measures for the battery of assessment, 6 on ths ratng scale, nstruments were obtaned on all study patents approxmately one week pror to OTAL Evaluaton Procedure the expermental treatment sesson. It was at 88 Because of the possblty of basng the ths tme that a responsble relatve was evaluaton of outcome, a procedure was set contacted and asked to provde addtonal up whereby the treatment team was sepa- nformaton. Shortly thereafter, the patent rated entrely from the follow-up evaluaton was seen by hs assgned therapst for hs I In- team. Not only dd therapsts not know the ntal sesson and then, later, for the actual atrc treatment condton they would admnster treatment sesson. Approxmately ten days s a untl the mornng of the actual treatment to two weeks after treatment, evaluaton was fac- sesson, but they were also kept unnformed conducted agan. table about all pror and follow-up testng of Follow-up evaluaton. The follow-up )n n patents, evaluaton perods were at three, sx, nne, 'hese The two follow-up socal workers were and 12 months after hosptal dscharge. A :ress, also kept "blnd" about the treatment of follow-up was regarded as successful only 3nce. ther assgned patents and were forbdden when the patent could be ntervewed wth to dscuss the patents wth any of the drectly on a face-to-face bass (nformaton L the therapsts. The traned nurses and other acqured through phone calls, letters, etc., hgh ward staff who mnstered to these study was not regarded as vald data). Formal nsm patents followng treatment knew who had contact wth relatves was scheduled for the receved LSD and who had not, but they sx- and 12-month perods. In order to _or-- were not told whch of the three LSD ncrease patent motvator/to partake n the _kng condtons the patents receved. Undoubted- follow-up evaluaton (even though each had lyzer ly, some leakage of nformaton among staff orgnally promsed to do so to be elgble ment must have occurred, but, consderng the for the study), a monetary ncentve was )m a scope of the project, ths leakage was added for the nne- and 12-month perods. _stru- consderedto be neglgble. If the patent voluntarly came n for the :',kng The treatment outcome evaluaton was nne- and 12-month sessons, he would dlow- dvded nto two phases--npatent and receve $35: he would receve $25 f he came rtble follow-up. In the npatent phase, evaluaton n only for the 12-month sesson. t the was drected toward the effects of treatment Snce alcoholcs are notorously poor The on symptomatology and personalty change, cooperators n follow-up studes, our follow- :d to The follow-up phase focused on smlar up phlosophy was necessarly aggressve. If rdng parameters but also ncluded evaluaton of patents refused to come back to the hosptal th-to- behavor and communty adjustment n a for evaluaton, our follow-up workers would real lfe settng. The schedule for the seek them out, even f ths meant conductng Rat- admnstraton of testng nstruments s ntervews at patent homes, n bars, n jal, was gvenntable 2. or at the place ot_ther employment.wth atent Inpatent evaluaton. After the patents such a follow-up approach, we successfully _: a) socal TABLE 2 t] so- Schedule for Admnstraton of TestngInstruments nlent. INPATIENT _d to BEFORE AFTER FOLLOW-UP(MONTH) valent INSTRUMENT TREATMENT TREATMENT THREE SIX NINE 12 :d to CPI X X X stered PEP X X X X X X fnute BA X X X X )f the DFF X X X X e for BRS X X X X X,tment BRS (relatve) X X X 1969 Amer._Y. Psychat. 126: 1, July 1969 [101]

6 :, 64 LSD TREATMENT IN ALCOHOLISM 4 secured the requred nformaton on these analyses revealed statstcally sgnf; percent, 94.3I percent, percent, and cant (p equal to or less than.05) changes n percent of the total sample of study the drecton of health or mprovement from ' patents at the three-, sx-, nne-, and 12- baselne to post-treatment evaluaton for all } month perods, respectvely, the treatment groups n most measures. A general schema for the overall evalua- However, comparson among the treatment '1 ton procedure may be found n table 3. groups faled to show any consstent '_ sgnfcant dfferences. Ths ndcated that : Results there was an overall mprovementfor all,', treatment