Full Description
In-patient treatment for alcoholism going beyond physical withdrawal from the drug has been available in Germany for more than 130 years. Particularly since the Second World War, treatment has broadened and changed in various ways. There are several reasons for this development. The recognition of alcoholism as a disease by the Supreme Court had widespread financial and administrative consequences. Since then in patient treatment has been funded mainly by the pension insurance institutions. Another reason is the strengthened influence of different psychotherapeutic schools on practice in treatment. At the present time in the Federal Republic of Germany there are about 250 treatment facilities (Suchtfachkliniken, or addiction centres), where around 25000 patients a year receive in-patient treatment. In addition to these, there are the addiction units in psychiatric and general hospitals, of which some offer withdrawal treatment, while others also offer rehabilit ation treatment. For out-patient treatment there are about 450 special addiction counselling and treatment centres, out-patient facilities available at local health authorities and university hospitals and, further to all this, there are thousands of self-help groups of various kinds. This system of interlocking treatment facilities of various kinds, from the first contact to the after-care stage, is called a treatment network or chain.
Contents
1 Introduction.- 1.1 Aim of the Study.- 1.2 Review of the Literature.- 2 Method.- 2.1 Basic Model.- 2.2 Structure of the Study.- 2.3 Selection of Patients.- 2.4 Patient Variables.- 2.5 Assessing the Outcome of Treatment.- 2.6 Study Procedure.- 2.7 Data Protection.- 2.8 Data Evaluation.- 3 Treatment Centres.- 3.1 Description.- 3.2 Factors in the Therapeutic Atmosphere.- 3.3 Summary.- 4 Admission Data.- 4.1 Data Collection.- 4.2 Sociodemographic Data.- 4.3 Use of Addictive Substances.- 4.4 Personality and Social Behaviour.- 4.5 Physical Condition.- 4.6 Previous Treatment for Alcoholism.- 4.7 Attitudes to Treatment (EZB).- 4.8 Life Events (LEL).- 4.9 Summary.- 5 Discharge Data.- 5.1 Data Collection.- 5.2 Sociodemographic Data.- 5.3 Behaviour and Symptoms During Treatment.- 5.4 Personality Changes.- 5.5 Summary.- 6 Six-Month Follow-Up.- 6.1 Data Collection.- 6.2 Sociodemographic Data.- 6.3 Use of Addictive Substances.- 6.4 Personality Changes.- 6.5 Physical Condition.- 6.6 Life Events.- 6.7 Treatment During the First 6 Months After Discharge.- 6.8 Comparison of Some Outcome Criteria.- 6.9 Summary.- 7 Eighteen-Month Follow-Up.- 7.1 Data Collection.- 7.2 Sociodemographic Data.- 7.3 Use of Addictive Substances.- 7.4 Personality and Social Behaviour.- 7.5 Physical Condition and Complaints.- 7.6 Life Events.- 7.7 Treatment During the Follow-Up Period.- 7.8 Comparison of Different Outcome Criteria.- 7.9 Summary.- 8 Data from Health and Pension Insurance Institutions.- 8.1 Health Insurance Companies.- 8.2 Pension Insurance Institutions.- 8.3 Summary.- 9 Reliability and Validity of Data.- 9.1 Heterogeneity of Data.- 9.2 Results.- 9.3 Summary.- 10 Changes Over the Course of the Study.- 10.1 Alcohol Abstinence.- 10.2 Marital Status, Living Arrangements and Work.- 10.3 Changes In andInteractions Between Outcome Criteria.- 10.4 Changes in Personality and Social Behaviour.- 10.5 Drop-Outs from Treatment, Length of Treatment and Outcome.- 10.6 Summary.- 11 Patients' Attitudes to and Experiences of Treatment.- 11.1 Attitudes to Treatment (EZB).- 11.2 Patients' Experiences of Therapy (TEL).- 11.3 Correlation Between EZB and TEL.- 11.4 Summary.- 12 Patient Variables as Prognostic Factors.- 12.1 Introduction.- 12.2 Method.- 12.3 Prognostic Factors for Drinking Behaviour.- 12.4 Prognostic Factors for Other Outcome Criteria.- 12.5 Analysis of Variables and Constructs of Special Clinical Relevance.- 12.6 Prognostic Significance of Dropping Out.- 12.7 Summary.- 13 Treatment Variables.- 13.1 Introduction.- 13.2 Grouping of Treatment Variables and Treatment Centres.- 13.3 Treatment Variables and Outcome.- 13.4 Effect of the Length of Treatment.- 13.5 Effects of After-Care in the Follow-Up Period.- 13.6 Summary.- 14 Indication.- 14.1 Introduction.- 14.2 Indication for Length of Treatment.- 14.3 Method.- 14.4 Results for Men.- 14.5 Indication Model for Men.- 14.6 Results for Women.- 14.7 Indication Model for Women.- 14.8 Prognosis and Indication.- 14.9 Summary.- 15 Other Factors Influencing Outcome.- 15.1 Influence Factors in After-Care and After-Treatment.- 15.2 Influence Factors in the Social Environment.- 15.3 Network of Influence Factors and Treatment Outcome.- 15.4 Summary.- 16 Discussion.- 16.1 Methodology.- 16.2 Results of the Individual Data Collections.- 16.3 Patients' Attitudes to and Experiences of Treatment.- 16.4 Prognosis.- 16.5 Treatment Variables.- 16.6 Indication.- 16.7 Influence Factors After Index Treatment.- References.- Appendices.
