Program Planning, Evaluation, and the Problem of Alcoholism ANDREW L. SELIG, MSW, ScD
Program planning and evaluation concepts are applied to the problem of alcoholism prevention and rehabilitation.
Introduction The idea of planning is not new. What is new is the attitude regarding its importance and necessity in program development. Increased competition for smaller amounts of available money has helped to promote planning and evaluation of programs, in order to prove the value of one's efforts. Furthermore, the public is less likely to continue supporting publicly financed programs if there is no accountability for results. The successful application of planning and evaluation procedures by various agencies, including government ones, has increased expectations that those in applied behavioral sciences should also be more aware of planning and evaluation. Eight different steps or functions can be delineated in the planning process, and each can be thought of as the primary responsibility of different levels in the organization.* These are: (1) value orientation, (2) problem identification, (3) goal setting, (4) goal-measuring criteria, (5) program planning, (6) program implementation, (7) assessment, and (8) feedback. The three levels of structure in a system can be conceptualized as (1) strategic, (2) management, and (3) operational. In this paper, we shall consider this planning and evaluative system as it relates to the prevention of Dr. Selig is Assistant Professor of Psychiatry and Social Work at the University of British Columbia, Vancouver. At the time data were collected, the author was a Consultant to the Massachusetts Department of Mental Health, Region III. * The framework is a synthesis of ideas from two sources: Evluation Research, ' which outlines the process of planning and evaluation, and Planning and Control Systems,2 which outlines a conceptual framework of three levels of planning and control systems. 72
AJPH JANUARY, 1975, Vol. 65, No. 1
alcoholism and the problem of providing services for alcoholics.
The Conceptual Framework Value orientation refers to making explicit the assumptions which are basic to the program. The view of alcoholism as a multifactor problem, a psychosocial or interpersonal and sometimes medical problem with which behavioral scientists as well as medical professionals should be concerned, is a value orientation. Others might plan very differently if they believed alcoholism to be only a medical problem and a disease. Theories of etiology of alcoholism include physiological, psychological, and sociocultural theories.9 Vitamin deficiencies and hormone imbalances have been suggested as causative,' although these theories do not have strong support at present. Our best generalization about the causes of alcoholism is that they are many and are probably made up of interrelating factors. But there is no doubt that whatever its etiology, once an individual develops alcoholism, he has an interpersonal problem. Problem identification refers to the process of diagnosis-determining the extent of the problem, its history, attitudes and beliefs about it, its function in the system, what is currently being done about it, and finally, what needs to be done. The complex problem of preventing alcoholism and providing services and rehabilitation for alcoholics is only now being recognized by any sizable number of people. For years a few dedicated people, professionals and others, have provided services and tried to gain public and private support. Alcoholics Anonymous, a self-help organization, 0
arose to meet some of the needs not being met by professionals. The alcoholic has historically been neglected by formal treatment agencies. He is still denied admission to some hospitals, and many professionals are both ignorant of and resistant to an alcoholic's problems, their impact on society, and the tremendous needs for preventive and rehabilitative programs.' 1 The magnitude of the problem and characteristics associated with it are shown by epidemiological surveys. Although the prevalence figures vary according to the criteria, approximately 5 to 10 per cent of our population have a problem in controlling their use of alcohol.5' 6, 1 2 Most alcoholics have some family or close friends, so there are three to four additional persons in each instance influencing or being influenced by the problem.' 3-16 Alcohol was associated with 50 per cent of the 49,000 fatal traffic accidents in 1965, and The National Council of Alcoholism estimates that the cost of alcoholism to industry is $2 billion per year.' 7, 18 In 1965 about 45 per cent of all arrests in the United States were for offenses involving drunkenness.' 9 The processes of goal setting, establishing explicit goals for the program should break these down into such subgoals as immediate, internediate, and long range goals. Estimations of the time needed to accomplish each level should be made and the goals at each level integrated together, so that step-by-step accomplishment of each will lead to the next. For example, reducing the prevalence of alcoholism would be an appropriate long range goal. Once goals have been made explicit and ranked in terms of temporal priority, some criteria must be developed to measure the extent of attainment. Using the goal stated above, a measurement criterion might be reduction of alcoholism prevalence in a defined area by 2 per cent in 5 years. The next step involves choosing among alternative programs the one which is most likely to reach the determined goals. To reduce the prevalence of alcoholism in a community, we need to consider not only treatment and rehabilitation, but also preventive programs. We have to design programs to reach the many persons and families currently needing help but not receiving it. Once a program has been established, it needs to be
