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For several decades it has been suggested that matching alcoholic patients to treatments based on their particular characteristics may have the potential to improve alcoholism treatment outcomes. This idea developed from observations that alcoholics differ and that while many benefit from treatment, no single treatment has been shown to be effective for all. In fact, in many areas of medicine, matching patients to treatments on the basis of patient characteristics is widely practiced; for example, patients with a cancer diagnosis may be matched to surgery, radiation, or chemotherapy.
Interest in matching for alcoholism treatment accelerated as evidenced from more than 30 studies accumulated in the literature (1). These studies examined the interaction between a number of treatment approaches (e.g., coping-skills training, interactional therapy, or relationship enhancement) and patients with particular characteristics to determine whether certain patients would benefit more from one type of treatment than another. Examples of the patient characteristics that were matched to particular treatments included psychiatric severity, sociopathy, cognitive impairment (2,3), and high or low social support (4).
These studies indicated that some treatment approaches were more effective than others for patients with certain characteristics. For example, Kadden and colleagues (2) found that coping-skills training was more effective than interactional therapy at the end of 6 months of treatment in preventing relapse among patients with more psychiatric problems or higher in a rating of sociopathy. These patients were followed for an additional 18 months after treatment, and these matches were still present at the end of this followup period (3). Contrary to their expectations, the researchers found that patients with cognitive impairment had better outcomes when treated with interactional therapy than with coping-skills training. In addition, Kadden and colleagues (5) found that patients who reported less anxiety and fewer urges to drink during their first skills training session experienced better outcomes with interactional therapy than with coping-skills training. Conversely, those who reported more anxiety or more urges to drink experienced better outcomes with coping-skills training than with interactional therapy (5).
Longabaugh and associates (4) studied patients randomly assigned to individually focused cognitive-behavioral treatment (a treatment in which patients are taught to cope with drinking-related stresses) or a combination of couples therapy and brief cognitive-behavioral treatment. They found that those patients with high social support did well with either treatment, and those with low support did better with cognitive-behavioral therapy. In this same study, they also found that patients who met DSM-III criteria for antisocial personality (ASP) drank less per drinking day if treated with cognitive-behavioral therapy than with relationship enhancement therapy. Both treatments were equivalent for patients without ASP (6).
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