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3 Alcoholism Therapies Found Equally Effective
Los Angeles Times
WEDNESDAY, DECEMBER 18, 1996
Page:A17
By MARLENE CIMONS
TIMES STAFF WRITER
* Health: Study weakens long-held beliefs, shows that the 'l2-step,'
cognitive and motivational treatments work well, despite wide variety of
patients.
WASHINGTON-A ground breaking study of alcoholism treatment has reached
the surprising conclusion that all three leading behavioral approaches
work equally well for a wide variety of patients, regardless of sex,
psychological condition, motivation or the extent of their drinking
problems.
The findings undermine long-held beliefs about the nation's nearly 14
million alcoholics. Treatment professionals have long thought that each
of the three therapies was most effective on patients who showed certain
traits.
For example, experts believed that individuals who demonstrated severe
drinking problems, and who typically were under heavy social pressure
from friends and family to drink, responded better to the "12-step"
program similar to that provided by Alcoholics Anonymous.
Similarly, cognitive therapy was thought to work best for women and for
those who suffer from psychological problems, while motivational therapy
was considered best for those with "low degrees of motivation,"
according to Thomas F. Babor, a professor of psychology at the
University of Connecticut School of Medicine and a researcher on the
study.
But the ambitious eight-year study sponsored by the National Institute
on Alcohol Abuse and Alcoholism showed that those considered best served
by "12-step" programs-and others-appeared to do equally well using any
one of the three therapeutic approaches.
The popular theories "in general, did not pan out," said Dr. Enoch
Gordis, director of the Institute. "The goal of science is not to find
out what we'd like to believe but what is." The results of "Project
MATCH" can be reassuring because patients "do not have to worry that
something better might have been achieved with another treatment,"
Gordis said.
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The findings appear in the January 1997 issue of the Journal of Studies
on Alcohol, the oldest journal in the field of alcohol research. Alcohol
abuse and alcohol dependence are regarded as serious conditions in this
country. More than 100,000 people die annually from alcohol-related
causes, including cirrhosis of the liver, suicide and accidents.
Those suffering from alcoholism are also prone to other health problems,
including neurological disorders, cardiovascular damage, pancreatic
disease and other liver ailments.
The condition also exacts a major toll not only on the lives of drinkers
but on their families and friends as well.
Alcoholism is regarded as a complex disorder that involves numerous
factors, including a genetic component.
Experts believe that alcoholism can be treated in a variety of ways,
including behavioral therapy and, for some people, the use of drugs --
or a combination of both. This study looked only at behavioral therapy.
The research examined three types of 12-week programs. "12-step"
therapy, cognitive therapy and motivational therapy.
The 12-step approach encourages patients to participate in traditional
Alcoholics Anonymous activities that promote fellowship among recovering
alcoholics. The AA formula emphasizes 12 "steps" to recovery, beginning
with "acceptance" and "surrender." Those with the most severe drinking
problems were thought to do better with the 12-step approach.
The cognitive approach is designed to help patients develop skills to
control their thoughts about alcohol and deal with urges to drink, Babor
said. Patients are taught, for example, how to refuse a drink in
high-risk situations and how to manage negative moods that might lead
them to drink.
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Motivational therapy Babor said is designed to help patients rally their
personal reResources and promote their individual responsibility to
abstain from drinking. It presents the ability to change as a force to
be unleashed within each patient, rather than something be learned from
a therapist.
For the study, researchers recruited 1,726 patients and screened them
for Individual traits, such a the severity of their drinking problems,
their level of motivation to overcome them and the extent of their
psychological problems. The patients were then enrolled in two parallel
arms of the study that matched them to various treatments.
In addition, some patients received only outpatient care, while others
received inpatient or day hospital treatment combined with after-care
therapy. All the participants showed "significant and sustained"
improvement in the number of days the abstained from alcohol and a
decreased number of drinks on those days they drank, researchers said.
"The striking differences in drinking from pre-treatment levels to all
follow-up points suggest that participation in any of the MATCH
treatments would be associated with marked positive change," Babor said.
Before treatment, patients drank about 25 days out of the month and
consumed large quantities of alcohol. The treatments reduced their
drinking to about six days a month, with less consumed during each
episode, "regardless of the treatment patients received," said Gerard J.
Connors, senior research scientist with the New York State office of
Alcoholism and Substance Abuse Services.
There were only a few differences among the three treatments in either
treatment arm. For example, outpatients who received 12-step treatment
were more likely to remain completely abstinent the following year than
outpatients who received the other treatments. Researchers also found
that out-patients with moderate psychological problems did somewhat
better with the 12-step program than with other approaches, although
that match was not among those believed appropriate at the outset of
the study.
The patients also showed declines in the use of other drugs and
depression and improved liver function, improvements that were
maintained throughout the 12 months following treatment, when most
relapses typically occur, the researchers said.
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