Deterioration following alcohol-use disorder treatment in project MATCH.

Abstract

This study examines the prevalence and predictors of deterioration during the three months following treatment in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three different treatments for alcohol-use disorders. The outpatient and aftercare samples of Project MATCH were examined to identify the prevalence of deterioration, as reflected by a decline in percent days abstinent between the 3 months prior to baseline and the 3 months immediately following treatment. Analyses of predictors of deterioration were based on baseline sociodemographic and psychological factors, including substance-related and psychiatric symptoms and treatment-related factors, including treatment type, treatment duration and therapeutic alliance. Approximately 10% (91/927) of patients in the outpatient sample and 7% (50/738) of patients in the aftercare sample deteriorated in the 3 months following treatment. Primary predictors of deterioration in the outpatient sample were lower baseline severity of alcohol dependence, higher baseline depression, fewer sessions of treatment and lower ratings of therapeutic alliance. The only factor associated with deterioration in the aftercare sample was fewer sessions of treatment. Despite the general positive response of patients to alcohol-use disorder treatment, researchers and treatment providers need to be aware of the potential for deterioration in a sizable minority of patients. Potential methods for identifying patients at risk for deterioration early in treatment are discussed.