Striking a match for alcoholism treatment 
Practitioners may soon be able to match different treatments to the patients who 
best respond to them. 
By Beth Azar
Monitor staff
Clinicians' intuition about which alcoholism treatments work best for which 
clients has not proved reliable, according to research. So alcoholism treatment 
researchers are turning to studies of patient-treatment matching to resolve the 
problem. 
There are many successful alcoholism treatments, but none works for everyone. 
Although Western medicine often searches for a 'magic bullet' that can cure 
disease quickly and easily, researchers have long known that there is no quick 
fix for treating alcoholism: The disorder is too complex and varied. 
Some small-scale studies have found patient characteristics that seem to foster 
success in different treatments. Based on those studies, in 1989 the National 
Institute on Alcohol Abuse and Alcoholism began a large-scale, multisite study 
to address the subject in the hope that some day practitioners can offer 
patients treatment based on empirical data rather than intuition. 
'We studied the degree to which clinicians could pick treatments for people,' 
said Mark Litt, PhD, of the University of Connecticut. 'The patient outcome 
didn't bear with clinicians' predictions…their matches were worse than chance.' 
Promising results
'Many small-scale patient-treatment matching studies have yielded promising 
results,' said Margaret Mattson, PhD, health science administrator in the 
Treatment Research Branch at NIAAA. Patient characteristics such as sociopathy, 
alcoholism subtype, severity of dependence and extent of social support seem to 
influence success in various treatments, she said. 
Ronald Kadden, PhD, and his colleagues examined the effect of patient 
psychopathology, particularly sociopathy, on treatment outcomes. They found that 
sociopathic patients did best with a structured, straightforward cognitive 
behavioral treatment that taught coping skills for managing urges and emotions. 
More adaptive people benefitted more from interactive, support therapy that 
explored relationships and emotions, said Kadden, professor of psychology at the 
University of Connecticut School of Medicine. 
Litt, one of Kadden's collaborators, reanalyzed the data, separating the 
patients by alcoholic type. As defined by alcohol researcher Thomas Babor, PhD, 
Type A alcoholics develop drinking problems later in life, have fewer childhood 
risk factors, less psychopathology, less severe dependence and fewer physical 
and social drinking-related consequences than Type B alcoholics, explained Litt. 

Litt's reanalysis found that Type A alcoholics responded best to the less 
structured interactional therapy, while Type B did best with the cognitive 
behavioral therapy. Categorizing patients this way predicted outcome just as 
well as sorting them by sociopathy, said Litt. 
Such small-scale studies 'can answer some important questions,' said Kadden. 
'But ultimately, if the results are going to be broadly useful, they will have 
to be tested broadly.' 
Indeed, because small-scale studies mainly use one treatment setting, any 
matching effect found could merely be an artifact of the setting, said 
psychologist Richard Longabaugh, PhD, of the Center for Alcohol and Addiction 
Studies at Brown University. 
Project MATCH
To avoid the pitfalls of single-site studies NIAAA initiated Matching Alcoholism 
Treatment to Client Heterogeneity-the largest, most comprehensive study of 
patient-treatment matching for alcoholism ever undertaken.A 23-member planning 
group-more than half of whom were psychologists-designed the study from October 
1989 to December 1990. Staff training and field testing of assessment procedures 
and therapy delivery occurred from January 1991 to March 1991 and data 
collection began April 1991. 
Project MATCH's ultimate goal is to develop a set of guidelines to help 
practitioners match treatments to patients who can best respond to them and to 
deliver treatments to maximize their usefulness, said Mattson. 
Through Project MATCH, researchers at nine clinical sites followed for one year 
more than 1,700 patients after they completed one of three 12-week treatments 
for alcoholism. Data collection ended late last year. Overall, patients 
completed two-thirds of the scheduled treatments and researchers successfully 
contacted more than 90 percent at all five follow-up evaluations-three, six, 
nine, 12 and 15 months after completion of treatment, said Mattson. 
Researchers randomly assigned patients to one of three 12-week treatments: 
twelve-step facilitation, which promotes active participation in Alcoholic 
Anonymous; 
cognitive-behavioral coping skills, which teaches techniques to enable patients 
to achieve and maintain sobriety, such as coping with potential drinking 
situations, managing thoughts and urges about alcohol, and learning ways to 
refuse a drink; and 
motivational enhancement therapy, which mobilizes the patient's own resources to 
effect behavior change by instilling motivation to initiate or maintain change, 
consolidating commitment to change, and monitoring and encouraging progress. 
The MATCH planning group chose the treatments because they are sufficiently 
different from each other and are widely used in treatment settings, according 
to a report detailing the project. 
In phase I of the project, researchers evaluated patient characteristics, such 
as demographic and clinical history, personality, psychosocial functioning, 
psychiatric disorder, attitude, motivation and social support. In phase II-which 
is ongoing-researchers conduct an intensive data analysis comparing patient 
characteristics and treatments against outcomes, said Mattson. The analysis 
should be completed this fall and should reveal which treatments are best for 
which patients and the reasons for the matching effects, she said. 
The researchers involved in the project recognize that their results must apply 
to the real world. 'We hope to give practical guidelines that clinicians can 
implement with the least changes,' said Mattson. 
But such lofty goals are a long way off, agree researchers. They need to 
complete many more studies like Project MATCH, using many other treatments. In 
the five years since the project was initiated, research on drug treatments for 
alcoholism has been successful. The development ReVia (naltrexone), the 
anticraving drug approved by the Federal Drug Administration last December, 
suggests that matching studies be done to include drug therapies and combination 
drug-behavioral therapies, said Mattson. 
'I can see macromatching variables such as inpatient versus outpatient treatment 
within the next 10 years,' said Longabaugh. 'In the domain of 
cognitive-behavioral therapy versus transactional analysis, however, there won't 
be a lot to say for a much longer time.' More large-scale projects such as MATCH 
should help to shorten that time. 




APA Home Page . Search . Site Map