Recent developments in alcoholism:behavioral treatment.

Behavioral approaches have made significant contributions to understanding the etiology and treatment of alcohol dependence. The present chapter provides a brief overview of changes that have occurred within this perspective over the past decade. Significant changes at a theoretical level have included a move toward mediational cognitive-behavioral models of etiology and maintenance, integrative multivariate models, and an empirical, developmental model based on the natural history of the drinking and alcohol problems. Significant changes in clinical practice have included an expanded role of assessment within the context of a biopsychosocial model of alcoholism, an increased focus on secondary prevention and brief intervention with less-alcohol-impaired individuals, a focus on "harm reduction" as a goal of such interventions, the development of a stepped-care approach to treatment with a reliance on patient-treatment matching, an increased emphasis on the maintenance of therapeutic gain and relapse prevention, and the incorporation of behavioral and cognitive principles into self-help programs.