view this paper - ICADTS International Council on Alcohol, Drugs

view this paper - ICADTS International Council on Alcohol, Drugs

Alcohol and driving: What research on
alcoholic relapse reveals
Gemot Lauer
1.
Introduction
T h e topic of alcohol d rin k in g and d ru n k e n d riv in g has a lo n g tradition o n b o th sides of the
A tlantic O c e a n (E chterhoff, 1991).
In th e U nited States 25.000 d eaths and 75.000 injuries a y e a r a re attributed to d ru n k driving
(N athan, 1983). M any of th o se killed or in ju re d a re y o u th fu l d riv ers; d ru n k d riv in g or
d riving w hile im paired (D W I) is a lea d in g cau se of d e a th am ong th e U nited States’ y o u n g
p e o p le . A cco rd in g to B o rk e n ste in (1981), th e in c id e n ce of d ru n k d riv in g m ight b e re d u c e d
b y sim ultaneously 1. re d u c in g p e r capita alcohol consum ption (by in c re a sin g p ric e an d /o r
raising d rin k in g age), 2. in c re a sin g e n fo rc e m e n t efforts to b rin g a b o u t g e n e ra l d e te rre n c e
of d rinkin g and d riv in g and 3. co nstructing streets and h ighw ays in su ch a w a y that th e y
p lace fe w e r dem ands o n d riv ers. A lth o u g h su ch a m assive p ro g ra m w ould d oubtless affect
the rates of d ru n k e n d riv in g it is n o t lik ely that legislative b o d ie s could b e m obilized
anytime to a u th o rize th e m onum ental e x p e n d itu re of p u b lic fu n d s n e c e s s a ry to p u t this
p ro g ram into action and operation.
In G erm an y 11.045 deaths and 510.926 injuries c a u s e d b y tr a f f ic h a d b e e n r e g is tr a te d in 1990
(Colditz, 1991), about 20% to 50% a re attributed to d ru n k d riv in g (S tephan, 1990a).
O sterm ann (1987) fo u n d in a su rv e y of th e literatu re o n re p e a te d o ffen ces v a ry in g rates
b e tw e e n 10% to 25% d u rin g five y e a rs; in his ow n study o n N=1531 first time offen ces
recidivism o cc u re d in 14,1% of all cases.
A 36 m onth long-term study o n th e "E ffectiveness of p ro g ram s for d riv e rs w ith se v e ra l
d rinking and d riving o ffen ces" (W inkler, Ja c o b s h a g e n & N ickel, 1988) d em onstrates a
rela p se -ra te for D W I of 13,3% for th e th re e treatm en t g ro u p s co m p ared w ith a re la p se -ra te
of 18,8% for th e control g ro u p . T h e th r e e d iffe re n t b e h a v io u ra l m odels o n w h ich th e
p ro g ram is b a se d (IFT, IRA K, LEER) p ro v e d to b e eq u ally su ccessfu l (H e in rich &
P o rsch en , 1988).
B ased on our re c e n t k n o w le d g e ab o u t th e p re d ic tio n of d ru n k e n d riv in g o ffen c es (e. g.
D onovan, M arlatt & S a lz b e r g 1983), giving an e x p e rt op inio n is a v e r y difficult and
resp o n sib le task (Stephan, 1990b). P sy ch o m etric diagnostics show o n ly a v e r y limited
success for th e p red ictio n of fu tu re d riv in g o ffen ces (K aiser, 1990). M ost test-p red icto rs of
D W I-relap se show usually low correlatio n s in th e .25 to .35 ra n g e (C raig & D res, 1989; Little
& R obinson, 1989).
S tep h an (1989) em p h asized to ta k e into ac co u n t th e results of r e s e a r c h o n alcoholism for th e
relaps e -p re v e n tio n of d rin k in g d riv ers. A dditionaly th e co n sid e ra tio n of th e results of
alcoholic re la p se re s e a rc h seem s h e lp fu l and n e c e ss a ry , b e c a u s e th e d rin k in g re la p se
p re c e d e s th e re la p se in d ru n k e n driving.
