Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH Three-Year Drinking Outcomes

Authors

  • Project MATCH Research Group

    1. Medical University of South Carolina, University of Houston, Research Institute on Addictions, Veterans Affairs Connecticut Healthcare System, Yale University School of Medicine, University of South Florida, University of Maryland Baltimore County, University of Washington and Veterans Affairs Puget Sound Health Care System, University of Connecticut Schools of Medicine and Dental Medicine, Brown University, University of New Mexico, George Washington University, and University of Wisconsin-Milwaukee.
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  • Project MATCH is a collaborative clinical trial sponsored by the National Institute on Alcohol Abuse and Alcoholism. The Project MATCH Research Group is composed of the following Steering Committee members who developed the research protocol and executed all aspects of the trial: John Allen, Ph.D., National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD; Raymond F. Anton, M.D., Medical University of South Carolina and Veterans Affairs Medical Center, Charleston, SC; Thomas F. Babor, Ph.D., University of Connecticut, Farmington, CT; Joseph Carbonari, Ed.D., University of Houston, Houston, TX; Kathleen M. Carroll, Ph.D., Yale University, New Haven, CT; Gerard J. Connors, Ph.D., Research Institute on Addictions, Buffalo, NY; Ned L. Cooney, Ph.D., Veterans Affairs Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT; Frances K. Del Boca, Ph.D., University of South Florida. Tampa, FL; Carlo C. DiClemente, Ph.D., University of Mayland Baltimore County, Baltimore, MD; Dennis Donovan, Ph.D., University of Washington and Veterans Affairs Puget Sound Health Care System, Seattle, WA; Ronald M. Kadden, Ph.D., University of Connecticut School of Medicine, Farmington, CT; Mark Litt, Ph. D., University of Connecticut School of Dental Medicine and School of Medicine, Farmington, CT; Richard Longabaugh, Ed. D., Brown University, Providence, RI; Margaret Mattson, Ph.D., National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD; William R. Miller, Ph.D., University of New Mexico, Albuquerque, NM; Carrie L. Randall, Ph.D., Medical University of South Carolina and Veterans Affairs Medical Center, Charleston, SC; Bruce J. Rounsaville, M.D., Yale University, New Haven, CT; Robert G. Rychtarik, Ph.D., Research Institute on Addictions, Buffalo, NY; Robert L. Stout, Ph.D., Brown University, Providence, RI; J. Scott Tonigan, Ph.D., University of New Mexico, Albuquerque, NM; Philip W Wirtz, Ph.D., George Washington University, Washington, D.C.; and Allen Zweben, D.S. W., University of Wisconsin —Milwaukee, Milwaukee, WI.

  • In addition to the Project MATCH Research Group, other investigators and institutions have collaborated in the conduct of this study. The names and affiliations of all participating investigators and collaborating institutions are listed in the Appendix to a companion paper published in the Journal of Studies on Alcohol 58:25–26, 1997.

  • The Steering Committee would like to acknowledge the efforts of the writing team, chaired by Ronald Kadden, that conducted the analyses and prepared the drafts of this manuscript: Joseph Carbonari, Mark Litt, Scott Tonigan, and Allen Zweben. We also wish to acknowledge the contributions and sustained efforts of Richard Fuller, M.D., Director of the Division of Prevention and Treatment Research, NIAAA, on behalf of Project MATCH throughout the period of study. Lastly, we thank Sharon Della Vecchia of the University of Connecticut School of Medicine for her considerable assistance in preparing the various drafts of the manuscript.

Reprint requests: Scientific Communications Branch, National Institute on Alcohol Abuse and Alcoholism, Willco Building, Suite 409, 6000 Executive Boulevard, Bethesda, MD 20892-7003.

Abstract

This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH, a multisite clinical trial designed to test a priori client treatment matching hypotheses. The main purpose of this study was to characterize the status of the matching hypotheses at the 3-year follow-up. This entailed investigating which matching findings were sustained or even strengthened across the 3-year study period, and whether any hypotheses that were not supported earlier eventually emerged at 3 years, or conversely, whether matching findings discerned earlier dissipated at this later time. This research also examines the prognostic effects of the client matching attributes, characterizes the overall outcomes at 37 to 39 months, and explores differential effects of the three treatments at extended follow-up. With regard to the matching effects, client anger demonstrated the most consistent interaction in the trial, with significant matching effects evident at both the 1-year and 3-year follow-ups. As predicted, clients high in anger fared better in Motivational Enhancement Therapy (MET) than in the other two MATCH treatments: Cognitive-Behavioral Therapy (CBT) and Twelve-Step Facilitation (TSF). Among subjects in the highest third of the anger variable, clients treated in MET had on average 76.4% abstinent days, whereas their counterparts in the other two treatments (CBT and TSF) had on average 66% abstinent days. Conversely, clients low in anger performed better after treatment in CBT and TSF than in MET. Significant matching effects for the support for drinking variable emerged in the 3-year outcome analysis, such that clients whose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET. Among subjects in the highest third of the support for drinking variable, TSF participants were abstinent 16.1 % more days than MET participants. At the lower end of this variable, difference in percent days abstinent between MET and TSF was 3%, with MET clients having more abstinent days. A significant matching effect for psychiatric severity that appeared in the first year posttreatment was not observed after 3 years. Of the 21 client attributes used in testing the matching hypotheses, 11 had prognostic value at 3 years. Among these, readiness-to-change and self-efficacy emerged as the strongest predictors of long-term drinking outcome. With regard to the overall outcomes, the reductions in drinking that were observed in the first year after treatment were sustained over the 3-year follow-up period almost 30% of the subjects were totally abstinent in months 37 to 39, whereas those who did report drinking nevertheless remained abstinent an average of two-thirds of the time. As in the 1-year follow-up, there were few differences among the three treatments, although TSF continued to show a possible slight advantage.

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