implemented. Implementation is separated as a function, since it involves skills and knowledge different from the function of program selection. After the program is implemented and has existed for the predetermined time, assessment follows, based on the goals and their measuring criteria outlined earlier. The final stage is that of feedback of information learned from the evaluation back into the planning process. Programs must continually adapt to their environments in order to survive, and part of their environment includes the goals and criteria that were specified initially. Each of the stages just outlined can, in general terns, be thought of as involving different actors and taking place at different hierarchical levels in the organization. The first of these is the strategic level, represented by leadership at the top of the organization, where responsibility for long
range goal setting and acquisition of resources to meet those goals is lodged. Strategic level planning also has primary responsibility for policy used in obtaining and allocating resources. The management level of an organization represents the process whereby managers see that resources are obtained and used efficiently and effectively in the accomplishment of the goals. Management level actors have primary responsibility for implementing the problem identification, criteria selection, program planning, and assessment functions. Operational control is the process of seeing that specific tasks are accomplished efficiently and effectively. The emphasis here is on particular tasks; some of the program planning and program implementation are also responsibilities at this level. To recap briefly: alcoholism is a major social and family problem and one that needs continued and increased attention. This will not be done effectively, however, until program development (including planning and evaluation) is more widely applied to the problem.
Case Study We have gathered selected data, which can be used as a first approximation in planning. The kind of data gathered represents that which is used by many professionals in their effort to build a viable program. This case study, while providing some facts and leads, is still missing information. Some of the missing but needed information can be described by comparing the case study to the conceptual framework. This will be done in the final section. The purpose of this data gathering was to begin the process of problem identification in the area of alcoholism for one geographic mental health area in Massachusetts. The setting was an inpatient ward for alcoholics located in a state mental hospital. This ward is the only inpatient service for alcoholics in its catchment area. Two sets of data were obtained. All consecutive admissions to the ward during a 6-month period, January 1 to July 1, 1970, made up one sample; data were gathered from statistical records maintained by the hospital. The second sample consisted of all admissions to the ward during 1 month, August, 1971. Each respondent was interviewed, and data were recorded on a semistructured questionnaire. The infornation gathered in the first sample consisted of selected demographic variables, while the second interview sample gathered information on both demographic and social variables. Of the three communities' served, one community accounts for most of the admissions, both absolutely and as a percentage of the population. Over all three communities, the divorced, widowed, and separated are overrepresented in the patient group compared to the population. Middleaged persons (35 to 54) have higher rates of admission than other age groups, and more males than females are hospitalized, the ratio being about 4:1. The second sample (N = 27) of all persons admitted to PROGRAM PLANNING: ALCOHOLISM 73
the ward during the month of August, 1971, yields social as well as demographic data. The trend is again to the middle-aged, divorced male. Two-thirds of patients had less than a high school education; the patients were quite mobile, with one-half changing their address at least once in the previous 2 years, and 40 per cent of these changing their residence over three times. This mobility occurred primarily in persons not married (divorced, separated, single, or widowed). The patients appeared to be socially isolated. One-half said they had no person to whom they could turn for help, and 79 per cent had less than monthly contact with any organization. Of the 60 per cent who had children, one-third saw their children only once or less in 6 months. Most patients (79 per cent) were Catholic, but only one-quarter of these attended church once a month or oftener. Their occupations tended to be semiskilled, and over one-half either had not worked in the past 2 years or had two or more jobs in the same time period. Financial constraints are obviously crucial in planning and providing services. Seventy per cent did, however, have some form of third-party insurance.
would be based on limited infonnation. Nevertheless some examples of goals, based on the data, can be mentioned. A significant trend in the case study is that persons separated, widowed, and divorced were overrepresented in the hospitalized group. The divorced, especially, appear to be at the highest risk of being hospitalized for alcoholism. Although which comes first, the drinking or the divorce, is unclear, a recent study suggests that divorce and separation seem to be crises that precede psychiatric difficulties.20 Preventing and decreasing the possible negative consequences of divorce and separation, such as depression, anxiety, and confusion, which may lead to eventual problems with alcohol, is an example of an intermediate range goal. A long range goal might be that of early identification through places of employment, unions, or children having problems in school (stemming from family problems related to alcohol), and appropriate interventions in the family system, prior to the necessity of divorce or separation.
