Desire to stop drinking could be more important than therapy

July 13, 2005

The positive outcomes of therapy for alcoholism may have less to do with the therapy itself and more to do with participants' determination to quit. These are the findings of a study published today in the Open Access journal, BMC Public Health, which provides a new analysis of previous data from Project MATCH, a clinical trial of three common forms of therapy used for the treatment of alcoholism. This analysis shows that the participants in the trial who attended all sessions did scarcely better than those who received no treatment. This contradicts previous analyses, which concluded that all three therapies for alcoholism were very effective.

The results highlight the importance of selection bias - the distortion of a statistical analysis by self-selection of participants. Individuals who come forward to take part in trials such as Project MATCH might be more likely to have positive outcomes. "Alcoholics who decide to enter treatment are likely to reduce drinking. Those who decrease their drinking are more likely to remain in treatment", explain Robert Cutler and David Fishbain from the department of psychiatry and behavioural sciences at the University of Miami, the authors of the study.

A fundamental principle underlying the treatment of alcoholism, and other addictions, is that psychosocial therapy - therapy involving both group meetings and personalised sessions with psychologists - is effective.

Cutler and Fishbain re-examined data from Project MATCH - a large trial carried out in the late 1990's, which concluded that therapy for alcoholism produced excellent outcomes, although the results were controversial and inconclusive.

Project MATCH assessed the effectiveness of three different therapies: Cognitive Behavioural Therapy (CBT), Motivational Enhancement Therapy (MET) and Twelve Step Facilitation (TSF). Cutler and Fishbain investigated the relationship between the number of therapy sessions attended and how successful project MATCH participants had been at reducing and abstaining from drinking. For all patients, drinking outcome was measured in two ways, percent days abstinent (PDA) and drinks per drinking day (DDD).

In one analysis, the participants of the study were divided into three groups: those who had attended either none, one, or all twelve of the treatment sessions. Overall, Cutler and Fishbain's data showed that participants who attended all twelve sessions had better outcomes, but there was only a very slight improvement over participants who attended no sessions. For participants who attended the twelve treatment sessions, PDA increased by 60% almost immediately, at week one, but increased by only a further four percent during the following 11 weeks of treatment. The researchers also found that participants who dropped out before the program even began had significantly better outcomes at the end of the program than those who dropped out after one session. In the long-term, the number of treatment sessions attended had a poor correlation with the outcome.

From the data, the authors conclude that "current psychosocial treatments for alcoholism are not particularly effective", and that "most of the improvement which is interpreted as treatment effect is not due to treatment". The authors attribute their findings to the importance of 'self-selection'; i.e., that patients who reduce their alcohol consumption are more likely to enter or remain in treatment, and those who are drinking are more likely to drop out of treatment. According to the authors if these patient characteristics are more important than attendance at therapy, then this "would have a profound influence on alcoholism treatment because it would shift focus away from treatment components and toward patient characteristics".
-end-
This press release is based on the article:
Are alcoholism treatments effective? The project MATCH data
Robert B Cutler and David A Fishbain
BMC Public Health 2005, 5:75 (14 July 2005)

This article is available free of charge, according to BMC Public Health's Open Access policy at:
http://www.biomedcentral.com/1471-2458/5/75/abstract

BioMed Central

Related Alcoholism Articles from Brightsurf:

Alcoholism treatment is potentially effective against COVID-19
A team of chemists from HSE University and the Zelinsky Institute of Organic Chemistry used molecular modelling to find out that two medications that have been known for a long time can be used to fight SARS-CoV-2.

Alcoholism without borders
In some former Soviet bloc countries, men often die early due to alcohol abuse.

Study reveals genes associated with heavy drinking and alcoholism
A large genomic study of nearly 275,000 people led by Penn Medicine researchers revealed new insights into genetic drivers of heavy drinking and alcohol use disorder (AUD), the uncontrollable pattern of alcohol use commonly referred to as alcoholism.

Social anxiety disorder may increase risk of alcoholism
New research published in Depression and Anxiety indicates that, unlike other anxiety disorders, social anxiety disorder may have a direct effect on alcoholism.

Study identifies new target to prevent, treat alcoholism
New research conducted at OHSU in Portland, Oregon, identifies a gene that could provide a new target for developing medication to prevent and treat alcoholism.

It's all in your head: Brain protein targeted for alcoholism cure
University of Houston chemist Joydip Das is reporting a cure for alcoholism could be found in a protein inside the brain that plays a big role in developing tolerance to drinking.

Building and breaking connections: How neuronal networks influence alcoholism
Although it has been known that alterations in the connections between neurons in the brain likely play a role in alcohol dependence and other addictions, the cause-and-effect between these brain alterations and behavior has been less clear.

Where to look for new treatments for alcoholism? The matrix
A new study in Biological Psychiatry may pave the way for treating alcohol addiction by reducing motivation to drink, rather than by altering the effects of alcohol itself.

Could OTC medicines be the answer to alcoholism?
The study is determining if two over-the-counter (OTC) medications can diminish alcohol abuse in diagnosed bipolar patients.

Alcoholism may be caused by dynamical dopamine imbalance
Researchers from the Higher School of Economics, Ecole Normale Supérieure, Paris, Indiana University and the Russian Academy of Sciences Nizhny Novgorod Institute of Applied Physics have identified potential alcoholism mechanisms, associated with altered dopaminergic neuron response to complex dynamics of prefrontal cortex neurones affecting dopamine release.

Read More: Alcoholism News and Alcoholism Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.