If I made a wiener out of fifty percent pork and fifty percent beef and labeled it and sold it to you as a 100% all beef kosher hot dog would I be committing fraud? Of course I would! But this is exactly what the NIAAA did with their 12 Step Facilitation Therapy in Project MATCH. If you get a copy of the Project MATCH 12 Step Facilitation Therapy manual (which you can buy form NIAAA for 6 bucks) you will clearly see that what Project MATCH calls 12 Step Facilitation Therapy is comprised of about fifty percent Alan Marlatt’s Relapse Prevention strategies and about fifty percent an interpretation of the first three steps of AA.
The Relapse Prevention strategies incorporated into Project MATCH’s 12 Step Facilitation Therapy are in diametrical opposition to both AA principles and the standard treatment practices found in 12 step treatment programs in the United States. For example, in typical US 12 step treatment programs it is standard operating procedure to kick people out for admitting to or getting caught using drugs or alcohol aka “having a relapse.” And although people are not kicked out of AA for “having a relapse” they are told that they have lost all their sober time and must start counting the days over again from day one. They are also told that they have lost all their progress and are back to square one. This also is standard procedure in the rare cases where relapsers are not kicked out of US 12 step treatment programs,
In the 12 Step Facilitation Therapy of Project MATCH, however, relapsers were told that every day which they abstained from alcohol was progress and a triumph whether the days were consecutive or not. No one was kicked out for relapsing. In fact, success was measured in terms or total number of alcohol free days instead of consecutive days and instead of making total abstinence a requirement! Can you imagine walking into an AA meeting and telling people that you are doing really well because you abstained 20 days out of the last 30? You would be shamed out of the room. You would be told that you had the “disease of denial.” Cherishing every day abstained comes straight out of Marlatt’s Relapse Prevention Counseling which is an evidence-based harm reduction strategy.
The simple fact is that it is impossible to tell in Project MATCH whether the results are a product of the 12 step element of the therapy or the relapse prevention aspect of the therapy. In Psych 101 we call this a “confound.” Here is a definition of a confound:
“Confounding is when a researcher does not control some extraneous variables that may influence the results…the only variable that should influence the results is the variable being studied. If a variable other than the one that is manipulated by the researcher has any affect at all on the measurements, then the study is said to be confounded. This is a very serious problem since the researcher can’t really claim that he/she established cause and effect. If the researcher is studying the effect of some pain medication (drug A) on the reduction of pain, but the researcher fails to control for participants taking other medications at the same time, how can the researcher claim that the results are due to the pain medication (drug A) or the other drugs that participants took? When the researcher controls all extraneous variables and can claim that only the variable that was manipulated has any effect on the results, the study is said to have internal validity.”
Everyone who takes Psych 101 is taught that they must avoid confounds in their experiments or their experiments will be invalid. Didn’t any of the researchers who designed Project MATCH take Psych 101?
We can, however, if we refer to certain other experiments make a good guess as to whether the Project MATCH results were due to the 12 step component of the treatment or the Marlatt Relapse Prevention component of the treatment. Brandsma et al (1980) studied a 12 step treatment which is representative of the typical 12 step treatment programs found in US treatment centers and found that it was highly ineffective since two thirds of the clients assigned to the 12 step treatment condition dropped out. Only one third of those assigned to the other treatment conditions dropped out so the other conditions were about twice as effective. Because of the high drop out rate it was impossible to tell whether those in the 12 step condition did better than the control group or not.
One other bit of evidence we have is that Marlatt’s Relapse Prevention strategies have been tested and proven effective in clinical trials (Marlatt 1985).
A second reason that Project MATCH gets an F in Psych 101 is that there was no control group!! This is not even Psych 101, this is so elemental that it is high school science!! This is the definition of a control group:
“During many experiments, researchers often include treatment groups (the groups that are given the treatment/IV) and a control group, which is identical to the treatment group in every single way except that the control group does not get the treatment. In this way, the researcher can study effect(s) of the treatment thoroughly. For example, if I am studying the effects of 2 different pain medications of headaches, I may give people who have headaches (the treatment groups) either Tylenol or Bayer. I can then wait one hour and ask participants to rate the level of pain they are experiencing. If the amount of pain in one group goes down significantly more than the other, I may conclude that one medication is more effective than the other in reducing headache pain. However, I can’t say that either are more effective than giving nothing at all. Maybe there was a placebo effect, and simply getting a pill made people believe their pain was reduced. So, I could include another group – a control group – which is treated and exposed to everything the other groups are except that they are given a placebo (maybe a sugar pill) instead of either Tylenol or Bayer. (Also see Experimental Condition).”
We have to conclude that the designers of Project MATCH were either knaves or fools to come up with an experiment this bad, deceptive, and meaningless. Were they fools who were ignorant of this much elementary science? I sincerely doubt it.
There exists a multibillion dollar 12 step treatment industry in the US and the bottom would fall out if the public knew that it is paying for something which is not merely totally ineffective but quite possibly did more harm than good. There was one hell of a monetary incentive for a fraudulent experiment and that is exactly what we got in Project MATCH.
Here is one other thing which we learned from the Brandsma study and this is surely the reason that Project MATCH deliberately avoided having the necessary control group.
At the end of treatment in the Brandsma study there were significant improvements in the groups which received CBT or psychodynamic therapy when compared to the control group–the 12 step group was not comparable because of the high drop out rate. At the three month follow up there were significant differences on 10 different variables. At the six month follow u p there were only significant differences on four different variables. At the 12 month follow up there were only significant differences on one variable: Total Days of Drinking.
It was not just that some of the gains of treatment were lost. The control group itself got significantly better in its drinking habits with no treatment at all. This is very common in Psych experiments. Since improvement without treatment is the norm a control group is always essential for any meaningful results in any Psych experiment!
Of course of Project MATCH had had a control group we would be able to still compare the treated group with the control group now these many years later. The odds are very strong that there would be no difference at all between the treated group and the untreated group.
The only conclusion we can derive from Project MATCH is that TREATMENT DOES NOT WORK.
If it worked the fraud would be unnecessary.
On the other hand harm reduction does work. Ten million clean needles can’t be wrong.
Brandsma, J.M., Maultsby, M.C., & Welsh, R.J.. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.
Marlatt GA, Gordon JR. (1985). Relapse prevention : maintenance strategies in the treatment of addictive behaviors. New York, Guilford Press
NIAAA (1995).Twelve Step Facilitation Therapy Manual, 123 pp. NIH Pub. No. 94-3722.
Copyright © 2012, The HAMS Harm Reduction Network