groups, but the specfc form of! Inpatent Evaluaton treatment, whether LSD was used or not, As noted prevously, npatent evaluaton dd not produce dfferental treatment effects. _! focused on symptomatology and personalty change, snce no relevant behavoral or Follow-Up Evaluaton : socal adjustment performance could be Although npatent evaluaton s mpor- _ evaluated. Patents were evaluated pror to tant, any technque used to treat alcoholsm "t treatment and two weeks after the exper- must be judged by ts effect on the patent mental treatment sesson but before beng after he has left the hosptal. The effect of assgned to dsulfram therapy, the treatment on drnkng behavor s of Sgnfcance of pretreatment to post- course essental, but the patent's adjustment treatment change was assessed by t tests for wth famly, employment status, and dftculcorrelated means for each treatment group ty wth the law nmst also be assessed. In! separately. Comparson among the four addton to the patent's own report of hs treatment groups was made usng analyss of adjustment, even f ths s obtaned n a face- _ covarance, wth the baselne score servng to-face ntervew, a smlar assessment from :_ as the covarant. Scores were avalable for a close relatve of the patent provdes the _! sx factors on the Psychatrc Evaluaton bass for an even sounder evaluaton. Profle and for 18 scales on the Calforna Snce half the patents n each of the four Psychologcal Inventory. The results of treatment groups receved dsulfram after leavngthe hosptal,we mustnowdeal wth TABLE3 two factors of therapy--the type of exper- ;{ GeneralSchemafor the OverallEvaluatonProceduremental treatment and whether or not dsulfram was subsequently admnstered. ' t INPATIENTPHASE:,_ 1. Patentadmttedto ATC unt. If patentmeets FIGURE2, crtera,ntal ntervews conducted. CumulatvePercentageof PatentsWho Returnedto t 2. Pretreatmentevaluatonby 1) socal worker,2) Drnkng researchassocate,and 3) therapst.responsble relatvecontactedby socalworker. 3. Treatment _00 j_ 4. Post-treatmentevahmton:1) researchassocate.2) Patent Patent nformed seenabout by... L5, dsulframprocedure, f assgned. /,,_,_, 5. Dscharge 2// 6. Three.monthfollow-up:Socal worker completes _ v4_.' approprateprocedures.next ntervewscheduled. _:; _':,_/7 ' proprateprocedures.dsulframrenewed,f assgned.responsblerelatvecontactedby completesap- socal,_ 2,0, 7. Sx-monthfollow-up:Socalworker worker.nextntervewscheduled. _'_ 8. Nne-month follow.up:socalworkercompletesapproprate procedures. Next ntervew scheduled. _,.,,., 9. Twelve-month follow-up:socal workercompletes... _,,,,.o,,,_,o_ approprateprocedures.responsblerelatvecon..-,._o_,,_,_o,_ tactedby socalworker....,... --"_ Drug therapy 5 MO_NT H I1 12 [102] Amer. J. Psychat. 126: 1, July ,,. _... _.. _ :,.._,;_., _,_,_ r_a-, m_,.,,. *,_.: '... _'_'_*'_

7 .,._<;2_,_.,,:._. :,.a.... _a,,_./;: _.0,,_.... _.:,,_._,,,_ &._....a_,..-,.x...a..._._... 2_m`_'_e_-a_;_.:_=_._:g_*.`a_`_g_;:_`:_`_..`_`_'_._a _, LUDWIG,LEVINE, STARK,AND LAZAR 65 L-- FIGURE3 n drnkng pretreatment to post-treatlnent,: Percentageof Patents DrnkngDurngAnyGvenN0nth but no dfferental results based oll type of It... treatmentor dsulframadmnstraton.,. _0 Objectvemeasurements of bloodalcohol levels at the tme of patent ntervews at sjx _t _o monthsand 12 monthsrevealedno dffertt 7o ences between the dsulfram group and the Lt _ /_ group not takng dsulfram or among the I1 _0 treatment groups 'f I,,o / Socal adjustment. Table 4 gves the mean _o total adjustment scores on the Behavor ;. _0 Ratng Scale (BRS) for each of the,o treatmentanddsulframgroupsat the three-, sx-, nne-, and 12-month perods. Analyss..., MONTH... of covarance among the groups reveals no _ t sgnfcantdfferencesfor any perod,but.. pretreatmentto post-treatment t testsreveal Therefore, to compare the dfferent treat- sgnfcant mprovement at every perod. ment groups, a two-way analyss of covar- Smlar results were obtaned from the ance was used. relatve ratngs of total adjustment at the Observable or reportable behavor (.e., sx-and 12-month perods. drnkng behavor). Fgure 2 graphcally S3v.' lomatology and personalty charac- :' depcts on a monthly bass (from