What NIAAA Research Actually Shows About Alcohol Treatment

Morristown, NJ

Abstract

Project MATCH was an extremely expensive clinical trial in which a volunteer, selected group of mainly alcohol dependent patients who had a small number of outpatient sessions of three different types of therapy with a highly trained and monitored staff reduced their drinking substantially over a year period. However, the primary purpose of the study was to show that alcoholics with different profiles will respond better to different sorts of treatment, so that overall outcomes can be improved by proper matching of alcoholics with treatment type. Project MATCH results disproved the matching hypothesis, which prominent clinical researchers had pushed for years (Allen & Kadden, 1995; IOM, 1990; Mattson, 1994; Miller, 1989).

In MATCH's aftermath, NIAAA director Enoch Gordis and other MATCH representatives touted the surprisingly good overall outcomes in the study, which they interpreted to show that alcoholism treatment as delivered in the U.S. (which in over 93 percent of centers is 12-step treatment; Roman & Blum, 1997) produces good results. This conclusion is unfounded. Indeed, a concurrent community study (NLAES) by the NIAAA revealed results of treatment as actually experienced in the U.S. to be shockingly bad, leading to outcomes worse than for those who went untreated for their alcohol dependence!

The NIAAA's willingness to interpret MATCH results to support ideas it could not properly test (in the absence of a nontreatment control group) is disturbing both because it is unscientific and because it seems to be politically motivated. Moreover, several revisionist commentators on Project MATCH (including the present author) have been attacked by MATCH investigators. MATCH and the NIAAA have embargoed alternative interpretations in order to control these results and spin them to their advantage and that of the alcoholism establishment.

The results that are consistent across both MATCH and NLAES are that (1) minimal or no treatment produces outcomes that are equal to/better than those from longer/standard treatments; (2) patient traits and initiative are far more important than treatment type or intensity for recovery; (3) reduced drinking is the most common outcome for alcohol-dependent individuals, an idea that has been verboten on the American alcoholism scene (Peele, 1992).

The Basic Project

Project MATCH Overview. MATCH was organized by the National Institute on Alcohol Abuse and Alcoholism to assess the impact of three different types of alcohol treatment (Coping Skills, Motivational Enhancement, and 12 Step) with special reference to patient characteristics that might predict better outcomes for each treatment for different types of alcoholics. Treatment was on an outpatient basis (for a purely outpatient group and an aftercare to hospital treatment group). Subjects were treated for 3 months and outcomes were measured at three-month points until a year after treatment. The two primary outcome measures were days abstinent and drinks per drinking day (Project MATCH Research Group, 1997).

Project Staff and Resources. The cost of Project MATCH was originally placed at $27 million. However, John Allen, an NIAAA administrator, has since put the cost at $35 million (Jeffrey Schaler, private communication, May, 1997). The training manuals created by MATCH include a foreword by Enoch Gordis announcing: "Researchers in Project MATCH are among the most senior and experienced treatment scientists in the field." Overall, MATCH involved up to 130 clinical professionals in its treatment, administration, and analysis components.

Subjects. The study began with 1,726 subjects, almost all of whom (>95%) measured alcohol dependent. Potential subjects were assessed for alcohol abuse/alcohol dependence according to DSM-III-R, but were excluded if they had concurrent drug dependencies (even though "combined alcohol and drug abuse show up as the most frequent problem at admission to substance abuse treatment"; SAMHSA, 1997). Initially, 4,481 subjects were identified. At initial screening, 459 declined to participate because of the "inconvenience" of treatment (which the Project MATCH Research Team, 1997, p. 11, asserted was "attributable to logistical considerations rather than... motivation"). Other potential subjects were excluded for "failure to complete the assessment battery; residential instability; legal or probation problems, etc.," but no figure is given for how many fell into each category.

Thus, subjects were volunteers with better than average prognosticators (e.g., residential stability; not also abusing drugs). But the study report did not compare patients who were treated to those who were eliminated from the study or to alcoholics in general. Nonetheless, the Team contended, "nor is there reason to believe that the recruitment procedures failed to provide a broad range of clients typically seen in these types of clinical settings" (p. 11).

About 10 years ago at the conference "Evaluating Recovery Outcomes" (University of California, 1988, p. 23), MATCH principal investigator Richard Longabaugh commented on a study at a private treatment center [Edgehill Newport] which found that "66 percent of the patients in the program were continuously sober at a one-year follow-up. However, the program report was limited to treatment of socially-stable patients... [along with other filters]. Was this population representative of the population they were treating?" Longabaugh contended that since the research did not analyze excluded subjects, "skeptics like myself" had to conclude it was worthless as a comparative assessment of treatment.