Are alcoholism treatments effective? The Project MATCH data

Abstract

Background: Project MATCH was the largest and most expensive alcoholism treatment trial ever conducted. The results were disappointing. There were essentially no patient-treatment matches, and three very different treatments produced nearly identical outcomes. These results were interpreted post hoc as evidence that all three treatments were quite effective. We re-analyzed the data in order to estimate effectiveness in relation to quantity of treatment.

Methods: This was a secondary analysis of data from a multisite clinical trial of alcohol dependent volunteers (N = 1726) who received outpatient psychosocial therapy. Analyses were confined to the primary outcome variables, percent days abstinent (PDA) and drinks per drinking day (DDD). Overall tests between treatment outcome and treatment quantity were conducted. Next, three specific groups were highlighted. One group consisted of those who dropped out immediately; the second were those who dropped out after receiving only one therapy session, and the third were those who attended 12 therapy sessions.

Results: Overall, a median of only 3% of the drinking outcome at follow-up could be attributed to treatment. However this effect appeared to be present at week one before most of the treatment had been delivered. The zero treatment dropout group showed great improvement, achieving a mean of 72 percent days abstinent at follow-up. Effect size estimates showed that two-thirds to three-fourths of the improvement in the full treatment group was duplicated in the zero treatment group. Outcomes for the one session treatment group were worse than for the zero treatment group, suggesting a patient self selection effect. Nearly all the improvement in all groups had occurred by week one. The full treatment group had improved in PDA by 62% at week one, and the additional 11 therapy sessions added only another 4% improvement.

Conclusion: The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment. Part of the remainder appears to be due to selection effects.

Figure 1

Percent days abstinent at follow-up. Percent days abstinent at pre-treatment and follow-up for patients who received 0, 1 or 12 treatment sessions. The 0 treatment dropout group showed great improvement from pre-treatment to follow-up. The 1 session attendance dropout group had worse scores than did the 0 treatment group. These data suggest that most of the improvement in the full 12 session attendance group cannot be due to treatment. See also Figure 2.

Figure 2

Drinks per drinking day at follow-up. Drinks per drinking day at pre-treatment and follow-up for patients who received 0, 1 or 12 treatment sessions. The 0 treatment dropout group showed great improvement from pre-treatment to follow-up. The 1 session attendance dropout group had worse scores than did the 0 treatment group. These data suggest that most of the improvement in the full 12 session attendance group cannot be due to treatment. See also Figure 1.

Figure 3

Percent days abstinent during treatment. Percent days abstinent at pre-treatment and during the 12 weeks of treatment for patients who received 0, 1 or 12 treatment sessions. The effective improvement in drinking was instantaneous, evident at week 1. The improvement was maintained at the same approximate level for the 12 weeks of scheduled treatment. The effect occurred for all groups, whether they attended all 12 treatment sessions, only one treatment session, or did not attend any treatment sessions. See also Figure 4.

Figure 4

Drinks per drinking day during treatment. Drinks per drinking day at pre-treatment and during the 12 weeks of treatment for patients who received 0, 1 or 12 treatment sessions. The effective improvement in drinking was instantaneous, evident at week 1. The improvement was maintained at the same approximate level for the 12 weeks of scheduled treatment. The effect occurred for all groups, whether they attended all 12 treatment sessions, only one treatment session, or did not attend any treatment sessions. See also Figure 3.