nforma- terstcs. The Psychatrc Evaluaton Profle ton collected every three months) the (PEP) and Calforna Psychologcal Inven- : cumulatve percentage of patents n each of tory (CP]) were used to assess ths area of :" the four expermental treatment groups w'ho outcome. Table 5 shows the mean PEP returned to drnkng. As can be seen, there scores obtaned at the sx- and 12-month r s a sharp ncrease durng the frst three evaluaton perods (adjusted for ntal r months, followed by a general plateaung level) for each of the treatment and 1 from sx to 12 months. Dfferences between dsulfram groups. In general, two-way the treatment groups are mnmal, analyses of covarance among the treatment t Fgure 3 depcts the percentage of and dsulfram groups produced no sgnfpatents drnl ng durng any gven month, cant dfferences for any, of the four PEP There s a sharp rse durng the frst three factors, but, as found on other measures, months, followed by a general plateaung at pretreatment to post-treatment t tests ret, about 55 percent from months four through vealed consstent sgnfcant nlprovement on 12. the Dstressand Competencefactorsfor all At ths pont, t also seems approprate to treatment groups. Inconsstent results were examne separately the drnkng pattern obtaned on the other two PEP factors. subscale of the Behavor Ratng Scale to Because the Calforna Psychologcal evaluate whether mprovement over baselne Inventory s composed of 18 ndvdual levels occurred due to treatment. Baselne to scales, results usng ths nstrument are too post-treatment t tests revealed sgnfcant mprovement for every group at every TABLE4 perod, whle two-way analyss of covar- MeanTotalAdjustment Scoresonthe BRS ance revealed no sgufcant dfferences among the treatment groups, between the MONTH TREATMENT THREE SIX NINE 12 group on dsulfram and the group not takng t, and no nteracton between the No therapy,or mleu I treatment group and whether dsulfram was Hypn0delc subsequently admnstered or not. Psychedelc Ratngs based on ntervews wth relatves Drug alone at the sx- and 12-month perods revealed No dsulfram dentcal results: that s, sgnfcant decrease Dsulframtherapy Amer. J. Psychat. 126." I, July 1969 [103]

8 _.,,._,.;.,.x., v.t._... _,_'-'_._,, :_e, _- _' _k_ll- '_'e... ",_ 66 LSD TREATMENT IN ALCOHOLISM I TABLE 5 MeanPsychatrc EvaluatonProfleScores "_ DISTRESS DISTRUST OPTIMISM COMPETEqCE _! TREATMENT 6 MOS. 12 MOS. 6 MOS. 12 MOS. 6 MOS. 12 MOS. 6 MOS. 12 MOS. _, Notherapy, ormleu _ Hypnodelc Psychedelc ; '_ Drugalone No dsulfram I Dsulframtherapy ] , extensve to be presented n tabular form, strong resoluton to dscontnue ther drnkbut the results obtaned are very smlar to nd. These affrmatons were often se! the above reported results. Namely, there s convncng that ward staff could not help but mprovement from pretreatment to post- be mpressed wth the effects of the! treatment testng on most measures but no treatment procedures. However, wth the dfferental outcome results based on the accumulaton of follow-up data, we soon ] dfferent treatment technques, began to harbor serous doubts about the '_ valdty of the patents' statements.! Dscusson In ntal studes assessng the relatonshp ;, of atttude to behavor(9) and the degree of It would be professonally gratfyng to alteraton n conscousness produced by the report sgnfcant results for the hypnodelc LSD procedures to subsequent personalty _' treatment technque as well as for the other change(12), we came to feel that these LSD treatment condtons purpose of cross-valdatng not only for the our pror fndparameters of patent tonng were relatvely experence ndependent and func- and that :_ ngs wth drug addcts but also for makng t would be nvald to extrapolate to some contrbuton 1o the treatment of behavoral or socal adjustment results from alcoholsm. Unfortunately, our conscous these parameters(8). If a "no therapy" _ wshes must yeld to the overwhelmng control group had not been used, the evdence that none of the LSD treatment treatment results of all three LSD proceprocedures prod_ces any greater therapeutc dures would have seemed most mpressve, beneft than can be realzed by the "no corroboratng the clncal mpressons