Alcohol, Drugs and Traffic Safety - T92
Ed. by Utzelmann / Berghaus / Kroj
Verlag TÜV Rheinland GmbH, Köln -1993
207
2. The alcoholics' relapse: Old myths and empirical facts
In most psy chiatric and somatic d iso rd ers (e. g. sc h iz o p h re n ia and d iabetes) re la p se s are
fre q u e n t and common, constituting an in te g ra l p a rt of th e diseases. P sychoanalysis c reated
the w ord "W ied e rh o lu n g szw ang" (repetition-com pulsion), w h ich m eans that rep etitio n s of
m aladaptive b e h a v io u rs a re n e c e s s a ry to h e a l a n e u ro sis. In th e diseas e -c o n c e p t of
alcoholism, re la p se s a re re g a r d e d as signs of a failure of treatm ent, of a lack of w illpow er, as
a catastrophe, as o n e m ore step in d e stru c tin g th e self o f th e alcoholic.
O ften th e se n e g ativ e em otions c o n c e rn in g th e alcoholics' re la p se lea d to an in te rru p tio n of
treatm ent and interv en tio n s, to acting out b y therapists (e. g. d isch arg e from inpatienttreatm ent) and a re a b u rd e n for both, co u n sello rs and clients, le a d in g to em otional problem s
and d ifferen t d efe n s e-m echanism (K orkel, 1991; K ö rk e l & L au er, 1992). A m oralistic attitude
about re la p se and ab stin en ce for a lo n g time clo u d ed scientific re s e a rc h o n th e to p ic of
addictions and alcoholism. A n e w u n d e rsta n d in g of re la p se finds in c re a sin g em pirical
support, and long -term ab stin en ce is s e e n as th e m ost fa v o u rab le re su lt of alcoholism
treatm ent, b u t re la p se is re g a r d e d as th e most com m on outcom e (L au er & K orkel, 1993).
2.1. W h a t h a p p e n s a fte r th e firs t re l a p s e ?
A study (Hunt, B arn ett & B ranch, 1971) dem ostrates, that re la p se is th e m o re comm on
outcom e th an is ab stin en ce after th e treatm en t of d iffe re n t addictions. A b o u t two thirds of all
re lap ses o c c u re d w ithin th e first 3 m onths follow ing treatm ent. T w e lv e m onths after
treatm ent term ination o n ly 20% to 30% of th e addicts re m a in e d co m pletely abstinent. B ut this
study (H unt, B arnett & B ranch, 1971) d o e s n o t show w hat h a p p e n s after th e first re lap se .
L o oking to an o th e r study (G ottheil, T h o rn to n , S k o lo d a & A lterm an, 1982), a follow -up of
N = 171 tre a te d alcoholics, ev alu a tin g th e d rin k in g status at 6, 12, and 24 m onths after
term ination of treatm ent, shows shifts from th e d rin k in g cate g o rie s rem issio n to re la p se and
from re la p se to rem ission. O th er studies (for a rev iew : F eu e rle in , 1990) give fu rth e r su p p o rt
to the opinion, that th e d rin k in g b e h a v io u r of alcoholics after treatm en t tak es a v e r y v ariab le
course. In a g erm a n m ulticenter study (K üfner & F e u e rlein , 1989) th re e p attern s of n o t
deterio ratin g re la p se s h a d b e e n identified for 72% of all re la p se d p erso n s:
1. 15% of all re la p se d alcoholics h ad o n ly o n e re n e w e d consum ption of alcohol
w ithin 18 m onths.
2.54% of all re la p se d alcoholics sh o w ed se v e ra l re la p se s w ith a maximum d uration
of th re e days 18 m onths after th e term ination of in p atien t alcoholism treatm ent.
3. 3% consum ed - p e rh a p s able for controlled d rin k in g - steadily m o d era te
am ounts of alcohol (30 to 60 g /d ay j w ithout d e terio ra tin g effects o n daily life.
T h u s, only 28% of th e re la p se s to o k a serio u s c o u rse , le a d in g to re n e w e d alcoholism and
p e rh a p s to re n e w e d treatm ent.
