Matching patients with alcohol disorders to treatments: Clinical implications from Project MATCH

Abstract

Project MATCH, a large multi-site clinical trial, tested the matching hypothesis that alcoholism treatment outcomes can be improved by matching subgroups of patients to treatments. Three psychosocial treatments (Twelve-Step Facilitation Therapy (TSF); Motivational Enhancement Therapy (MET); and Cognitive Behavioral Therapy (CBT)) were tested for potential to match to a set of over 20 client attributes. Detailed findings have been reported in previous publications. The purpose of this article is to discuss the clinical relevance of the results. (1) Matching. Four client characteristics produced statistically significant matches which differed in magnitude of effect and time course: psychiatric severity, anger and support for drinking in out-patients and alcohol dependence in aftercare patients. These four matches represent reasonable starting points for the planning of treatment in settings where the indicated therapy is available. Apart from these few client attributes, matching as an overall treatment strategy did not substantially enhance outcomes. (2) Overall outcomes. The three treatments had favorable (and similar) effects upon drinking and related outcome measures. The treatment effects endured over time periods from 12 months to 3 years. TSF abstinence results were as favorable as those for other well-tested approaches, and the MET findings add to accumulating evidence in support of brief interventions. (3) Compliance to therapy. Efforts to attain good compliance were successful, patient satisfaction ratings were positive, and high compliance was associated with better outcome. These results suggest that the three Project MATCH treatments are appropriate for use with a wide range of alcoholics. Achievement of satisfactory therapy attendance with this population of heavy drinkers appears feasible. The strategies used in Project MATCH to enhance compliance are described in manuals available to practitioners and researchers. (4) Therapist training. Over 80 therapists from diverse backgrounds received careful training and supervision using structured therapist manuals and were able to implement these treatments successfully and with fidelity. Manuals describing the three treatments also are available.