of therapy" condton n the context of the patent mprovement noted shortly after general ward mleu program. ]t s not that therapy. However, by employng a con- _. substantal gans do not occur followng trolled comparson desgn, we were able to these expermental procedures, for our ascertan that the therapeutc affrmatons _ results ndcate sgnfcant mprovement on and resurgence of constructve motvaton _ most measures both at npatent and follow- followng LSD procedures dd not ensure up evaluatons for each of the four any better treatment response than smple expermental condtons; rather, t appears exposure to the hosptal ward mleu. that the gans are relatvely smlar for all The matter of relatvely sustaned theracondtons, ncludng that of no therapy, peutc gan followng any of these therapy To a large extent, these research fndngs condtons deserves further comment. In a dd not conform to the frequently dramatc way, ths fndng should not prove so, responses shortly after of the patents varous observed LSD treatments. clncally In surprsng cal and emotonal consderng state the deterorated of patents at physthe verbal accounts and wrtten statements tme of hosptal admsson. Wth the obtaned mmedately after the expermental opportunty for medcal care, adequate treatments, t was rather common for nutrton, group dscusson of ther probpatents to clam sgnfcant nsghts nto lems, exposure to an ant-drnkng but ther problems, to feel that they had been supportve envronment, and, most mporgven a new lease on lfe, and to make a tant, the sudden cessaton of drnkng and l1041 Amer. J. Psychat. 126: 1, July 1969

9 _,_ LUDWIG, LEVINE, STARK, AND. LAZAR 67 the perpetuaton of ths sobrety for at least mportance, we shall reserve dscusson of one month, tm vcous crcle of chronc thenl for a later report. For present : alcoholsm tends to be dsrupted, enablng purposes, suffce t to say that we do not the patent to regan some self-confdence regard ths drug as an neffectve agent n '_' and gan some perspectve on the personal tself: t s ahnost tautologcal to state that and socal consequences of hs drnkng patents who relgously take ths drug wll behavor reman abstnent from alcohol. Rather, the Despte ths overall mprovement n major therapeutc problem seems to be the _ patents, the total trealment program s falure of any of the expermental treatment generally unsuccessful n producng sobrety, condtons to stnmlate sufscent motvaton.-: Ths s attested to by the hgh percentage of for patents to contnue takng ths drug patents fallng off the wagon by the three- after hosptal dscharge. > month perod (65 percent) and reachng 80 It could be argued by staunch devotees of _: to 90 percent by the 12-month evaluaton. LSD therapy that the falure to obtan _ On the surface, ths fndng contradcts the dramatc or even sgnfcant results wth the _: general mprove/nent n patents noted on three LSD condtons s due to two basc c our atttude and socal adjustment measures, faults of the expermental treatment pron It must be made clear, however, that return gram: a) nsuffcent preparaton of patents T. to drnk does not mply sustaned, contnued pror to ther LSD treatment and b) drnkng behavor thereafter or even a nadequate follow-up care, whch excludes serous dsrupton of gans made n other the possblty of admnsterng addtonal c areas of performance, treatments. Concernng the frst matter, : For example, ths cunmlatve percentage vrtually all patents seelned suffcently ; of patents returnng to drnk masks the prepared so as to experence the panoramc, fndng that at any gven month after three spectacular effects of ths drug wthout any months only 50 to 60 percent of the patents adverse reactons (only two LSD sessons t are drnkng. Ths s stll poor testmony to had to be termnated). For the most part, the adequacy of a treatment program especally wth the hypnodelc and psyche-,_ stressng the vrtues of sobrety, but t delc condtons, the patents' responses ndcates that most patents are able to carry durng therapy and ther enthusastc test- : on most of ther other socal tasks at least at monals mmedately followng therapy were a hgher level than that noted on hosptal all that could have been hoped