Treatment Matching in Alcoholism

Treatment Matching in Alcoholism. Edited by T. F. Babor and F. K. Del Boca. International Research Monographs in the Addictions (IRMA), Cambridge University Press, 2003, 275 pp., indexed, £55. ISBN 0-521-65112-3. Hardback.

The sheer size of this US government-funded project is a well-known fact. The book is dedicated to the 1726 research subjects, 159 research personnel, 81 therapists, and the many others who were involved. It is also widely recognized that Project Match set new standards of methodology for alcoholism treatment research. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) made available protocols for the three treatments, which are now being used around the world.

Despite the Project's fame, for some in the alcoholism treatment world its results are a mystery, misunderstood or myth-reported: ‘Project Match cost millions of dollars ($28 m according to this book) but showed nothing—for example, it was too complex/subjects were so over-selected that they all got better anyhow/the research assessments were so lengthy they obliterated all between-group differences’.

The 26 scientists in the research group elegantly set the record straight in this monograph, bringing together data published in papers in several journals over the past 7 years, as well as some previously unpublished analyses.

The chief aim of MATCH was to discover which of three out-patient treatments (individual not group-based) best helped prevent relapse in which types of alcoholic patients: Motivational Enhancement Therapy (MET), Cognitive Behavioural Therapy (CBT) and Twelve Step Facilitation (TSF). TSF helped the client to link with Alcoholics Anonymous and start attending meetings regularly, assisting the patient to understand the principles of AA. Clients were randomly allocated to one of the three treatments. Each therapist working on the project only conducted his or her usual form of therapy.

Some subjects entered the study on discharge from in-patient treatment (‘Aftercare’), the others as outpatients. More of those who entered at the end of residential treatment sustained complete abstinence for the first 15 months than those entering the study in the outpatient arm (26.7 vs 13.8%). In both arms there was also a decrease in heavy drinking sessions, as shown by average drinks per drinking day. In the Outpatient arm this diminished from 15 to 3 drinks per drinking day.

Three out of the four ‘matching’ effects that emerged were in the Outpatient arm.

  1. The benefit of TSF compared to MET was strongest for those clients who had little support in their community or family to help sustain abstinence.
  2. For clients who were ‘angry’ at the initial assessment, MET was associated with better outcomes than either TSF or CBT (conversely, it was less effective than either for clients who were low on anger).
  3. At least in the first 9 months, TSF was superior to CBT for clients who did not have concomitant psychiatric impairment.
  4. Among Aftercare subjects, CBT was more effective than TSF for clients with relatively low dependence, whereas TSF was more effective in sustaining abstinence than CBT for clients having high dependence.

AA attendance was associated, in all treatment groups, with more abstinence.

Other chapters deal with precious MATCH byproducts. On the inter-relation between outcome measures, we see that drinks per drinking day better predicted absence of problems than per cent days abstinent. However, the authors do not give a rate for those who managed to drink occasionally and completely avoid adverse consequences of drinking throughout the follow-up—the holy grail of ‘return to unproblematic drinking’.

Another chapter deals with motivation, ‘the process of intentional behaviour change’ and therapist variables. The authors speculate on why, even in this large study, more specific effects of these different treatments did not emerge. Although some improvement could be explained by the natural course of alcoholism, where periods of sobriety intervene between periods of problematic drinking, the MATCH data suggest that the quality of the relationship with the therapist, perhaps as much as the therapy method, can also be important. As in some recent cognitive therapy research, the client's assessment of the working alliance (not the therapist's assessment!) predicted outcome: Project Match found that certain ‘outlier’ therapists, more often than by chance, had clients who did poorly. Although MATCH has given succour to many that ‘treatment works’, it is important to be reminded that treatment, wrongly conducted, could sometimes cause harm.

Jonathan Chick





This Article
Extract
FREE Full Text (PDF)
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Request Permissions
Google Scholar
Articles by Chick, J.
PubMed
PubMed Citation
Articles by Chick, J.