Project MATCH Gets an F in Psych 101

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.”

http://www.alleydog.com/glossary/definition.php?term=Confound

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).”

http://www.alleydog.com/glossary/definition.php?term=Control%20Condition%20%28control%20group%29

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.

REFERENCES:

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

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The Difference Between A Moderate Drinking Program And An Alcohol Harm Reduction Program

Moderate drinking programs are aimed primarily at early stage problem drinkers who wish to stay within moderate drinking limits, such as the NIAAA limits of 4 standard drinks daily and 14 weekly for men and 3 daily and 7 weekly for women. Research such as that of Martha Sanchez-Craig shows that these programs can be quite effective with early stage problem drinkers but that those with more severe problems are less likely to stick to such limits.

An alcohol harm reduction approach is aimed at all drinkers but in particular offers options to those who are unwilling, unable, or not yet ready to abstain from alcohol. A harm reduction approach always supports successful abstinence or successful moderation as ways to resolve alcohol problems, but in addition it offers options for those who are not abstaining or sticking to moderate limits.

Just as it is true that the more heroin one shoots, the more one needs clean needles, so it is true that the more alcohol related problems one has the more one needs to apply harm reduction strategies to deal with them.

The old idea that people with drug or alcohol problems need to “hit bottom” in order to change has been quite discredited. The reality is that many people who use drugs or alcohol do so because they have suffered trauma, and increasing their trauma only serves to increase their drug or alcohol use.

People often need to be built up to get strong enough to recovery from their drug or alcohol problems—tearing people down dos not help. Helping people to reduce drug or alcohol related harm and to improve mental, physical and financial health does NOT enable people to continue their addiction, rather it enables people to recover.

Sometimes recovery can be defined in terms of abstinence, and sometimes it is defined in terms of non-problematic drug or alcohol use.

However, it is always of the first importance to keep people alive and healthy. Safety first. Because once you are dead you are beyond recovery.

   Copyright © 2012, The HAMS Harm Reduction Network

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The Stages of Change Model Vs. the “Hitting Bottom” Model

When Prochaska et al did their extensive research on the change process they did not find evidence that a dramatic and traumatic event such as AA’s notion of “hitting bottom” caused people to change their behaviors. What they found instead was that change occurred in six distinct stages:

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination

In precontemplation people are not even thinking about making a change. In contemplation mode people are thinking about making a change. A trigger is needed to move people from precontemplation to contemplation–we will call this trigger the “tipping point.” However, this tipping point does not have to be something huge and dramatic like AA’s conception of “hitting bottom”; it can be an accumulation of small things or even just one non-dramatic incident. My tipping point for deciding to quit cigarettes was my 5 year old adopted nephew’s insistence that I quit so that I didn’t die like his grandmother had.

Then why does AA talk about the need to “hit bottom”? “Hitting bottom” is a very useful tool when we look at the process of Religious Conversion. Religions with a tradition of intense proselytization such as the Hare Krishnas or the Unification Church (Moonies) seek out people when they are at their most vulnerable, because this is when people are ripe for religious conversion. For example, the Cult Hotline and Clinic tells us that, “Everyone has the potential to be susceptible to cult recruitment and coercion at particularly vulnerable points of their life.

Transitional times tend to increase vulnerability:

  • During a vacation
  • First year away at school
  • A year “off” or after graduation
  • A job change or loss
  • After suffering any loss
  • Upon reaching new life stages
  • Following the break-up of a relationship
  • Soon after moving to another city or country
  • During a search for meaning, or to “find oneself.”
  • Lonely, without, or away from friends or family”

http://www.cultclinic.org/qa6.html

Religious proselytization in AA is known as “doing 12th step work.” The 12th step says, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” In fact, the “Big Book” essentially says that proselytizing others is necessary to avoid an alcoholic death: “Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics. It works when other activities fail.” (Big Book p. 89) AA finds ripe grounds for converts by battening on people who have lost wives, or jobs, or who are in prison or hospitals due to their drinking. Since vulnerability makes one ripe for religious conversion it is no wonder that so many AA members speak of how they affiliated with AA after another AA member approached them when they had “hit bottom.”

