The impact of free choice in alcohol treatment. Primary outcomes of the self-match study

Abstract

Introduction: A paternalistic approach to treatment planning is common, but there is a growing interest in involving clients in the planning of their own treatment, both in medical care and psychotherapy. Several studies on matching patients to treatment have failed to improve outcome. Studies on Shared Decision-Making in mental health are encouraging but somewhat ambiguous in addiction treatment.

Objective: This study investigated whether self-matching (Informed Choice) to treatment improves alcohol consumption, retention, and quality of life.

Method: 402 consecutive clients (female 46.7 %, mean age 47.4) seeking treatment for alcohol use disorder at the outpatient clinic in Odense, Denmark were enrolled in this single-blinded randomized controlled trial. Clients randomized to the intervention group watched an 8-minute video presentation of the treatments and then chose the treatment they preferred. Clients in the treatment as usual (TAU) group were allocated to treatment by an evidence-based algorithm. Measurements on alcohol consumption, quality of life, and retention in care were completed at baseline and 6-month follow-up.

Results: There was no significant difference on primary and secondary outcome measures between the Informed Choice group and TAU group at 6-month follow-up. 80 % of clients in the Informed Choice group were satisfied with being randomized to self-matching whereas 24 % in the TAU group were satisfied with being assigned by expert matching.

Conclusion: Our hypothesis, that outcome is improved if clients choose their own treatment, was not supported. However, an important finding is that client self-matching is just as beneficial as expert matching.

Keywords: Addiction; Alcohol use disorder; Informed choice; Medical decision making; Treatment planning.