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.

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Inhaltsangabe1 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.- 2.2.1 Design.- 2.2.2 Selection of Treatment Centres.- 2.2.3 Description of Treatment Centres.- 2.3 Selection of Patients.- 2.4 Patient Variables.- 2.4.1 Sociodemographic Data.- 2.4.2 Social Behaviour.- 2.4.3 Life Events and Stress.- 2.4.4 Drinking Behaviour and Patients' Attitudes to It.- 2.4.5 Complaints and Alcohol-Related Illnesses.- 2.4.6 Personality Traits.- 2.4.7 Attitudes to Treatment.- 2.4.8 Experiences of Therapy.- 2.5 Assessing the Outcome of Treatment.- 2.5.1 Drinking Behaviour and Use of Other Addictive Substances.- 2.5.2 Physical Health.- 2.5.3 Social Integration.- 2.5.4 Personality.- 2.6 Study Procedure.- 2.6.1 Data Recorded at Admission and Discharge.- 2.6.2 Data Recorded at 6- and 18-Month Follow-Up.- 2.7 Data Protection.- 2.8 Data Evaluation.- 3 Treatment Centres.- 3.1 Description.- 3.1.1 Size.- 3.1.2 Staffing.- 3.1.3 Admission Criteria.- 3.1.4 Goals of Treatment.- 3.1.5 General Description of Treatment.- 3.1.6 Particular Aspects of Therapy.- 3.2 Factors in the Therapeutic Atmosphere.- 3.2.1 Introduction.- 3.2.2 Method.- 3.2.3 Reliability of K-SEKT.- 3.2.4 Importance of Factors in the Therapeutic Atmosphere (K-SEKT-A).- 3.2.5 Implementation of Factors in the Therapeutic Atmosphere (K-SEKT-B).- 3.2.6 Comparison of K-SEKT-A and K-SEKT-B.- 3.3 Summary.- 4 Admission Data.- 4.1 Data Collection.- 4.2 Sociodemographic Data.- 4.3 Use of Addictive Substances.- 4.3.1 Drinking Behaviour.- 4.3.2 Medicaments and Drugs.- 4.4 Personality and Social Behaviour.- 4.4.1 Personality: Freiburg Personality Inventory.- 4.4.2 Social Behaviour: Self-Assertiveness Questionnaire.- 4.4.3 Psychosocial Problems.- 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.- 5.3.1 Drop-Outs.- 5.3.2 Relapses.- 5.3.3 Changes in Patients' Attitudes to Their Drinking Behaviour.- 5.3.4 Secondary Psychiatric Diagnoses and Other Symptoms.- 5.3.5 Participation of Patients and Significant Persons in Treatment.- 5.3.6 Clinical Prognosis.- 5.4 Personality Changes.- 5.4.1 Freiburg Personality Inventory.- 5.4.2 Self-Assertiveness Questionnaire.- 5.4.3 Interpretation.- 5.5 Summary.- 6 Six-Month Follow-Up.- 6.1 Data Collection.- 6.2 Sociodemographic Data.- 6.3 Use of Addictive Substances.- 6.3.1 Alcohol.- 6.3.2 Medicaments.- 6.3.3 Smoking.- 6.3.4 Interpretation and Conclusions.- 6.4 Personality Changes.- 6.4.1 Freiburg Personality Inventory.- 6.4.2 Self-Assertiveness Questionnaire.- 6.5 Physical Condition.- 6.6 Life Events.- 6.7 Treatment During the First 6 Months After Discharge.- 6.7.1 Psychotherapy.- 6.7.2 In-Patient Treatment.- 6.7.3 Interpretation and Conclusions.- 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.- 7.3.1 Alcohol.- 7.3.2 Other Addictive Substances.- 7.3.3 Diagnoses of Secondary Abuse of or Dependence on Medicaments or Drugs.- 7.4 Personality and Social Behaviour.- 7.4.1 Freiburg Personality Inventory.- 7.4.2 Selected Complaints.- 7.4.3 Self-Assertiveness Questionnaire.- 7.5 Physical Condition and Complaints.- 7.6 Life Events.- 7.7 Treatment During the Follow-Up Period.- 7.7.1 Self-Help Groups and Out-Patient Treatment.- 7.7.2 In-Patient Treatment.- 7.8 Comparison of Different Outcome Criteria.- 7.9 Summary.- 8 Data from Health and Pension Insurance Institutions.- 8.1 Health Insurance Companies.- 8.1.1 Data Collection.- 8.1.2 Method.- 8.1.3 Results.- 8.2 Pension Insurance Institutions.- 8.2.1 Data Collection.- 8.2.2 Results.- 8.3 Summary.- 8.3.1 Health Insurance Companies.- 8.3.2 Pension Insurance Institutions.- 9 Reliability and Validity of Data.- 9.1 Heterogeneity of Data.- 9.2 Results.- 9.2.1 Comparison