Introduction

No single treatment approach is effective for all individuals with alcohol problems (Institute of Medicine, 1990). There is now evidence that some treatments are more effective than others for certain patients, but which treatments work? In very general terms, about one-third of individuals entering treatment will do very well during the first year after the treatment episode. Here, improvement means abstinence, moderation of drinking and freedom from or a reduction in alcohol-related problems (Miller et al., 2001). The remaining two-thirds will continue to have periods of heavy drinking, but they drink less frequently and when they drink they consume less. This certainly results in a reduction in alcohol-related health and social problems. A narrow focus on drinking outcomes misses the fact that treatment confers substantial benefits on patients. It is also likely that factors outside the treatment setting have a differential impact on the behavioural change process. Another issue, not always considered, is that treatment outcomes are likely to be different in different countries. For instance, European outcomes are not as favourable as those from the USA (see Miller et al., 2001). It must be remembered, however, that there will always be a proportion of dependent drinkers who go on to kill or wreck themselves, despite treatment.

Our basic plea is that treatment choices should, wherever possible, be research based while at the same time a spurious scientism should not be allowed to inhibit the efforts of the individual therapist who is trying to help the individual patient in difficult and unique circumstances.