S e v e ra l th e o rie s try to ex p lain th e re la p se -p ro c e ss (review : K o rk el & L au er, 1992). A w ay
from th e diseas e-c o n c e p t of alcoholism, w h ich se e s re la p se s trig g e re d b y biochem ical
deficiencies of th e alcoholic, p sy c h o dynam ic, b e h a v io u ra l and cognitive a p p ro a c h e s h ad
b e e n d e v e lo p e d . A c c o rd in g to Marlatt and G o rd o n (1985) re la p se s h a v e multiple
208
determ inants: emotional, cognitive and physiological factors; p erso n a lity and life-style; social
relationships and drinking-norm s of th e society.
2.2. F a c to rs a s s o c ia te d w ith th e p r o g n o s is a fte r r e la p s e s
In a re c e n t re v ie w (K ö rk el & L au er, 1992) some associations w ith a b e tte r p ro g n o sis after
the first re la p se h ad b e e n found:
1. T y p e , duratio n and intensity of alcoholism treatm ent. A lo n g e r and m o re
in ten sive inpatient-treatm ent lead s to a b e tte r p ro g n o sis, e. g. lo n g e r ab stin en ce
and few er and sh o rter re la p se -e p iso d e s.
2. F eatures of th e alcoholic. A n alcoholic w ith less positive expectatio n s
co n c e rn in g th e effects of alcohol b e v e r a g e will h a v e a d e c re a s e d re la p se -risk
(B row n, 1985; C o n n o rs, O 'F arre ll & Pelcovits, 1988; R ather & Sherm an, 1989).
N egative em otional states (e. g. d e p re ssio n , frustration, a n g e r, hostility,
aggression) a re associated w ith an in c re a se d risk of re la p se (G le n n & P arsons,
1991). C ognitive dysfunctions - o ften th e re su lt of lo n g -stan d in g alcoholism - a re an
im portant contributing factor fo r re la p se s (A bbott & G re g so n , 1981). Deficits of
social com p eten ce, esp ecially in situation with h ig h p re s s u re to consum e alcoholic
b e v e ra g e s , a re associated with a h ig h e r risk of re la p se (B u rlin g Reilly, M o ltzen &
Ziff, 1989; D e Jo n g -M e y e r, H e y d e n , S c h ie re c k & S kaletz, 1988; Miller, Ross,
E m m erson & T o d t, 1989). T h e se a rc h fo r a re lap se -p e rso n a lity has failed as the
se a rc h fo r an alcoholic-personality has failed.
3. E xternal factors. R elap ses do o ften follow n e g a tiv e life-e v en ts (M ittag L ie b ig
F reu n d & S ch w a rz e r, 1991). T h e c o p in g b e h a v io u r of re la p se d alcoholics is
im paired in com parison to abstinent alcoholics. T h e r e is a stro n g relationship
b e tw e e n low econom ical and social status, la ck of social ties and re s o u rc e s and
re la p se . Single liv in g p e rs o n s a re m o re re la p s e -p ro n e th a n abstinent alcoholics,
living in a stable and satisfying p a rtn e rsh ip . C o n tin u ed afterca re , e. g. contact to
self-help g ro u p s lik e A lcoholics A nonym ous, or a stead y contact to a co u n sello r, is
o n e of th e m ost im portant factors fo r re la p se -p re v e n tio n and re lap s e -in terv e n tio n
(K üfner, 1990; L au er, 1990, 1992). U n em ploym ent in c re a se s th e risk of re lap se .
E ig h teen m onths after in p atient-treatm ent for u n e m p lo y e d alcoholics th e re la p se rate is tw ice th e re la p se -ra te of em ployed alcoholics (for a re v ie w : H e n k e l, 1990).
Som e factors associated w ith re la p se s m ay b e m odified to in c re a se th e p ro b ab ility of
continued abstinence.