for. The admsson, whleengagng n perodc drnk- dffculty was that these clams had lttle nf. Furthermore, t seems that durng the mpact on the crteron measures for one-year perod of follow-up, maladaptve treatment outcome. patterns of behavor are not reestablshed at Wth regard to the second crtcsm, ther prevous level, further treatment would have some mert f Concernng the comparsons between we had seen even a glmmer or trend of patents treated wth dsulfram and those greater 'therapeutc beneft due to any of not, we agan fnd the overall follow-up these expermental condtons. The fact that results to be very dsappontng. At none of no encouragng sgns were noted at the postthe four postdscharge evaluaton perods treatment npatent evaluaton or even at the does the assgnment of dsulfram make any three-month postdscharge evaluaton nddfference n terms of treatment outcome, cated the futlty of admnsterng further We are n_. nave enough to beleve that the treatment sessons. assgnment of dsulfram to patents means Another matter bears comment. Ths that the), wll necessarly, take the drug In pertans to the possble dfference n therafact, our follow-up data ndcate that almost pst skll as a crucal varable n affectng all patents for whom dsullram s prescrbed, treatment outcome. It s certanly reasonable regardless of the expermental treatment pre- to assume that a gven psychatrc treatment vously receved, tend to stop takng t some- or form of psychotherapy may be more tme wthn the year of follow-up, effectvely admnstered by one psychatrst Snce the problems of admnsterng than another. We have attempted to control dsulfram are numerous and of consderable for ths varable by assgnng therapsts an Amer. J. Psychat. 126: 1, July 1969 [105]

10 _,_, "**_'::'*'&'_l_* a,,._*u*_, _,_'_-o:la_,_ "_- _'_' '_a_'-'*e _-._~ _, _...,,, _,_... _,._... _...,_:_L_=,,._,,_:,.,_ 68 LSD TREATMENT IN ALCOHOLISM I,U t equal number of patents n each expermental treatment category, thereby balancalcoholc patents. Detaled clncal assessments pertanng to symptomatology and._ ng out ther personal charsma or competence over all condtons. Moreover, n personalty change, drnkng behavor, and socal adjustment were made ol all patents stratfed on the varables of therapst three months over a perod of one year after dfferences and degree of clncal experence hosptal dscharge. Drect blood alcohol : on our crteron measures. The results readngs were also obtaned on patents at! prelnfnary statstcal analyses we have durng ther 30-day npatent stay and every 6 obtaned cause us to concludethat these the tmeof follow-up. 7 therapst varables are nsgnfcant n nflu- Although the results ndcated sgnfcant encngtreatment effect, mprovement from baselne to post-treat- _, As a fnal note, t must be emphaszed ment and follow-up testng for all treatment 8. that the major focus of ths report has been condtons (ncludng the no therapy cond- I to ss present of treatment a relatvely outcome uncomplcated n heterogeneous analy- ton), superor no to one any treatment other. Therefore, condton we proved were 1 samples of chronc alcoholc patents ran- forced to conclude that the dramatc clams :I donfy ment condtons. assgned to It the s possble expermental that further treat- made alcoholsm for the were effcacy scentfcally of LSD unjustfed. treatment n 9. analyses (already n progress) amed at determnng types patents whch of respond best to whch types of treatment, or Acknowledgments controllng for potentally mportant var- We would lke to thank Mrs. Blle ables (.e.,suggestblty, measures ofmotva- Penzkover, Mss Gall Wnter, and Mrs. :{ ton for treatment, etc.), may yeld results Gretchen Petersen for ther mportant conwhch wll cause us to modfy our current trbuton to ths project n the area of conclusons. Ths s a possblty but one follow-up and Mrs. Ann Mueller, Mss Jan that s hghly unlkely. Kaster, Mrs. Maran Lull, and Mss Barbara The overwhelmng, consstent, emprcal Luther for the excellent nursng servce they fndngs force us to conclude that the provded. Mrs. Inda Henneger also played varous LSD procedures, as used n ths an essental role n coordnatng the program study, do not offer any more for the and