Prospective matching of alcoholic clients to cognitive-behavioral or interactional group therapy

Objective: In earlier work, client sociopathy and global psychopathology we re effective variables for treatment matching: clients low on both sociopat hy and severity of psychopathology were likely to benefit from interactiona l group therapy whereas those scoring high on either of these dimensions be nefited more from a coping skills intervention. The present study assessed whether outcomes improve further when clients are assigned to group treatme nts prospectively based on a matching strategy derived from the previous fi ndings. Method: All participants (N = 250, 66% men) met criteria for alcoho l dependence or abuse. About half were prospectively assigned to either cog nitive-behavioral (CB) coping skills training or interactional therapy; tho se with higher levels of psychiatric severity or sociopathy were given CB a nd those who were low on both dimensions were given interactional therapy. The other half were randomly assigned to those treatments, replicating the procedure of the earlier study. Outcome data were collected at the conclusi on of treatment and at 3-month intervals for 1 year following. Results: Pro spective matching of clients to treatment did not produce superior drinking outcomes compared to random treatment assignment. Randomly assigned client s were more likely to be abstinent at the end of treatment, but this effect disappeared at later follow-ups. Prospectively matched clients had fewer n egative consequences of drinking than did those assigned randomly (unmatche d). Neither sociopathy nor psychiatric severity was particularly effective for matching. Conclusions: The matching effects from our previous study wer e not replicated. Nevertheless, prospective matching did reduce the negativ e consequences of drinking, consistent with our previous results.