of alcohol abuse and alcohol dependence (alcohol-
ism) high priorities.
Over the years, many treatment approaches
have been applied to problem drinkers; most of
these treatments preach total abstinence. These
have ranged from medical treatments and medica-
tions such as disulfiram (Antabuse) and naltrexone
to traditional psychotherapy and group supportive
strategies such as Alcoholics Anonymous. However,
alcoholism is a problem that has been extremely
resistant to virtually all intervention, and the relapse
rate is high.
Another, more controversial, approach to the
treatment of alcohol problems iscontrolled drinking
(Sobell & Sobell, 1978). As the name implies, this
approach has as its goal light to moderate (but con-
trolled) drinking. Clients are taught to develop alter-
native coping responses (other than drinking) and to
closely monitor alcohol intake. The field is divided as
to the merits of this approach, but research does sug-
gest that controlled drinking is a viable treatment
option for some alcoholics (U.S. Department of
Health and Human Services, 2000). Many alcohol
treatment programs also incorporaterelapse prevention
training (Marlatt & Gordon, 1985). The majority of
clients treated for alcohol problems have a relapse
episode soon after treatment is terminated. Rather
than see this as a failure (a sign that total relapse is
imminent), clients are taught coping skills and beha-
viors they can use in“high-risk”situations to make
total relapse less likely.
Alcohol abuse and dependence are complex
problems that will probably require multimodal
treatment strategies. Because of the difficulties
with secondary and tertiary approaches to treat-
ment or prevention, more and more professionals
have turned to primary prevention to forestall
the development of problem drinking. For both
drinking and drug abuse, programs similar to
those designed to prevent adolescents from smok-
ingexist.Often,theseprogramsareimplemented
throughhealtheducationcoursesinhighschool
or media campaigns. School-based prevention
programs typically involve one or more of the fol-
lowing components: affective education (build
self-esteem, increase decision-making skills); life
skills (communication skills, assertiveness training);
resistance training (learn to resist pressures to drink
alcohol); and correction of erroneous perceptions
about peer norms (Foxcroft & Tsertsvadze, 2011).
Overall, the effectiveness of these programs varies
greatly, and at the most only about half of the
major studies of these programs show significant
effects beyond what is seen from a standard school
curriculum on alcohol and its effects (Foxcroft &
Tsertsvadze, 2011).Obesity
Behavioral treatments for obesity have been more
common than for any other condition. One rea-
son for this emphasis is that obesity is associated
with such medical disorders as diabetes, hyperten-
sion, cardiovascular disease, and certain cancers
(Brannon & Feist, 2010). It is also a socially stig-
matizing condition that impairs the self-concept
and inhibits functioning in a wide array of social
settings. It is estimated that over 62% of adults in
the United States are overweight (and 27% meet
criteria for obesity—a body mass index of 30 or
greater; Pleis et al., 2010). Often, problems of
weight can be traced to childhood: 20% of all
children are obese (National Center for Health
Statistics, 2011), and 80% of these individuals
become obese adults.
Although it is clear that obesity has a genetic
component (Wadden, Brownell, & Foster, 2002),
causes of obesity undoubtedly represent complex
interactions among biological, social, and behav-
ioral factors, and exact mechanisms are difficult to
pin down. The increased prevalence of obesity
appears to be more a function of changes in our
eating habits and activity levels than in our gene
pool (Wadden et al., 2002). Traditional medical
and dietary methods of treatment have not been
very effective; obese individuals lose weight but
then quickly regain it. Furthermore, the dropout
rate may be high in traditional weight-control pro-
grams. Most behavior modification programs
include components aimed at restricting certainHEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 501