Goal Measuring
The Case Study Applied to the Conceptual Framework
Decreasing abuse of alcohol in 60 per cent of persons identified through the place of employment, in 1 year, is an example of goal-measuring criteria.
Value Orientation
Program Planning
The data gathered suggest a sociocultural orientation; however this needs further verification. The value orientations are basically important to any program, since they help set the context in which the entire planning process and program take place. For example, how do the strategic level administrators view the problem? Do the physicians, at the operational level, think alcoholism is only a medical problem?
Rehabilitation and employment counselors, along with local businessmen's organizations, places of employment, unions, and schools need to be part of the program. Increasing community care services to deal with families in crisis is indicated; perhaps intervention by clergy, welfare workers, and school personnel would help prevent some basic family problems. The case study does not provide enough information to give examples of implementation, assessment, and feedback. These functions could be delineated with information about the perception, needs, knowledge, and skills of the varied consumers to the program. Fitting the proposed program into the existing structure, using local citizens and professionals in the planning, and meeting felt needs are general principles used to implement a program.
Problem Identification The case study gathered data on selected social and demographic factors of treated patients. This information fulfills only part of the problem identification function. These data do reveal something about who is presently utilizing existing services. They do not reveal the actual number of persons and families in the community who need help. They do not tell us how the problems are defined and perceived by other consumers, such as families, hospitals, social agencies, welfare departments, community
organizations, etc. The reasons that a person is admitted to the alcoholism ward are multiple. Although the attitudes influencing the decisions and pathways into the hospital were not the immediate concern, in the case study, they must be dealt with in the planning of any program. Goal Setting Since the case study needs expansion to more validly define the problem, any further planning is limited, since it 74
AJPH JANUARY, 1975, Vol. 65, No. 1
Summary Rational program planning and evaluation has been suggested as a necessary skill. First, a conceptual framework for planning and evaluation was presented and discussed, using the example of preventing alcoholism and providing services and rehabilitation for alcoholics. Second, a case study was presented, which is similar to that used by many professionals in their efforts to plan programs. Finally, some of the marked limitations of the case study were pointed out, when it was projected upon the
conceptual framework.
ACKNOWLEDGMENTS The author expresses his appreciation to Margo Brown, AB, and Ellen Wise Selig, MEd, for their editorial assistance,; to Arnold Abrams, MD, for making the case study possible; and to Robert C. Benfari, PhD, for his theoretical suggestions.
10. 11. 12.
References
13.
1. Suchman, E. A. Evaluative Research. Russell Sage Foundation, New York, 1967. 2. Anthony, R. N. Planning and Control Systems, A Framework for Analysis. Harvard University, Boston, 1965. 3. Menninger, K. A. Man Against Himself. Harcourt Brace, New York, 1938. 4. Chafetz, M. E., and Demone, H. W., Jr. Alcoholism and Society, pp. 39-52. Oxford University Press, New York, 1962. 5. Leighton, D. C., Harding, J. S., Macklin, D., MacMillan, A., and Leighton, A. The Character of Danger. Basic Books, New York, 1963. 6. Bailey, M. B., Haberman, P. W., and Alksene, H. The Epidemiology of Alcoholism in an Urban Residential Area. Q. J. Stud. Alcohol 26:19-40, 1965. 7. Bailey, M. B., Haberman, P. W., and Sheinberg, J. Identifying Alcoholics in Population Surveys; A Report on Reliability. Q. J. Stud. Alcohol 27:300-315, 1966. 8. Bales, F. F. Cultural Differences in Rates of Alcoholism. Q. J. Stud. Alcohol 6:482-498, 1946. 9. Horton, D. The Functions of Alcohol in Primitive
14. 15.
16. 17.
18. 19. 20.
