ABSTRACT
Matching treatments according to the specific needs of alcoholic patients has evoked considerable interest among researchers, practitioners, and policy-makers. Scientific literature on “patient-treatment matching” is reviewed in this chapter. The primary emphasis is on the results of Project MATCH, a multisite U.S. trial of patient-treatment matching comparing three different psychotherapeutic treatments: Twelve-Step Facilitation (TSF), Cognitive-Behavioral Therapy (CBT), and Motivational Enhancement Therapy (MET). Project MATCH tested 21 predicted matches. Only four were verified — three in the outpatient cohort arm and one in the aftercare group (i.e., those who had a period of inpatient, residential, or day hospital treatment just prior to being treated with one of the MATCH therapies). Among the outpatients, those high in anger had better outcomes when treated with MET, and those with a social network permissive of drinking or who were low in psychiatric severity benefited more from TSF. The match between patients low in psychiatric severity and TSF treatment did not persist 1 year after treatment. Those patients initially treated as inpatients and who were higher in severity of dependence benefited more from TSF. While these results only weakly support the patient-treatment matching hypothesis, they do suggest that there will be some incremental improvement in treatment outcome if outpatients are screened for anger, type of social network, and psychiatric severity and aftercare patients for severity of alcohol dependence.
