Matching Alcoholism Treatments To Client Heterogeneity Research Articles

An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use.

This study examined the interactions of therapist directiveness with patient anger and patient reactance among an alcohol-treatment-seeking sample. Participants in the study consisted of 139 individuals with alcohol abuse or dependence who received treatment at a single clinical research unit of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). Analyses tested for the independence of the two interactions, identified components within the directiveness construct and examined the relationship between those components and the patient attributes. Results showed that the interactions between directiveness and anger and between directiveness and reactance each accounted for unique variance in predicting posttreatment alcohol use as measured by percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Principal components analysis of the directiveness construct generated two underlying components that were interpreted to be confrontation and structure. Significant interactions were observed between patient reactance and both the confrontation and structure components. Confrontation also interacted with patient anger; however, no interaction was found between anger and structure. The interactions of therapist directiveness with patient anger and reactance demonstrated both shared and unique qualities. These results highlight the importance of focusing on specific aspects of directiveness to better understand the effect of patient-treatment interactions on alcohol use. This study has implications for theory and research as well as for the delivery of treatment services.

Deterioration following alcohol-use disorder treatment in project MATCH.

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.

Current developments in psychosocial treatments of alcohol and substance abuse.

This article reviews recent findings and new developments in alcohol and substance abuse treatment over the past 2 years. Outcome results from two large clinical trials: Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) for alcohol dependent patients; and the National Institute on Drug Abuse Collaborative Cocaine Treatment Study for cocaine dependent patients; and the naturalistic Drug Abuse Treatment Outcome Study have yielded important results on the possibility of patient treatment matching. The promising community reinforcement approaches have been expanded to opiate dependent and homeless populations. Finally, a number of studies point to the important role of self-help groups and the power of 12-step-based treatment approaches.

Developments in the Treatment of Alcoholism

The treatment of alcoholism has changed during the past 2 decades. Notable developments have occurred in pharmacotherapy, psychotherapy, and health-care delivery. A better understanding of the biologic basis for addiction has led to clinical trials of medications that target neuroreceptors. One such medication is the opiate antagonist naltrexone, which decreases the craving for alcohol. Psychosocial interventions continue to be the mainstay of alcohol treatment programs. The efficacy of three different therapies was demonstrated in a study called Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). This study, however, did not prove the patient-treatment "matching" hypothesis. In addition to therapies provided by addiction specialists, interest is growing in the use of brief motivational techniques in primary-care settings. As the field of addiction responds to an unfolding health-care delivery system, a broader range of treatment options in conjunction with a greater opportunity to individualize patient care is evolving.

Internal validity of project MATCH treatments: Discriminability and integrity.

Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) is a multisite collaborative project designed to evaluate patient-treatment interactions in alcoholism treatment. To evaluate whether major threats to the internal validity of the independent (treatment) variable in Project MATCH could be ruled out, we investigated several aspects of treatment integrity and discriminability. In this study, 1,726 alcohol-dependent participants at 10 sites were randomized to 3 treatments: cognitive-behavioral treatment (CBT), motivational enhancement therapy (MET), and 12-step facilitation (TSF). Participants received treatment either as outpatients or as aftercare following a more intensive inpatient or day hospital treatment. For both the outpatient and aftercare arms of the study, treatments were discriminable in that therapists implemented each of the treatments according to manual guidelines and rarely used techniques associated with comparison approaches. Participants received a high level of exposure to their study treatments, and the intended contrast in treatment dose between MET and the 2 more intensive treatments (CBT and TSF) was obtained. Alcoholics Anonymous involvement was significantly higher for participants assigned to TSF versus MET or CBT, whereas the treatments did not differ in utilization of other nonstudy treatments. Nonspecific aspects of treatment such as therapist skillfulness and level of the therapeutic alliance were comparable across treatment conditions.