Societies: A Cross-Cultural Study. Q. J. Stud. Alcohol 4:199-320, 1943. Williams, R. J. Alcoholism: The Nutritional Approach. University of Texas Press, Austin, 1959. Knox, W. J. Attitudes of Psychiatrists and Psychologists toward Alcoholism. Am. J. Psychiatry 127:16751679, 1971. Keller, M. The Definition of Alcoholism and the Estimation of Its Prevalance. In Society, Culture and Drinking Patterns, edited by Pittman, D. J., and Snyder, C. R. Wiley, New York, 1962. Saenger, G., and Gerard, D. A Follow-up Study of Patients Seen in Out-patient Clinics Associated with the North American Association of Alcoholism Programs. Presented at the Annual Meeting of the NAAAP, Miami, October 30, 1963. Block, M. A. Alcoholism: Its Facets and Phases. John Day, New York, 1966. Plant, T. F. A. Alcohol Problems, A Report to the Nation by the Cooperative Commission on the Study of Alcoholism. Oxford University Press, New York, 1967. Williams, A. F. Epidemiology and Ecology of Alcoholism. Int. Psychiatry Clin. 3:17-49, 1966. National Clearinghouse for Mental Health Information. Alcohol and Alcoholism, Public Health Service Publication No. 1640. U.S. Government Printing Office, Washington, DC, 1967. Presnall, L. F. Business Week, September 21, 1963. U.S. Federal Bureau of Investigation. Uniform Crime Reports for the United States-1965. U.S. Department of Justice, Washington, DC, 1966. Smith, W. G. Critical Life-Events and Prevention Strategies in Mental Health. Arch. Gen. Psychiatry 25:103-109, 1971.
ASSOCIATION OF PLANNED PARENTHOOD PHYSICIANS TO MEET APRIL 17-18, 1975 The Thirteenth Annual Scientific Meeting of the Association of Planned Parenthood Physicians will be held at the Century Plaza Hotel, Los Angeles, CA, April 17-18, 1975. The meeting will feature the latest advances in family planning including abortion, surgical contraception, and human sexuality. Abstracts, 1/2 to 1-1/2 pages in length, are invited. On April 16, preceding the major clinical program, five postgraduate courses will be offered. The courses will include: Male and Female Infertility, Scientific Update on Contraception, Human Sexuality Counseling, Research and Clinical Aspects of Male Reproduction, and Endoscopic Techniques-Diagnostic and Therapeutic. Inquiries should be directed to: Joseph E. Davis, MD, Program Chairman, Association of Planned Parenthood Physicians, 810 Seventh Ave., New York, NY 10019.
PROGRAM PLANNING: ALCOHOLISM
75
Program planning and evaluation concepts are applied to the problem of alcoholism prevention and rehabilitation.
Introduction The idea of planning is not new. What is new is the attitude regarding its importance and necessity in program development. Increased competition for smaller amounts of available money has helped to promote planning and evaluation of programs, in order to prove the value of one's efforts. Furthermore, the public is less likely to continue supporting publicly financed programs if there is no accountability for results. The successful application of planning and evaluation procedures by various agencies, including government ones, has increased expectations that those in applied behavioral sciences should also be more aware of planning and evaluation. Eight different steps or functions can be delineated in the planning process, and each can be thought of as the primary responsibility of different levels in the organization.* These are: (1) value orientation, (2) problem identification, (3) goal setting, (4) goal-measuring criteria, (5) program planning, (6) program implementation, (7) assessment, and (8) feedback. The three levels of structure in a system can be conceptualized as (1) strategic, (2) management, and (3) operational. In this paper, we shall consider this planning and evaluative system as it relates to the prevention of Dr. Selig is Assistant Professor of Psychiatry and Social Work at the University of British Columbia, Vancouver. At the time data were collected, the author was a Consultant to the Massachusetts Department of Mental Health, Region III. * The framework is a synthesis of ideas from two sources: Evluation Research, ' which outlines the process of planning and evaluation, and Planning and Control Systems,2 which outlines a conceptual framework of three levels of planning and control systems. 72
AJPH JANUARY, 1975, Vol. 65, No. 1
alcoholism and the problem of providing services for alcoholics.
