MATCHING ALCOHOLISM TREATMENTS TO CLIENT HETEROGENEITY - PROJECT MATCH POSTTREATMENT DRINKING OUTCOMES

Objective: To assess the benefits of matching alcohol dependent client s to three different treatments with reference to a variety of client attributes. Method: Two parallel but independent randomized clinical t rials were conducted, one with alcohol dependent clients receiving out patient therapy (N = 952; 72% male) and one with clients receiving aft ercare therapy following inpatient or day hospital treatment (N=774; 8 0% male). Clients were randomly assigned to one of three 12-week, manu al-guided, individually delivered treatments: Cognitive Behavioral Cop ing Skills Therapy, Motivational Enhancement Therapy or Twelve-Step Fa cilitation Therapy. Clients were then monitored over a 1-year posttrea tment period. Individual differences in response to treatment were mod eled as a latent growth process and evaluated for 10 primary matching variables and 16 contrasts specified a priori. The primary outcome mea sures were percent days abstinent and drinks per drinking day during t he 1-year posttreatment period. Results: Clients attended on average t wo-thirds of treatment sessions offered indicating that substantial am ounts of treatment were delivered, and research follow-up rates exceed ed 90% of living subjects interviewed at the 1-year posttreatment asse ssment. Significant and sustained improvements in drinking outcomes we re achieved from baseline to 1-year posttreatment by the clients assig ned to each of these well-defined and individually delivered psychosoc ial treatments. There was little difference in outcomes by type of tre atment. Only one attribute, psychiatric severity, demonstrated a signi ficant attribute by treatment interaction: In the outpatient study, cl ients low in psychiatric severity had more abstinent days after 12-ste p facilitation treatment than after cognitive behavioral therapy. Neit her treatment was clearly superior for clients with higher levels of p sychiatric severity. Two other attributes showed time-dependent matchi ng effects: motivation among outpatients and meaning-seeking among aft ercare clients. Client attributes of motivational readiness, network s upport for drinking, alcohol involvement gender, psychiatric severity and sociopathy were prognostic of drinking outcomes over time. Conclus ions: The findings suggest that psychiatric severity should be conside red when assigning clients to outpatient therapies. The lack of other robust matching effects suggests that, aside from psychiatric severity , providers need not take these client characteristics into account wh en triaging clients to one or the other of these three individually de livered treatment approaches, despite their different treatment philos ophies.