2.3. W h a t c a n b e d o n e to p r e v e n t o t to in t e r r u p t r e l a p s e s ?
T h e probability of ab stin en ce m ay b e in c re a se d b y m e a su res fo r p rim ary and se c o n d a ry
re la p se -p re v e n tio n (L auer, 1990, 1991, 1992; L au er, K ö rk e l & Sohns, 1992):
209
1. D u rin g a fte rc a re th e contact to self-help g ro u p s is an im portant contributing
factor to ab stinence. T h e study of K üfner and F e u e rle in (1989) shows that 71,6%
of th e alcoholics with re g u la r contact to self-help g ro u p s re m ain e d abstinent, b u t
only 48% of th o se with irre g u la ry contact d u rin g 18 m onths. P ro fessio n al
outpatient p sy c h o th e ra p y and co u n sellin g is a fu rth e r m eans fo r p rim ary re la p se
p re v e n tio n . T h e effect of a b e h a v io u ra l con tract is d em o n strated in a study of
A hles, Schlundt, P ru e and R ych tarik (1983). T h e e x p erim en tal g ro u p a g re e d to a
re g u la r afte rc are participation and 73% rem ain e d abstinent; th e co n tro l g ro u p h ad
an ab stin en ce-rate of 17% half a y e a r after inpatient-treatm ent.
2. S e c o n d a ry rela p s e -p re v e n tio n aimes to an e a rly re sto ra tio n of ab stin en ce after
the (first) re la p se . A dditional social skills trainings d u rin g inpatient-treatm ent
sh o rte n re la p se -e p iso d e s d u rin g th e y e a r after treatm en t (C h an ey , O 'L e a ry &
Marlatt, 1978; E riksen, B jörnstad & G ötestam, 1986; O e i & Ja c k so n , 1982). Little is
k n o w n ab o u t th e ro le of self-help g ro u p s for se c o n d a ry re la p s e -p re v e n tio n
d u rin g aftercare, p e rh a p s b e c a u se m any alcoholics stop contact after th eir first
relap se. B eh av io u ra l afte rc a re a rran g em en ts show a v e r y stro n g em pirical
su p p o rt as h e lp fu l strategies fo r se c o n d a ry re la p s e -p re v e n tio n (Ahles, Schlundt,
P ru e & R ychtarik, 1983; H unt & A zrin , 1973).
T h u s, p rim ary and se c o n d a ry relap s e -p re v e n tio n a re realistic goals for inpatien t-treated
alcoholics.
3. S om e p ro p o s a ls fo r tra ffic sa fe ty
T h e d rinking re la p se p re c e d e s th e re la p se in d ru n k e n d riv in g and d riv in g w hile im paired
(D W I) p re c e d e s th e driv in g offen ces. T h u s som e p ro p o sals from alcohol re la p se re s e a rc h
c a n b e m ade to im p ro v e p ro g ram s for d ru n k e n driv ing and - p e r h a p s traffic safety.
1. D rin k in g d riv ers and alcoholics stem p ro b a b ly n o t from th e sam e b u t from
d ifferen t populations. T his m ay b e s e e n from th e d iffe re n ce s in re la p s e -rate s. T h e
rela p se -ra te s of d riv e rs w ith se v e ra l d rin k in g and d riv in g o ffen ces a re lo w er th an
the rela p se -ra te s of in p atien t-treated alcoholics. B ut this m ay b e th e re su lt of a
g reat nu m b er of n o t catc h ed d ru n k e n d riv ers.
2. In treatm en t p rogram s fo r d ru n k e n d riv ers th e positive alcohol consum ption
expectations should b e assessed b y ro u tin e, b e c a u s e h ig h e r positive expectatio n s
a re v e r y stro n g p re d ic to rs of re n e w e d alco h o l consum ption. P e rh a p s in a few
y e a rs w e will h a v e p sy ch o m etric instrum ents for th e assessm ent of alcohol
consum ption exp ectatio n s w ith norm s for alcoholics, h e a v y d rin k ers, th e g e n e ra l
pop u latio n and abstinents.
3. Multiple d ru n k e n driv in g o ffe n d ers n e e d additional treatm en t and a steady,
controlled and su p e rv ise d a ftercare.
i T h e social situation of d ru n k e n d riv e rs (e. g. single living, unem ploym ent)
n e e d s special attention.
