Project Match: A Study of Alcoholism Treatment Approaches

Research Update

The following is a Research Update excerpt from the Butler Center for Research. Download the PDF to read the entire Update.

Most issues of Research Update discuss current findings from multiple research studies. However, because of its major contribution to the understanding of addiction treatment and recovery, this Research Update focuses exclusively on one study—Project MATCH.

Background and Rationale

It was long observed and acknowledged that no single treatment regimen worked best for all alcoholic patients. Many studies of alcoholism treatment suggested that different treatment approaches (types of treatment and levels of care) might be more effective than others for certain types of patients.1,2 This basic notion is known as "patient matching," or finding the best type of treatment for a particular type of patient.

In order to test that hypothesis and examine the nature and strength of associations between various treatment and patient "matches," the National Institute on Alcohol Abuse and Alcoholism initiated Project MATCH—Matching Alcoholism Treatment to Client Heterogeneity. Generally speaking, the goal was to determine what type of treatment worked best with what type of patient by conducting a large-scale, multi-site, statistically rigorous, randomized, clinical research study, the results of which would have important implications for clinical practice.3

Study Design

Project MATCH conducted two independent treatment matching studies using the following client groups:

1. 952 outpatients at five sites, and

2. 774 aftercare patients at five sites, who had recently completed an episode of inpatient or intensive day hospital treatment.

For both the outpatient and aftercare group, the same randomization techniques, data collection instruments, treatment protocols, and follow-up procedures were used. Patients were enrolled into the study over a two-year period.

Table describing three different Alcoholism Treatment Approaches 

Ten client characteristics examined were based on the literature: severity of alcohol involvement, cognitive impairment, conceptual level, gender, meaning seeking, motivation, psychiatric severity, social support for drinking versus support for abstinence, sociopathy, and alcoholic typology.

For each treatment approach, a detailed, written manual was developed. It was accompanied by therapist training, supervision, and certification. The three treatment approaches were:

1. Cognitive Behavioral Therapy (CBT),

2. Twelve Step Facilitation (TSF), and

3. Motivational Enhancement Therapy (MET).4

Study Results—Few "Matches" Found

Outcomes were measured in terms of percent of days abstinent (PDD) and drinks per drinking day (DDD). There were no significant differences across treatment approaches during and after treatment; patients in all treatment groups reported considerable reduction in drinking.5, 6 Generally speaking, clients with higher alcohol problem severity at intake did better at three years follow-up than clients with lower severity. (Severity was measured by alcohol involvement, alcohol dependence, and type of alcoholic).7 Subsequent analyses also revealed that patients with higher anger levels had better outcomes with MET than the other two therapies.7 At months 37–39 another match appeared: clients who had a social network that supported their drinking before they received treatment had better outcomes with TSF than MET.7 This difference is explained, in part, by the higher AA involvement of TSF clients.8

Post treatment Drinking Outcomes

Patients in all three treatment groups reported significant reductions in drinking during the one year, post treatment follow-up period. Differences across treatment groups were not significant, although TSF showed a slight advantage.6

At three years follow-up, however, a significantly higher abstinence rate was found with TSF clients. Among TSF clients 36% were abstinent, compared with 27% of MET and 24% of CBT clients (p< 0.007).7

Implications for the Delivery of Treatment

Project MATCH remains the largest behavioral intervention trial conducted on alcoholism to date. The main implication of Project MATCH findings is that all three treatment approaches are effective in the treatment of alcoholism: TSF, CBT and MET.6 The fact that few patient-treatment matches resulted in modestly improved treatment outcomes suggests that a major overhaul is unwarranted in the manner and extent of treatment triaging based on client characteristics.

Project MATCH was the first scientifically rigorous demonstration of the effectiveness of TSF, a widespread, but previously untested approach to alcoholism treatment.

Finally, contrary to the popular belief that treatment for alcoholism is not very effective, Project MATCH found that up to one half of patients were abstinent or had significantly reduced their drinking one and three years after treatment.9

Further, the reductions in drinking were greater for the sample of patients who entered Project MATCH after completion of a residential program (not simply treated on an outpatient basis). This raises the possibility that a prolonged period of abstinence enhances long-term success and brings into question, according to Enoch Gordis, M.D., Director of the National Institute on Alcohol Abuse and Alcoholism, whether the best interests of many alcoholic patients are being best served by managed-care organizations’ replacement of residential treatment services in favor of outpatient settings.9

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