It is rather amazing that the US government spent 35 million dollars on a project as flawed and fraudulent as project MATCH. Project MATCH purported to compare 12 Step Treatment with Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET), but in actuality it did nothing of the kind. The first huge problem with Project MATCH was that the 12 Step Facilitation Therapy (TSF) used in Project MATCH bears no resemblance to any 12 step treatment programs available to the public and also no resemblance to the original 12 step program, AA. The TSF used by Project MATCH incorporated huge amounts of Harm Reduction and this is why it was successful.
In standard 12 Step Treatment Programs clients are kicked out of treatment if they relapse. If not discharged they are hugely shamed and degraded for their relapse. Project MATCH, on the other hand, told clients that they should value every one of their abstinence days and not beat themselves up for relapse. They were told that the total number of abstinence days was far more important than the number of consecutive abstinence days. They were not shamed, degraded, or kicked out of treatment for relapse. These are PURE HARM REDUCTION STRATEGIES which are not to be found in any 12 step treatment program you will pay money for in the US.
Imagine walking into an AA meeting and declaring that you were doing really great because you had abstained from alcohol for 20 days of the last 30. Anyone attempting such a thing would get a clear message from everyone’s subsequent “shares” that they were an alcoholic in denial and leading themselves down the road to death be thinking that they could control their drinking instead of surrendering to God.
Why did Project MATCH conduct such a fraudulent study instead of just looking at 12 step treatment as generally available in the US? The answer to this is quite simple. A huge controlled trial of standard 12 step treatment, CBT, and Psychodynamic Therapy called Project SHARP had already been conducted by Jeffrey Brandsma and his colleagues in the 1970s. What this study had shown us was that 12 step treatment programs are a resounding failure. Two thirds of clients assigned to the 12 step treatment groups dropped out. Only one third of clients assigned to CBT, Psychodynamic Therapy, or the control group dropped out. Clearly a therapy cannot be successful if it drives the clients away and they don’t complete it. What Project MATCH demonstrated was that even something is poor as 12 step treatment can be made successful if you add enough Harm Reduction elements to it.
A second huge flaw of Project MATCH was the lack of a control group. Even a high school science student knows that the results of your experiment are meaningless unless you have a control group to compare them to. Perhaps Project MATCH should have spent some of their 35 million dollar budget to hire a high school science student to do the project design for them. All studies of people with alcohol dependence show that a control group which receives no treatment at all always shows significant improvements over baseline. In fact, the NESARC study showed us that the natural outcome of alcohol dependence is recovery without treatment and without AA, albeit it can take up to 20 years for this recovery to take place. This study showed us that 75% of people with alcohol dependence recovered–and three fourths of those who recovered did so without treatment and without AA.
Moreover, it is essential to compare a treated group with a control group over a long period of time to show that the changes brought about by the treatment are permanent and do not disappear with the passage of time. In the Brandsma study at the three month follow up the treated groups showed significantly better outcomes than the control group on numerous measures including: number of times the subject stopped at one or two drinks, number of ounces of alcohol consumed over the 90 day period, number of drinking days in the 90 day period, and the number of times the subject abstained from alcohol for more than one day. However, at the one year follow up period there was only one significant difference between the treated groups and the control group: that was the total number of drinking days. All the other significant differences had disappeared by the time one year had passed.
Enoch Gordis, former head of the NIAAA, claimed that Project MATCH demonstrated that treatment worked, regardless of what the treatment was. This statement is eminently false. Without a control group and a lifelong follow up we have no idea if the treatments had any real impact at all. Moreover, testing treatments which are not available to the general public tells us nothing about the effectiveness or ineffectiveness of those treatments which are available to the general public.
Project MATCH proved that Harm Reduction works. However, I will bet that there is not a single 12 step treatment program in the United States toady where you will find the Harm Reduction strategies from Project MATCH incorporated into the treatment program. Rather than waste 30 thousand dollars on a treatment program that does not work and may well make you sicker than you were when you started, you can just stay home and read a good book about quitting or controlling your drinking. Or if you want a support group, SMART, HAMS and some others are free and are based on scientifically tested principles which are proven to work.
Or you could even go to AA if you like that kind of approach–it is not for me but some of my colleagues like it. At least it is free.
Brandsma, J.M., Maultsby, M.C., & Welsh, R.J.. (1980). Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.
NIAAA (2009). Alcoholism Isn’t What It Used To Be. NIAAA Spectrum. Vol 1, Number 1, p 1-3. http://www.spectrum.niaaa.nih.gov/media/pdf/NIAAA_Spectrum_Sept_09_tagged.pdf
NIAAA (1995).Twelve Step Facilitation Therapy Manual, 123 pp. NIH Pub. No. 94-3722.
NIAAA (1994).Motivational Enhancement Therapy Manual, 121 pp. NIH Pub. No. 94-3723..
NIAAA (1995).Cognitive-Behavioral Coping Skills Therapy Manual, 101 pp. NIH Pub. No. 94-3724.
Copyright © 2012, The HAMS Harm Reduction Network