210
5. For d ru n k e n d riv ers th e re c o v e r y of th eir d riv in g lice n ce should b e limited and
tied o n additional conditions b y b e h a v io u ra l contracts.
6. A stonger co o p e ra tio n b e tw e e n traffic re s e a rc h e rs and clinical p sy c h o lo g y is
n e c e s s a ry for fu rth e r im provm ents of traffic safety in th e field of alcohol and
driving.
4. References
A bott M W & G re g so n R A (1981): C ognitive d y sfu n ctio n in th e p re d ic tio n of re la p se in
alcoholics. Jo u rn a l of Studies o n A lcohol, 42, 230-243 - A hles T A, S chlundt D G, P ru e D M
& R ychtarik R G (1983): Im pact of a fte rc are a rran g em en ts o n th e m ain ten an ce of treatm en t
success in abusive d rin k e rs. A ddictive B eh av io rs, 8, 53-58 - B o rk e n ste in R F (1981):
Problem s of e n fo rc e m e n t In: G o ld b e rg L (ed.): A lcohol, drugs, and traffic safety (p. 239252), Stockholm: Almqvist & W ik sell - B ro w n S A (1985): R ein fo rce m e n t e x p e c ta n c ie s and
alcoholism treatm en t outcom e after a o n e -y e a r follow -up. J o u rn a l of Studies o n A lcohol, 46,
304-308 - B urling T A, R eilly P M, M o ltzen J 0 & Ziff D C (1989): Self-efficacy and re la p se
am ong inpatient d ru g and alcohol ab u sers: A p re d ic to r of outcom e. J o u rn a l of Studies o n
Alcohol, 50, 354-360 - C h a n e y E F, O 'L e a ry M R & M arlatt G A (1978): Skill train in g with
alcoholics. Jo u rn a l of C onsulting and Clinical P sy ch o lo g y , 46, 1092-1104 - C olditz H P (1991):
H an d b u c h für V erk e h rssic h e rh e it. Frankfurt: W D V W irtschafts dienst G esellsch aft für
M ed ien & K om m unikation - C o n n o rs G J, O 'F a r r e llT J & Pelcovits M A (1988): D rin k in g
outcom e ex p ectan cies am ong male alcoholics d u rin g re la p se situations. British Jo u rn a l of
A ddiction, 83, 561-566 - C raig R & D re s D (1989): P red ic tin g D U I recidivism w ith th e M M PI.
A lcoholism T re a tm e n t Q u arterly , 6, 97-103 - D e J o n g -M e y e r R, H e y d e n T , S c h ie re c k H &
Skaletz R (1988): V e rg le ic h rü ck fällig er u n d n ich trü ck fällig er A lk o h o lab h än g ig er.
S u ch tg efah ren , 34, 81-89 - D o n o v a n D M, M arlatt G A & Sal2b e r g P M (1983): D rin k in g
b eh av io r, p erso n ality factors and h ig h -risk driving. A re v ie w and th e o re tic a l form ulation.
Jo u rn a l of Studies o n A lcohol, 44, 395-428 - E ch terh o ff W (1991): V e rk e h rsp sy c h o lo g ie .
