Research Update (2000 June): Project MATCH: A Study of Alcoholism Treatment Approaches

2 Pages·2000·0.28 MB·English

by  Butler Center for Research

Au
three treatment approaches
are effective in the treatment
ofalcoholism...
BUTLER CENTR FOR RESEARCH
The Hazelden Experience
UPDATE
The Hazelden Foundation, estabhshecl in
1949, pioneered an approach to alcoholism
treatment that incorporates the philosophy of
Alcoholics Anonymous into the treatment
experience. In order to standardize the
components and delivery of that therapeutic
treatmentmodalityfortheprirposesofProject
MATCH, Hazeldenprovidedexpert consulta NE, 2000
tion in the development of the manual on Project MATCH:
Twelve Step Facilitation TSF))’ Hazelden’s
treatment, in practice, utilizes elements of
A Study of Alcoholism Treatment Approaches
CBT and METapproaches aswell.
Controversies & Questions
Most issues of Research Update discuss between various treatment and p1tie3t
The release of Project MATCH findings current findings from multiple research “matches,” the National Institute on Alcohol
sparked a flurry of methodological and other studies. However, because ofits major contri Abuse and Alcoholism initiated Project
discussions, applause, and criticism. On the butiontotheunderstandingofaddictiontreat— MATCH—MatchingAlcoholismTreatmentto
one hand, the study was criticized for using nient and recovery, this Reseacell Update Client Heterogeneity. Generallyspeaking, the
the Randomized Controlled Clinical Trial focuses exclusively on one study—Project goal was to determinewhat type oftreatment
(RCT) as the basis thr its design rather than MATCH. worked bestwithwhat type ofpatientb’con
testingapredetermined setofmatchingrules. ducting a large—scale, multi—site, statistically
Background and Rationale
On the other hand, Project MATCH was ngorous, randomized, clinical research study,
lauded as a rigorous test of the utility of It was long observed and acknowledged the results of which would have important
patientltreatmentmatching. Ofmostconcern, that no single treatment regimen worked best
implications forclinicalp3ractice.
howevei; has beenthe (langerofmisinterpret forall alcoholicpatients. Manystudies ofalco
ingthe results ofthe stud holism treatment suggested that different Study Design
Question: iso‘t Twelce Step Facilitation the treatment approaches (types oftreatmentand Project MATCH conductedtwo independ
sante asAlcoholicsAnonymons. levels of care) might be more effective than ent treatment inatclnng studies using the
others for certain tYpes of patients) This followingclientgroups:
No. Twelve Step Facilitation is nnt the
same as Alcoholics Anonymous (AA) or a basic notion is b’own as patient matching,’ 1) 952 outpatients at five sites, and
referral to AA. It refers to a therapeutic or findingtile best ts’pe oftreatmentfor apar 2) 774 aftercarepatients at five sites, who had
approachwhereinaseriesofone-to-one ticulartype ofpatient. recentlycompleted an episode ofinpatient
seling sessions occurbetween a therapist aad In order to test that hypothesis and exam— orintensive dayhospital treatment.
patient, that address the basics of alcoholism me the nature and strength of associations
as a chronic, long-term disease. The sessions CONTINUEDON BACKPAGE
also cover the basic philosophy ofAA (partic
All patients were randomly assigned to one ofthree treatment approaches:
ularlv the first five steps). and address the
spirituality compmlent of recovery. The
TYPEOFTREATMENT cIOALOFTREATMENT DESCRIPTION FREQUENCY
patientis encouragedtoparticipateinAA.
CBT Learnskillstoachieve Coping anddrink-refusal 12weeklysessions
How to Use This Information (Cognitive andmaintainsobriety skillstaughtbytherapist
BehavioralTherapy) to handlestatesand
situationsknownto
Clinicians in alcohol treatirientsettingscan
precipitaterelapse
apply these findings regarding angel; psvchi
attic severity alcohol dependence, and social TSF Acceptanceofthe Patientsintroduced 12weeklysessions
supportnetworksfordrinking,in ordertobet (TwelveStep diseaseofalcoholism bytherapisttothefirst
ter assess patients upon entry into treatment. Facilitation) and lossofcontrol stepsofAlcoholics
Clinicians can also examine the manuals, overdrinking Anonymousand encour
agedtoattendmeetings
counselor training, and patient assessment
components dictated by the Project MATCH
MET Mobilizethe person’s Therapistapplies 4sessionsin 12weeks
study as a general approach to treatment that
(Motivational own commitmentand motivational psychology
workswell. Enhancement motivationto change toexamine effectof
Therapy) drinkingon patient’s
life,and develop and
HAZELDEN® implementa planto
stopdrinking
Project MATCH
continued
For both the outpatient and attercare Generally speaking, clients with higher Project MATCH findings is that all three
group, the same randomization techniques, alcoholproblem seventyatintake didbetter treatment approaches are effective in the
data collection instruments, treatment pro at three years follow—up than clients with treatment of alcoholism: TSF, CBT and
tocols. and follow_up procedureswere used. lower seventy Severity was measured 1w MET.’ The fact that fi’w patient-treatment
Patients were enrolled into tile study over a alcohol involvement, alcohol dependence. matches resulted iii modestly improved
