Matching Clients to Treatment

The largest clinical trial ever conducted for alcoholism treatment methods was Project MATCH, a collaborative study involving nine clinical sites, a coordinating center, and NIAAA. CASAA was one of the nine performance sites.  1,726 clients were randomly assigned to

            (1) 12 sessions of Twelve-Step Facilitation Therapy

            (2) 4 sessions of Motivational Enhancement Therapy, or

            (3) 12 sessions of Cognitive-Behavioral Skills Training.

Five sites (including CASAA) treated outpatients, and five treated patients in aftercare following intensive treatment. An excellent summary of the entire study is provided by Babor & Del Boca (2003).

            Overall, the three treatments yielded substantial and statistically equivalent outcomes through follow-up periods as long as 3 years (Project MATCH Research Group, 1997a, 1998a). The principal purpose of the study, however, was to determine which clients responded best to which treatments. Four such effects were found. Clients who entered treatment with a high level of state/trait anger fared best in Motivational Enhancement Therapy through the three years of follow-up (PMRG 1997b, 1998a; Waldron et al., 2001). Those whose social support systems favored continued drinking rather than abstinence benefitted most from Twelve-Step facilitation. Outpatients with less concomitant psychopathology likewise fared better in Twelve-Step facilitation than in Cognitive-Behavior

therapy. Finally, the Twelve-Step treatment was more beneficial for aftercare patients with high levels of alcohol dependence, whereas those with lower levels of dependence fared better in Cognitive-Behavior Therapy (Babor & Del Boca, 1993).

            A research design paper demonstrated that it is not necessary to conduct prospective matching studies in which patients are intentionally matched vs. mismatched to treatments. Such a design is, under most conditions, equivalent to a normal randomized clinical trial. This means that matching analyses of the kind used in Project MATCH can be conducted with ordinary clinical trials, as long as adequate measures are included to characterize clients, and a priori hypotheses are stated (Miller & Cooney, 1994).

            Within Project MATCH, the Albuquerque site was particularly active in examining effects of ethnicity (Arroyo et al., in press), AA involvement (Connors et al., 2001a; Tonigan et al., 2000, 2001a), spirituality (Connors et al., 2001b; Tonigan et al., 2001b), motivation (Miller & Tonigan, 2001), therapist effects (Project MATCH Research Group, 1998d), severity of alcohol problems (Rychtarik et al., 2001), and client anger (Waldron et al.,2001) on treatment outcomes.

            Project MATCH investigators generated nine monographs and more than a hundred research articles that can be located through the Project MATCH home page at http://www.commed.uchc.edu/match/.  The best full summary of the project is found in:

Thomas F. Babor & Frances K. Del Boca (Eds.) (2003), Treatment matching in alcoholism.  Cambridge, UK: Cambridge University Press.

Publications on Client/Treatment Matching (in chronological order)

Miller, W. R., & Hester, R. K. (1986).  Matching problem drinkers with optimal treatments.  In W. R. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 175-203).  New York: Plenum Press.

Miller, W. R. (1989).  Matching individuals with interventions.  In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (pp. 261-271).  Elmsford, NY: Pergamon Press.

Project MATCH Research Group (1993).  Project MATCH: Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment.  Alcoholism: Clinical and Experimental Research, 17, 1130-1145.

Miller, W. R., & Cooney, N. L. (1994).  Designing studies to investigate client/treatment matching.  Journal of Studies on Alcohol, Supplement No. 12, 38-45.

Project MATCH Research Group (1997).  Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes.  Journal of Studies on Alcohol, 58, 7-29.

Project MATCH Research Group (1997).  Project MATCH secondary a priori hypotheses.  Addiction, 92, 1671-1698.

Project MATCH Research Group (1998).  Matching alcoholism treatments to client heterogeneity:  Project MATCH three-year drinking outcomes.  Alcoholism: Clinical and Experimental Research, 22, 1300-1311.

Project MATCH Research Group (1998).  Matching alcoholism treatments to client heterogeneity: Treatment main effects and matching effects on drinking during treatment.   Journal of Studies on Alcohol, 59, 631-639.

Project MATCH Research Group, (1998). Matching patients with alcohol disorders to treatments: Clinical implications from Project MATCH.  Journal of Mental Health, 7, 589-602.

Project MATCH Research Group (1998).  Therapist effects in three treatments for alcohol problems.  Psychotherapy Research, 8, 455-474.

Babor, T. F., Miller, W. R., DiClemente, C. C., & Longabaugh, R.  (1999).  A study to remember: Response of the Project MATCH Research Group.  Addiction, 94, 66-69.

Westerberg, V. S., Miller, W. R., & Tonigan, J. S. (2000).  Comparison of outcomes for clients in randomized versus open trials of treatment for alcohol use disorders.  Journal of Studies on Alcohol, 61, 720-727.

Connors, G. J., Tonigan, J. S., & Miller, W. R. (2001).  Religiosity and responsiveness to alcoholism  treatments.  In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 166-175). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Miller, W. R., & Tonigan, J. S. (2001).  Alcohol problem recognition and treatment outcomes.  In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 223-238). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Rychtarik, R. G., Miller, W. R., & Tonigan, J. S. (2001).  The alcohol involvement  matching hypothesis and findings. In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 44-60). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Tonigan, J. S., Miller, W. R., & Connors, G. J. (2001).  Prior Alcoholics Anonymous involvement and treatment outcome.  In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 276-284). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Tonigan, J. S., Miller, W. R., & Connors, G. J. (2001).  The search for meaning in life as a predictor of alcoholism treatment outcome.  In R. Longabaugh & P. W. Wirtz(Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 154-165). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Waldron, H. B., Miller, W. R., & Tonigan, J. S. (2001).  Client anger as a predictor of differential response to treatment.  In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 134-148). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Connors, G. J., Miller, W. R.,  Anton, R. F., & Tonigan, J. S. (2003).  Clinical assessment: Measuring matching characteristics and treatment outcomes.  In T. F. Babor & F. K. Del Boca (Eds.), Treatment matching in alcoholism (pp. 29-41).  Cambridge, UK: Cambridge University Press.

DiClemente, C. C., Carroll, K. M., Miller, W. R., Connors, G. J., & Donovan, D. M.(2003).  The effects of therapist characteristics and the process of psychotherapy.  In T. F. Babor & F. K. Del Boca (Eds.), Treatment matching in alcoholism (pp. 166-183). Cambridge, UK: Cambridge University Press.

Miller, W. R., & Longabaugh, R. (2003).  Summary and conclusions.  In T. F. Babor & F. K. Del Boca (Eds.), Treatment matching in alcoholism (pp. 207-221).  Cambridge, UK: Cambridge University Press.

Owen, P.L., Slaymaker, V., Tonigan, J.S., McCrady, B.S., Epstein, E.E., Kaskutas, L.A., Humphreys, K., Miller, W.R. (2003). Participation in alcoholics anonymous: intended and unintended change mechanisms. Alcohol Clinical Experimental Research, 27(3), 524-32.

Tonigan, J. S., Connors, G., & Miller, W. R. (2003).  Participation and involvement in Alcoholics Anonymous.  In T. F. Babor & F. K. Del Boca (Eds.), Treatment matching in alcoholism (pp. 184-204). Cambridge, UK: Cambridge University Press.

Miller, W. R. (2005).  Are alcoholism treatments effective?  The Project MATCH data: Response.  BMC Public Health, 5:76. (http://www.biomedcentral.com/1471‑2458/5/76).