Entw icklung, T h e m e n , R esultate. Köln: V e rla g T Ü V R h ein lan d - E rik se n L, B jörnstad S &
G ötestam K G (1986): Social skills train in g in g ro u p s fo r alcoholics: O n e -y e a r treatm en t
outcom e for g ro u p s and individuals. A ddictive B eh av io rs, 11,309-329 - F e u e rle in W (1990):
L a n g zeitv erläu fe des A lkoholism us. In: S ch w o o n D R & K rau sz M (eds.): S u c h tk ra n k e D ie u n g e lie b te n K inder d e r P sychiatrie (p. 69-80), Stuttgart: E n k e - G le n n S & P arso n s 0 A
(1991): P red ictio n of resu m p tio n of d rin k in g in p o sttreatm en t alcoholics. T h e In tern atio n al
Jo u rn a l of th e A ddictions, 26, 237-254 - G ottheil E, T h o rn to n C C, S k o lo d a T E & A lterm an E
I (1982): Follow-up of abstinent and n o n a b stin e n t alcoholics. A m erican Jo u rn a l of Psychiatry,
139, 560-565 - H ein rich H C & P o rs c h e n K M (1988): D ie W irk sam k e it v o n K u rsen für
w ied erh o lt alkoholauffällige K raftfahrer. Z eitschrift fü r V e rk e h rss ic h e rh e it, 34, 129-131 H e n k e l D (1990): A rbeitslosigkeit u n d A lkoholism us. In: S ch w o o n D R & K rau sz M (eds.):
S u ch tk ran k e - D ie u n g e lie b te n K inder d e r P sychiatrie (p. 25-49), Stuttgart: E n k e - H u n t G M
& A z rin N H (1973): A co m m unity-reinforcem ent a p p ro a c h to alcoholism. B eh av io r
R e se a rc h and T h e ra p y , 11, 91-104 - H u n t W A, B arn ett L W & B ra n c h L G (1971): R elap se
rates in addiction program s. J o u rn a l of Clinical P sy ch o lo g y , 27, 455-456 - K aiser H J (1990):
Z ur A u fg ab en ad äq u ath e it v e rk e h rsp sy c h o lo g isc h e r B e g u ta c h tu n g e n alkoholauffälliger
K raftfahrer
P lä d o y e r
für
e in e
b e ra tu n g so rie n tie rte
A u sw eitu n g
d er
211
O bergutachtertätig k eit. In: H öfling S & Butollo W (e d s ): P sy cho lo g ie für M en sc h e n w ü rd e
u n d L ebensqualität, B and 3 (p. 179-192), B onn: D e u tsc h e r P sy c h o lo g e n V e rla g - K ö rk e l J
(1991): D er R ückfall v c n A lk o h o lab h än g ig en . A uf d em W e g e z u ein em n e u e n V erständnis
des Rückfalls. V e rh a lte n sth e ra p ie u n d p sy c h o so z ia le Praxis, 23, 321-337 - K ö rk e l J & L au er
G (1992): D er R ücktall d es A lk o h o iab h än g ig en . E in fü h ru n g in die T h em atik u n d Ü b erb lick
ü b e r d e n For schungs stand. In: K ö rk el J (ed.): D e r R ückfall des S u c h tk ra n k e n - Flucht in die
Sucht? (p. 3-122), B erlin: S p rin g er - K üfner H (1990): D ie Z eit d a n a c h - A lk o h o lk ran k e in
d e r N a c h so rg ep h a se . In: S ch w o o n D R & K rau sz M (eds.): S u ch tk ran k e - D ie u n g e lie b te n
K inder d er Psychiatrie (p. 189-203), Stuttgart: E n k e - K üfner H & F e u e rle in W (1989):
Inpatient treatm en t for alcoholism. A m ulticenter study. B erlin: S p rin g e r - L a u er G (1990):
Prim äre u n d se k u n d ä re R ü ck fallp räv en tio n b e i A lkoholabhängigkeit. P a p e r, p re s e n te d at
the K o n g reß für Klinische P sy ch o lo g ie u n d P sy c h o th e ra p ie , B erlin, 18.-23.2.1990 - L a u e r G
(1991): Alcoholism: Strategies of p rim ary and se c o n d a ry re la p se p re v e n tio n . P ap e r,
p re s e n te d at the 2nd E u ro p e a n C o n g re ss of P sy ch o lo g y , B udapest, 8.-12.7.1991 - L au er G
(1992): In terv en tio n s Studien zu r R ück fallp ro p h y lax e: E rg eb n isse u n d P ro b lem e. In: K ö rk el
J (ed.): D er Rückfall des S u ch tk ra n k e n - Flucht in die Sucht? (p. 217-237), B erlin: S p rin g er L au er G & K örkel J (1993): V o n d e r A b stin en z zum Rückfall: Ü b e r d e n u n au sw e ich lic h e n
P arad ig m en w ech sel in d e r S u chtforschung. P a p e r, p re s e n te d at th e 2nd K o n g reß d e r
N e u e n G esellschaft für P sy ch o lo g ie, B erlin, 14.-17.2.1993 (accep ted ) - L au er G, K ö rk e lJ &
Sohns R (1992): Alcoholism: M odels and em pirical r e suits o n p rim ary and se c o n d a ry re la p se p re v e n tio n . P a p e r, p re s e n te d at th e 22nd C o n g re ss of th e E u ro p e a n A ssociation for
B eh av io u r T h e ra p y , Coim bra, 9 -12.9.1992 - Little G & R o b in so n K (1989): R elationship of
D U I recidivism to m oral reaso n in g , sen satio n seek in g , and M acA n d rew alcoholism scores.