The Conceptual Framework Value orientation refers to making explicit the assumptions which are basic to the program. The view of alcoholism as a multifactor problem, a psychosocial or interpersonal and sometimes medical problem with which behavioral scientists as well as medical professionals should be concerned, is a value orientation. Others might plan very differently if they believed alcoholism to be only a medical problem and a disease. Theories of etiology of alcoholism include physiological, psychological, and sociocultural theories.9 Vitamin deficiencies and hormone imbalances have been suggested as causative,' although these theories do not have strong support at present. Our best generalization about the causes of alcoholism is that they are many and are probably made up of interrelating factors. But there is no doubt that whatever its etiology, once an individual develops alcoholism, he has an interpersonal problem. Problem identification refers to the process of diagnosis-determining the extent of the problem, its history, attitudes and beliefs about it, its function in the system, what is currently being done about it, and finally, what needs to be done. The complex problem of preventing alcoholism and providing services and rehabilitation for alcoholics is only now being recognized by any sizable number of people. For years a few dedicated people, professionals and others, have provided services and tried to gain public and private support. Alcoholics Anonymous, a self-help organization, 0
arose to meet some of the needs not being met by professionals. The alcoholic has historically been neglected by formal treatment agencies. He is still denied admission to some hospitals, and many professionals are both ignorant of and resistant to an alcoholic's problems, their impact on society, and the tremendous needs for preventive and rehabilitative programs.' 1 The magnitude of the problem and characteristics associated with it are shown by epidemiological surveys. Although the prevalence figures vary according to the criteria, approximately 5 to 10 per cent of our population have a problem in controlling their use of alcohol.5' 6, 1 2 Most alcoholics have some family or close friends, so there are three to four additional persons in each instance influencing or being influenced by the problem.' 3-16 Alcohol was associated with 50 per cent of the 49,000 fatal traffic accidents in 1965, and The National Council of Alcoholism estimates that the cost of alcoholism to industry is $2 billion per year.' 7, 18 In 1965 about 45 per cent of all arrests in the United States were for offenses involving drunkenness.' 9 The processes of goal setting, establishing explicit goals for the program should break these down into such subgoals as immediate, internediate, and long range goals. Estimations of the time needed to accomplish each level should be made and the goals at each level integrated together, so that step-by-step accomplishment of each will lead to the next. For example, reducing the prevalence of alcoholism would be an appropriate long range goal. Once goals have been made explicit and ranked in terms of temporal priority, some criteria must be developed to measure the extent of attainment. Using the goal stated above, a measurement criterion might be reduction of alcoholism prevalence in a defined area by 2 per cent in 5 years. The next step involves choosing among alternative programs the one which is most likely to reach the determined goals. To reduce the prevalence of alcoholism in a community, we need to consider not only treatment and rehabilitation, but also preventive programs. We have to design programs to reach the many persons and families currently needing help but not receiving it. Once a program has been established, it needs to be
implemented. Implementation is separated as a function, since it involves skills and knowledge different from the function of program selection. After the program is implemented and has existed for the predetermined time, assessment follows, based on the goals and their measuring criteria outlined earlier. The final stage is that of feedback of information learned from the evaluation back into the planning process. Programs must continually adapt to their environments in order to survive, and part of their environment includes the goals and criteria that were specified initially. Each of the stages just outlined can, in general terns, be thought of as involving different actors and taking place at different hierarchical levels in the organization. The first of these is the strategic level, represented by leadership at the top of the organization, where responsibility for long
range goal setting and acquisition of resources to meet those goals is lodged. Strategic level planning also has primary responsibility for policy used in obtaining and allocating resources. The management level of an organization represents the process whereby managers see that resources are obtained and used efficiently and effectively in the accomplishment of the goals. Management level actors have primary responsibility for implementing the problem identification, criteria selection, program planning, and assessment functions. Operational control is the process of seeing that specific tasks are accomplished efficiently and effectively. The emphasis here is on particular tasks; some of the program planning and program implementation are also responsibilities at this level. To recap briefly: alcoholism is a major social and family problem and one that needs continued and increased attention. This will not be done effectively, however, until program development (including planning and evaluation) is more widely applied to the problem.
