Pimping Project MATCH

The results of Project MATCH—an NIAAA-administered clinical trial comparing coping skills, motivational enhancement, and 12-step approaches to alcohol treatment—received a great deal of attention. The overriding goal of the project was to uncover the traits that predicted which type of alcoholic responded best to each type of treatment (and hence, should be matched with it). The broad results of this study were that no treatment proved superior to any other, while virtually no identifiable patterns differentiated those who responded to each treatment (Project MATCH Research Group, 1997). Faced with a $25 million boondoggle that did little more than disconfirm a decade's worth of theorizing about optimizing patient-therapy matching, the NIAAA put the best face forward on this study by asserting it showed in what great shape American alcoholism treatment is.

The NIAAA and the researchers did this by pointing to the high remission rates reported for all treatments. The man mainly charged with carrying this message was Enoch Gordis, an MD and career hospital/treatment/government bureaucrat. According to Gordis, "The good news is that treatment works" (Bower, 1997). Gordis did not start out as a treatment booster. A decade earlier, shortly after becoming the NIAAA's director in 1986, he issued the following rather pessimistic pronouncement about the state of American alcoholism treatment, which at the time (as it is today) was almost completely 12-step oriented.

After all [many of us assert], we have provided many of our treatments for years. We really are confident that the treatment approaches are sound. We can point to thousands of caring....treatment staff, many of whom are recovering alcoholics themselves. It seems impossible to imagine that what these splendid people are doing may be, at least in part, useless, wasteful or occasionally harmful. Yet the history of medicine demonstrates repeatedly that unevaluated treatment...is frequently useless and wasteful and sometimes dangerous and harmful. (Gordis, 1987, p. 582)

Gordis's apparent skepticism here reflects his own research showing that public hospital alcoholism patients didn't fare very well (Gordis et al., 1981).

Why do the MATCH results differ so dramatically from the decades of research summarized by Miller et al. (1995) and Gordis's own experience? Project MATCH, remarkably well-funded as it was, bears no resemblance to treatment as ordinarily practiced in the U.S. In the first place, MATCH carefully selected 1726 subjects out of 4481 who were screened for participation. Almost 500 eliminated themselves after first volunteering because they felt treatment was inconvenient. Others were discarded for "failure to complete the assessment battery; residential instability; legal or probation problems, etc. " Leading therapists trained and supervised the ongoing administration of therapy and both those being treated and those providing treatment realized they were under the spotlight (all therapy sessions were videotaped, and these tapes were reviewed). Project MATCH itself acknowledged: "The overall effect of being part of Project MATCH, with extensive assessment, attractive treatments, and aggressive follow-up may have minimized naturally occurring variability among treatment modalities and may, in part, account for the favorable treatment outcomes" (Project MATCH Research Group, 1997, p. 24).

But this research was not designed to show that treatment works in general. After all, the study had no non-treatment group experiencing comparable attention and support (without therapy) to the treatment groups. This study's all-encompassing positive outcomes resemble those in the famed 1950s Hawthorne studies at the Western Electric plant, where a group of hourly employees was separated and subjected to a study of the effects of different lighting, rest intervals, and other trivial environmental factors. What in fact caused productivity to rise dramatically in all the conditions was the intensive, personalized attention they received no matter what the experimental variation being studied.

Of course, since American alcoholism treatment is 12-step treatment, these results mean that this treatment can safely be promoted as effective and treatment can continue as is in the U.S. According to one of the NIAAA sponsors of Project MATCH, Margaret Mattson (1997), "The results indicate that the Twelve Step model, which is the most widely practiced treatment model in the U.S., is beneficial." What makes the promotion of Project MATCH as proof of the effectiveness of American treatment doubly strange is that the NIAAA has simultaneously conducted comparative research of those receiving actual alcohol treatment in the U.S. with untreated alcoholics, the National Longitudinal Alcohol Epidemiologic Survey. Its results, described below, do not confirm assertions by Mattson, Gordis, and others at NIAAA or involved in Project MATCH about the effectiveness of American alcoholism treatment.

Meanwhile, MATCH investigators have systematically attacked those who have commented on MATCH results—Richard Longabaugh, a MATCH PI, attacked me on an Internet list of the American Psychological Association for my comments on the 22-page Project MATCH report published in the Journal of Studies on Alcohol. Longabaugh claimed that I was speaking of MATCH results without awaiting further publications because "discussion is 'livelier' without the facts." Meanwhile, his request that outside investigators withhold commenting until further results are published in a year or more—while Gordis, Mattson and others spin the MATCH results—amounts to government suppression of public commentary. (Schaler, 1996, described similar efforts by MATCH personnel to silence revisionist interpretations of study results.)