P sychological R eports, 65, 1171-1174 - M arlatt G A & G o rd o n J (eds.) (1985): R elap se
p rev en tio n . M aintenance strategies in th e treatm ent of addictive b e h av io rs. N ew Y ork:
G uilford - Miller P J, Ross S M, E m m erson R Y & T o d t E N (1989): Self-efficacy in
alcoholics: Clinical validation of th e situational c o n fid e n c e q u estio n n aire. A ddictive
B ehaviors, 14, 214-224 - Mittag W , L iebig H, F re u n d A & S c h w a rz e r R (1991):
Selbstaufm erksam keit u n d b e la ste n d e L e b e n se re ig n isse : E ine L ängsschnittstudie z u r
R ückfälligkeit v o n A lk oholikern. Z eitschrift für Klinische P sy ch o lo g ie, 20, 154-165 - N ath an
P E (1983): Failures in p re v e n tio n . W h y w e can't p r e v e n t th e d ev astin g e ffect of alcoholism
and d ru g abuse. A m erican Psychologist, 38, 459-467 - O e i T P S & J a c k s o n P R (1982): Social
skills and cognitive b e h a v io ra l a p p ro a c h e s to th e treatm en t of p ro b le m drinking. J o u rn a l of
Studies o n A lcohol, 43, 532-547 - O sterm an n S (1987): D as R ü c k fa llg e sc h e h e n b e i
A lk o h o le rsttä te rn - F o lg e ru n g e n für die N ach sch ulu n g . B lutalkohol, 24, 11-22 - R ath er B C
& S herm an M F (1989): R elationship b e tw e e n alcohol e x p e c ta n c ie s and le n g th of ab stin en ce
am ong alcoholics anonym ous m em bers. A ddictive B eh av io rs, 14, 531-536 - S te p h a n E (1989):
R ückfallprophylax e
b e i tru n k en h eitsau ffällig en
K raftfah rern :
Zur
n o tw e n d ig e n
B erü ck sich tig u n g d er A lkoholism usforschung. In: W a tz l H & C o h e n R (eds.): R ückfall u n d
R ückfallprophylax e (p. 81-103), B erlin: S p rin g er - S te p h a n E (1990a): L eistu n g sm in d ern d e
Suchtstoffe im S tra ß e n v e rk e h r. B estan d sau fn ah m e u n d einig e S c h lu ß fo lg e ru n g e n für
K ontrolle u n d T h e ra p ie . In: D e u tsch e H auptstelle g e g e n die S u c h tg e fa h re n (ed.): J a h rb u c h
Sucht 1991 (p. 103-114), H am burg: N eu lan d - S tep h a n E (1990b): Ist e in e w issenschaftlich
fu n d ierte F a h re ig n u n g sb e g u ta ch tu n g b e i alkoholauffälligen K raftfah re rn m öglich? In:
H öfling S & Butollo W (eds.): P sy ch o lo g ie fü r M e n sc h e n w ü rd e u n d L ebensqualität, B and 3,
(p. 169-178), B onn: D e u tsc h e r P sy c h o lo g e n V e r la g - W in k le r W , Ja c o b s h a g e n W & N ickel
W R (1988): W irksam keit v o n K u rse n für w ie d e rh o lt alkoholauffällige K raftfah rer. Unfallu n d S ich erh eitsfo rsc h u n g S tra ß e n v e rk e h r, 64
212