Are alcoholism treatments effective? The Project MATCH data

Area of Science:

• Addiction research
• Clinical psychology
• Psychosocial interventions

Background:

• Project MATCH, a large alcoholism trial, yielded disappointing results with no significant patient-treatment matches.
• Three distinct treatments showed nearly identical outcomes, interpreted as evidence of their effectiveness.

Purpose of the Study:

• To re-analyze Project MATCH data to estimate treatment effectiveness in relation to the quantity of treatment received.
• To investigate the impact of treatment duration on outcomes for alcohol-dependent individuals.

Main Methods:

• Secondary analysis of a multisite clinical trial involving 1726 alcohol-dependent volunteers receiving outpatient psychosocial therapy.
• Primary outcome variables included percent days abstinent (PDA) and drinks per drinking day (DDD).
• Comparison of outcomes across groups: immediate dropouts, one-session dropouts, and those attending 12 sessions.

Main Results:

• Overall, only 3% of drinking outcome improvement was attributable to treatment, with most gains observed by week one.
• The group receiving no treatment (dropouts) showed significant improvement (72% PDA), duplicating 2/3 to 3/4 of the full treatment group's gains.
• One therapy session worsened outcomes, suggesting a self-selection effect; further sessions yielded minimal additional benefit.

Conclusions:

• Current psychosocial treatments for alcoholism appear to have limited effectiveness.
• Significant improvement is observed in untreated alcoholics in clinical trials.
• Much of the perceived treatment effect is likely due to selection bias and natural improvement, not the interventions themselves.