Case Study We have gathered selected data, which can be used as a first approximation in planning. The kind of data gathered represents that which is used by many professionals in their effort to build a viable program. This case study, while providing some facts and leads, is still missing information. Some of the missing but needed information can be described by comparing the case study to the conceptual framework. This will be done in the final section. The purpose of this data gathering was to begin the process of problem identification in the area of alcoholism for one geographic mental health area in Massachusetts. The setting was an inpatient ward for alcoholics located in a state mental hospital. This ward is the only inpatient service for alcoholics in its catchment area. Two sets of data were obtained. All consecutive admissions to the ward during a 6-month period, January 1 to July 1, 1970, made up one sample; data were gathered from statistical records maintained by the hospital. The second sample consisted of all admissions to the ward during 1 month, August, 1971. Each respondent was interviewed, and data were recorded on a semistructured questionnaire. The infornation gathered in the first sample consisted of selected demographic variables, while the second interview sample gathered information on both demographic and social variables. Of the three communities' served, one community accounts for most of the admissions, both absolutely and as a percentage of the population. Over all three communities, the divorced, widowed, and separated are overrepresented in the patient group compared to the population. Middleaged persons (35 to 54) have higher rates of admission than other age groups, and more males than females are hospitalized, the ratio being about 4:1. The second sample (N = 27) of all persons admitted to PROGRAM PLANNING: ALCOHOLISM 73
the ward during the month of August, 1971, yields social as well as demographic data. The trend is again to the middle-aged, divorced male. Two-thirds of patients had less than a high school education; the patients were quite mobile, with one-half changing their address at least once in the previous 2 years, and 40 per cent of these changing their residence over three times. This mobility occurred primarily in persons not married (divorced, separated, single, or widowed). The patients appeared to be socially isolated. One-half said they had no person to whom they could turn for help, and 79 per cent had less than monthly contact with any organization. Of the 60 per cent who had children, one-third saw their children only once or less in 6 months. Most patients (79 per cent) were Catholic, but only one-quarter of these attended church once a month or oftener. Their occupations tended to be semiskilled, and over one-half either had not worked in the past 2 years or had two or more jobs in the same time period. Financial constraints are obviously crucial in planning and providing services. Seventy per cent did, however, have some form of third-party insurance.
would be based on limited infonnation. Nevertheless some examples of goals, based on the data, can be mentioned. A significant trend in the case study is that persons separated, widowed, and divorced were overrepresented in the hospitalized group. The divorced, especially, appear to be at the highest risk of being hospitalized for alcoholism. Although which comes first, the drinking or the divorce, is unclear, a recent study suggests that divorce and separation seem to be crises that precede psychiatric difficulties.20 Preventing and decreasing the possible negative consequences of divorce and separation, such as depression, anxiety, and confusion, which may lead to eventual problems with alcohol, is an example of an intermediate range goal. A long range goal might be that of early identification through places of employment, unions, or children having problems in school (stemming from family problems related to alcohol), and appropriate interventions in the family system, prior to the necessity of divorce or separation.
Goal Measuring
The Case Study Applied to the Conceptual Framework
Decreasing abuse of alcohol in 60 per cent of persons identified through the place of employment, in 1 year, is an example of goal-measuring criteria.
Value Orientation
Program Planning
The data gathered suggest a sociocultural orientation; however this needs further verification. The value orientations are basically important to any program, since they help set the context in which the entire planning process and program take place. For example, how do the strategic level administrators view the problem? Do the physicians, at the operational level, think alcoholism is only a medical problem?
Rehabilitation and employment counselors, along with local businessmen's organizations, places of employment, unions, and schools need to be part of the program. Increasing community care services to deal with families in crisis is indicated; perhaps intervention by clergy, welfare workers, and school personnel would help prevent some basic family problems. The case study does not provide enough information to give examples of implementation, assessment, and feedback. These functions could be delineated with information about the perception, needs, knowledge, and skills of the varied consumers to the program. Fitting the proposed program into the existing structure, using local citizens and professionals in the planning, and meeting felt needs are general principles used to implement a program.
Problem Identification The case study gathered data on selected social and demographic factors of treated patients. This information fulfills only part of the problem identification function. These data do reveal something about who is presently utilizing existing services. They do not reveal the actual number of persons and families in the community who need help. They do not tell us how the problems are defined and perceived by other consumers, such as families, hospitals, social agencies, welfare departments, community
organizations, etc. The reasons that a person is admitted to the alcoholism ward are multiple. Although the attitudes influencing the decisions and pathways into the hospital were not the immediate concern, in the case study, they must be dealt with in the planning of any program. Goal Setting Since the case study needs expansion to more validly define the problem, any further planning is limited, since it 74
AJPH JANUARY, 1975, Vol. 65, No. 1
Summary Rational program planning and evaluation has been suggested as a necessary skill. First, a conceptual framework for planning and evaluation was presented and discussed, using the example of preventing alcoholism and providing services and rehabilitation for alcoholics. Second, a case study was presented, which is similar to that used by many professionals in their efforts to plan programs. Finally, some of the marked limitations of the case study were pointed out, when it was projected upon the
conceptual framework.