provdng other servces. treatment of alcoholsm than an ntensve We would also lke to thank the followng mleu therapy program, and the latter, at psychatrsts who generously offered ther ] best, s qute neffectve n deterrng drnk- tme and skll to act as therapsts for the ng. It s unfortunate that the promse of program: Rchard Arnesen, M.D., Martn! these dramatc procedures, when subjected Bauman, M.D., Rodney Chan, M.D., Gor-! to strct research scrutny, should prove to don Chunn, M.D., Davd Clne, M.D., Daryl 1 be only a nfrage. Damond, M.D., Kent Keller, M.D., Arnold Marx, M.D., Phlp Mussar, M.D., Noe t Sunmmry Neaves, Norton Zarem, M.D., M.D. Leonard Sten, M.D., and Ths report represents the culmnaton of :_ a three-year nvestgaton desgned to obtan REFERENCES more conclusve answers relevant to the :1 followng ssues" 1) whether there would be 1. Borkensten, R. F., and Smth, H. W.: The dfferental effectveness among three exper- Breathalyzer and lts Applcaton, Med. Sc. mental LSD treatment condtons and a Law2:13-22, October1961. control treatment condton; and 2) whether 2. Breathalyzer Instructon Manual. Redbank, N. J.: Stephenson Corp., the couldeffectveness be enhancedof any by placng of thesethe technques patents 3. Gough, Inventory. H. PaloG.: Alto, Calforna Calf.: Consultng Psychologcal Psy on dsulfram subsequent to hosptal ds- chologsts Press, 1956, charge. 4. Levne, Conscousness J., and ProducedbyCombnatons Ludwg, A. M.: Alteratons of Th'rteen psychatrsts partcpated n the LSD, Hypnoss and Psychotherapy, Psycho study [106] and treated a total of 176 male. pharmacologa Amer. J. Psychat. 7: , 126: , July 1969,4t_ " _.._,._._,_ ",,... _"_-',_:-, _,,,, '_'_'a_:_'_h_"_,'f_- - : _..,, _'_

11 I.ISM LUDWIG_ LEVINE_ STARK_ AND LAZAR 69 ;sess- '5. Levne, J., and Ludwg, A. M.: "The to Behavor: Prelmnary Results and Implcaand ttypnodelc Treatment Technque," n Abram- lons for Treatment Evaluaton Studes," n and son, H. A., ed.: The Use of LSD n ScMen, J., Hunt. H. F., Matarazzo, J., and Psychotherapy. New York: Bobbs-Merrll Co., Savage, C., eds.: Research n Psychotherapy,, :ents vol. 3. Washngton, D. C.: Amercan Psy- :very 6. Levne, J., and Ludwg, A. M.: The chologcal Assocaton, 1968, pp after Psychatrc Evalualon Profle (PEP): A New 10. Ludwg, A. M., and Levne, J.: A Controlled ",')hol Self-Report Inventory, read at the 12th annual Comparson of Fve Bref Treatment Tech- _S at conference of the VA Cooperatve Studes n Psychatry, Denver, Colo., March nques Employng LSD, Hypnoss and Psychotherapy, Amer. J. Psychother. 19: , 7. Levne, J., Ludwg, A. M., and Lyle, W.H.: '<ant The Controlled Psychedelc State, Amer. J. 11. Ludwg, A. M., and Levne. J.: "Hypnodelc,eat- Cln. Hypn. 6: , Therapy," Psychatrc n Masserman, Therapes, vol. J., 7. ed.: Current New York: ment 8. Ludwg, A. M.: A Model for Evaluatng the Grune & Stratton, 1967, pp ,nd- Clncal and Therapeutc Effects of Psychedel- 12. Ludwg, A. M., Levne, J., Stark, L., and,wed c Agents, read at the sxth annual meetng of Lazar, R.: The Relatonshp of Altered States were the Amercan College of Neuropsychophar- of Conscousness to Therapeutc and Personalmacology, San Juan, P. R., December 12-15, ty Change, read at the annual meetng of the ams AmercanPsychologcal Assocaton,Washng,t n 9. Ludwg, A. M.: "The Relatonshp of Atttude ton, D. C., September 1-5, 1967.?lle Mrs. cono[ Jan.bara they ayed ram wng From the precedng remarks we see that nsanty s often but an effect ther, of a slght njury or dsease of a part of the bran, and n many cases only the a few of the faeultles of the mnd are dsordered. From ths we nfer that artn the bran s not a sngle organ, but a congeres of organs, as mantaned by the llustrous Gall and hs celebrated successors Spurzhem and Combe. [3or- Thus each mental faculty has an especal organ, and therefore certan )aryl facultes may be dsordered by dsease of the bran, whle others are not hold affected; a fact every day observed n Lunatc Asylums, but whch we Noe and know not how to explan f we beleve the bran to be a sngle organ. --TILE A_IERICAN JOUnNAL OF INSANITY, VOLUN_E ], page , The Sc.?ank, _gcal Psyns n IS Of cho A,ner. J. Psychat. 126: 1, July 1969 [107]