MATCHING ALCOHOLISM TREATMENTS TO CLIENT HETEROGENEITY - PROJECT MATCH 3-YEAR DRINKING OUTCOMES

This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH, a multisite clinical tria l designed to test a priori client treatment matching hypotheses. The main purpose of this study was to characterize the status of the match ing hypotheses at the 3-year follow-up. This entailed investigating wh ich 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 matchin g findings discerned earlier dissipated at this later time. This resea rch also examines the prognostic effects of the client matching attrib utes, characterizes the overall outcomes at 37 to 39 months, and explo res differential effects of the three treatments at extended follow-up . With regard to the matching effects, client anger demonstrated the m ost consistent interaction in the trial, with significant matching eff ects evident at both the 1-year and 3-year follow-ups. As predicted, c lients high in anger fared better in Motivational Enhancement Therapy (MET) than in the other two MATCH treatments: Cognitive-Behavioral The rapy (CBT) and Twelve-Step Facilitation (TSF). Among subjects in the h ighest third of the anger variable, clients treated in MET had on aver age 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 drinkin g variable emerged in the 3-year outcome analysis, such that clients w hose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET. Among subjects in the highes t third of the support for drinking variable, TSF participants were ab stinent 16.1% more days than MET participants. At the lower end of thi s variable, difference in percent days abstinent between MET and TSF w as 3%, with MET clients having more abstinent days. A significant matc hing effect for psychiatric severity that appeared in the first year p osttreatment was not observed after 3 years. Of the 21 client attribut es used in testing the matching hypotheses, 11 had prognostic value at 3 years. Among these, readiness-to-change and self-efficacy emerged a s 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 foll ow-up period: almost 30% of the subjects were totally abstinent in mon ths 37 to 39, whereas those who did report drinking nevertheless remai ned abstinent an average of two-thirds of the time. As in the 1-year f ollow-up, there were few differences among the three treatments, altho ugh TSF continued to show a possible slight advantage.