ACKNOWLEDGMENTS The author expresses his appreciation to Margo Brown, AB, and Ellen Wise Selig, MEd, for their editorial assistance,; to Arnold Abrams, MD, for making the case study possible; and to Robert C. Benfari, PhD, for his theoretical suggestions.
10. 11. 12.
References
13.
1. Suchman, E. A. Evaluative Research. Russell Sage Foundation, New York, 1967. 2. Anthony, R. N. Planning and Control Systems, A Framework for Analysis. Harvard University, Boston, 1965. 3. Menninger, K. A. Man Against Himself. Harcourt Brace, New York, 1938. 4. Chafetz, M. E., and Demone, H. W., Jr. Alcoholism and Society, pp. 39-52. Oxford University Press, New York, 1962. 5. Leighton, D. C., Harding, J. S., Macklin, D., MacMillan, A., and Leighton, A. The Character of Danger. Basic Books, New York, 1963. 6. Bailey, M. B., Haberman, P. W., and Alksene, H. The Epidemiology of Alcoholism in an Urban Residential Area. Q. J. Stud. Alcohol 26:19-40, 1965. 7. Bailey, M. B., Haberman, P. W., and Sheinberg, J. Identifying Alcoholics in Population Surveys; A Report on Reliability. Q. J. Stud. Alcohol 27:300-315, 1966. 8. Bales, F. F. Cultural Differences in Rates of Alcoholism. Q. J. Stud. Alcohol 6:482-498, 1946. 9. Horton, D. The Functions of Alcohol in Primitive
14. 15.
16. 17.
18. 19. 20.
Societies: A Cross-Cultural Study. Q. J. Stud. Alcohol 4:199-320, 1943. Williams, R. J. Alcoholism: The Nutritional Approach. University of Texas Press, Austin, 1959. Knox, W. J. Attitudes of Psychiatrists and Psychologists toward Alcoholism. Am. J. Psychiatry 127:16751679, 1971. Keller, M. The Definition of Alcoholism and the Estimation of Its Prevalance. In Society, Culture and Drinking Patterns, edited by Pittman, D. J., and Snyder, C. R. Wiley, New York, 1962. Saenger, G., and Gerard, D. A Follow-up Study of Patients Seen in Out-patient Clinics Associated with the North American Association of Alcoholism Programs. Presented at the Annual Meeting of the NAAAP, Miami, October 30, 1963. Block, M. A. Alcoholism: Its Facets and Phases. John Day, New York, 1966. Plant, T. F. A. Alcohol Problems, A Report to the Nation by the Cooperative Commission on the Study of Alcoholism. Oxford University Press, New York, 1967. Williams, A. F. Epidemiology and Ecology of Alcoholism. Int. Psychiatry Clin. 3:17-49, 1966. National Clearinghouse for Mental Health Information. Alcohol and Alcoholism, Public Health Service Publication No. 1640. U.S. Government Printing Office, Washington, DC, 1967. Presnall, L. F. Business Week, September 21, 1963. U.S. Federal Bureau of Investigation. Uniform Crime Reports for the United States-1965. U.S. Department of Justice, Washington, DC, 1966. Smith, W. G. Critical Life-Events and Prevention Strategies in Mental Health. Arch. Gen. Psychiatry 25:103-109, 1971.
ASSOCIATION OF PLANNED PARENTHOOD PHYSICIANS TO MEET APRIL 17-18, 1975 The Thirteenth Annual Scientific Meeting of the Association of Planned Parenthood Physicians will be held at the Century Plaza Hotel, Los Angeles, CA, April 17-18, 1975. The meeting will feature the latest advances in family planning including abortion, surgical contraception, and human sexuality. Abstracts, 1/2 to 1-1/2 pages in length, are invited. On April 16, preceding the major clinical program, five postgraduate courses will be offered. The courses will include: Male and Female Infertility, Scientific Update on Contraception, Human Sexuality Counseling, Research and Clinical Aspects of Male Reproduction, and Endoscopic Techniques-Diagnostic and Therapeutic. Inquiries should be directed to: Joseph E. Davis, MD, Program Chairman, Association of Planned Parenthood Physicians, 810 Seventh Ave., New York, NY 10019.
PROGRAM PLANNING: ALCOHOLISM
75