two-yearperiod. and pe ofalcoholic). Subsequentanalyses treatment outcmnes suggests that a major
Ten client characteristics examined were alsn revealedthatpatientswith higheranger overhaul is inmwarranted in the manner and
based on the literature: severity of alcohol levels had better outcomes with MET than extent oftreatment triagingbased on client
involvement, cognitive impairment. concep the other two therapies. At months :37—:39 characteristics.
tual level, gendei; meaning seeking, motiva another match appeared: clients who had a ProjectMATCHwas timefIrstscientifically
tion, psychiatric severib social support fi)r socialnerivork thatsupported their drinking rigorous demonstration of tile effectiveness
drinking versus support for abstinence, before they received treatment had better ofTSF, awidespread,butpreviouslyinmtested
sociopath\ and alcoholictvpologv. outcomeswithTSF than MET. This differ approach to alcoholism treatment.
ence is explained, in part, 1w the higher AA
For each treatment approach, a detailed. Finally,contrarytothepopularbeliefthat
written nomualwasdeveloped.Itwasaccom involvementofTSF cients. treatment for alcoholism is not very effec
paniedbytherapisttraining,supervision, and Post treatment Drinking Outcomes tive, Project MATCH found that up to one
certification. Thethree treatmentapproaches halfofpatients were abstinentorhad sigiiif—
Patients in all three treatment groups
were: icantlvreducedtheirdrinkingone andthree
reported significant reductions in drinking
1) Cognitive BehavioralTherapy CBT. during tile one year, post treatment follow— years aftertreatment.’
2) Twelve Step Facilitation TSF’, and imp period. Differences across treatment Further, the reductions iii drinking were
:3) Motivational EnhancementTherapy groups were not significant, although TSF greater for the sample of patients who
(MET). showeda shght advantage.’ enteredProjectMATCH aftercompletionof
a residentialprogram (not simplytreated on
At three ears follow—up, however, a sig—
Study Results an outpatient basis). This raises the possibil—
— nificantlv Inglier abstinence rate was found
Few “Matches” Found itv that a prolonged period of abstinence
with TSF clients. Anmong TSF clients 36%
Outconses were measured in terms of enhances long—term success and brings into
wereabstinent, comparedwith 27C ofMET
percent ofdays abstinent PDD and (lnnks question, accordingto Enoch Gordis, M.D..
and 24 ofCBTclients (p< 0.007).
per drinking day (DDD’. There were no Directorofthe NationalInstituteonAlcohol
significant differences across treatment Implications for the Delivery Abuse and Alcoholism, whether the best
approaches during and after treatment; of Treatment interestsofmanyalcoholicpatientsarebeing
patients in all treatment groups reported Project MATCH remains the largest best served 1w managed—care organizations
considerable reduction in drinking. behavioral intervention trial conducted on replacementofresidentialtreatmentservices
alcoholism to date. The main implication of in favorofoutpatient settings.’
REFERENCES
1. Institute ofMedicine. (1990). Broadeningthe baseoftrealmentfor Group. (1997). Matching alcoholism treatments to client lieterogene—
alcoholproblems. NationalAcadenwPress. Washington, D.C. 2. Del itv: Project MATCH posttreatnient drinking outcomes. Journal of
Boca, Frances K., and Mattson, Margaret E. (1994). Developments in Studies on Alcohol. Vol. 58. 7. Project MATCH Research Group.
alcoholism treatment research: Patient—treatment matching. Alcohol. (1998). Matching alcoholism treatments to client hmeterogenei:
Vol. 11. No. 6. 3. Project MATCH Research Grmup. (1993). Project Project MATCH three year drinking outcomes. Alcoholism: Clinical
MATCH: Rationale and methods foramultisite clinical trialmatching (111(1 Expelilnemlial Research. Vol. 22. No. 6. 8. Longabaugli, Richard,
patients to alcoholism treatment. Alcoholism: Clinical 011(1 W’irtz, Phillip \V, Zwehen, Allen, and Stout, Robert L. (1998).
Experimental Research. Vol. 17. No. 6. 4. Donovan, Dennis M., Network support for drinking, Alcoholics Anonvnmous and long—term
Kadden, Ronald M., DiClemente, Carlo C., Carroll, Kathleen M., matchingeffects. Addiction. Vol. 93. No. 9. 9. Commentaries (1999).
Longabaugh, Richard, Zwehen, Allen, and Rvchtarik, Robert. (1994). Comments on Project MATCH: matching alcohol treatment to client
Issues in the selection and development of therapies in alcoholism heterogeneib Addiction. Vol. 94. No. 1. 10. Carroll, Kathleen M.,
treatment matching research. Journal of Studies on Alcohol. Kadden, Ronald M., Donovan, Dennis M., Z\vehen, Allen, amid
Supplement No. 12. 5. Project MATCH Research Group. (1998). Roimnsaville, BruceJ. (1994). Implementingtreatment and protecting
Matching alcoholism treatments to client heterogeneity: treatment tilevalidityoftheindependentvariablein treatmentmatchingstudies.
main effects and matching effects on drinking during treatment. Journal ofStudies on Alcohol. Supplement No. 12.
Journal ofStudieson Alcohol. Vol. 59. 6. Project MATCH Research
BUTLER CENTER Dedicated tothe advancement of knowledge and understanding of
FOR RESEARCH addiction recovery through research, collaboration, and communication.
Patricia Owen, Ph.D., Director, Butler Centerfor Research, Hazelden Foundation
P.O. Box 11, Center City, MN 55012-0011 • [phone] • www.research.hazelden.org
©2000 Hazelden