PROJECT MATCH SECONDARY A-PRIORI HYPOTHESES

Aims. (1) To assess the benefits of matching alcohol dependent clients to three treatments, based upon a priori hypotheses involving II clie nt attributes; (2) to discuss the implications of these findings and o f matching hypotheses previously reported from Project MATCH. Setting and participants. (1) Clients receiving outpatient therapy (N = 952; 7 2% male); (2) clients receiving aftercare therapy following inpatient or day hospital treatment (N= 774; 80% male). Intervention. Clients we re randomly assigned to one of three 12-week, manual-guided, individua l treatments: Cognitive Behavioral Coping Skills Therapy (CBT), Motiva tional Enhancement Therapy (MET) or Twelve-Step Facilitation Therapy ( TSF). Design. Two parallel but independent randomized clinical trials were conducted, one with outpatients, one with aftercare clients. Part icipants were monitored over 15 months including a I-year post-treatme nt period. Individual differences in response to treatment were modele d as a latent growth process and evaluated for 17 contrasts specified a priori. Outcome measures were percentage of days abstinent and drink s per drinking day. Findings. Two a priori contrasts demonstrated sign ificant post-treatment attribute by treatment interactions: (1) outpat ients high in anger and treated in MET had better post-treatment drink ing than in GBT; (2) aftercare clients high in alcohol dependence had better post-treatment outcomes in TSF; low dependence clients did bett er in CBT. Other matching effects varied over time, while still other interactions were opposite that predicted. Conclusions. (I) Anger and dependence should be considered when assigning clients to these three treatments; (2) considered together with the results of the primary hy potheses, matching effects contrasting these psychotherapies are not r obust. Possible explanations include: (a) among the client variables a nd treatments tested, matching may not be an important factor in deter mining client outcomes; (b) design issues limited the robustness of ef fects; and (c) a more fully specified theory of matching is necessary to account for the complexity of the results.