Can a dramatic and traumatic event such as “hitting bottom” trigger change in the absence of an AA recruiter who fastens onto the vulnerable person? Yes it is possible that the “tipping point” can be triggered by a dramatic and traumatic event. However, it is far more likely that such an event will lead to increased drinking or drug use than it will to stopping drinking or drug use. “Tough Love” approaches which seek to traumatize people in order to make them “hit bottom” are more likely to lead to increased drinking and drugging than to reform. The evidence shows that the more resources which people have intact and the less they are traumatized, the better their chances of recovery. A harm reduction approach which minimizes the damages caused by drugs and alcohol will have far more success in leading people to recovery than will torture therapy. Torture therapy is practiced by sadists and not by the compassionate–they have been with us to prey on the weak, vulnerable, and socially rejected in every generation from the concentration camps of Nazi Germany to the Tough Love camps of the American addiction treatment system. The evidence shows that the normal outcome of addiction is spontaneous remission; torture therapy camps prevent spontaneous remission and lead to greater drug and alcohol use than no treatment at all.

In conclusion, “hitting bottom” is great for leading people to religious conversion and affiliation with AA; however, hitting bottom is not necessary for changing an addiction and may actually lead to deeper addiction instead. AA itself often becomes the new substitute addiction for those who “hit bottom.” By way of contrast, harm reduction enables recovery from addiction.

REFERENCES:

Denning P, Little J. (2011). Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions. The Guilford 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

Prochaska JO, Norcross JC, Diclemente CC. (1994). Changing for good. New York, Avon Books.

Wilson, W. (1939, 1976). Alcoholics Anonymous. New York: Alcoholics Anonymous World Services.

Wilson, W. (1953). Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services.

  Copyright © 2012, The HAMS Harm Reduction Network

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Drinking Again

If you have successfully resolved your problems with alcohol via long term (6 months or more) abstinence from alcohol then HAMS urges you to use great caution before you consider drinking again. Studies (NIAAA 2009) show that about half of persons with Alcohol Dependence resolve the problem by quitting completely. HAMS is always supportive of total abstinence as a recovery goal; since the “A” in HAMS stands for Abstinence we like to say that “Quitting drinking is our middle name.” Harm reduction strategies are aimed at those who are unwilling, unable, or not yet ready to abstain from alcohol. This includes people who have attempted abstinence and ultimately not succeeded at it but instead have gone on major benders after short abstinence periods. It also includes those who have never attempted abstinence or who currently have no interest in abstinence. Increased trauma produces increased drinking (Denning & Little 2011). The more resources people have intact, the better their odds of achieving recovery–whether abstinent or non-abstinent recovery. Harm reduction helps keep people’s resources intact enabling them to recover more quickly and easily than if they lost all.

If you are succeeding at abstinence and your alcohol related problems have disappeared or are disappearing then we strongly urge you to continue with what you find to be working–i.e. abstinence. However, if you have already decided that you are going to dink again then HAMS is a safe place to experiment with controlled drinking and you will be far safer here than if you attempt this on your own with no support at all.

If you are wavering and have not yet decided whether or not you wish to drink again then we strongly suggest that you do a Cost Benefit Analysis (aka a Decisional Balance Sheet) which compares the pros and cons of continuing to abstain with the pros and cons of drinking again. We also suggest that you write out a list of alcohol related losses and problems and a list of what you have gained as a result of abstinence from alcohol.

Some people are more likely to succeed in drinking again than others:

People whose drug of choice was not alcohol. If you went to rehab for heroin or some other drug which was not alcohol you were probably told that you were cross addicted to all mood altering drugs and that you must never drink again or you would relapse. The simple fact is that this is not true. You may well have noticed your rehab counselors using mood altering drugs like caffeine and nicotine all the time and not calling this a relapse. The fact is that if you try to use alcohol as a direct substitute for heroin and get as drunk as possible all the time instead of shooting heroin then you will certainly have alcohol problems. However, if you get your life together and become a whole new person with a whole new life there is no chemical reason in your brain why you should not have an adult beverage at times. Opioids are directly cross-tolerant with each other; they are only slightly cross-tolerant with alcohol. Other drugs like speed are not cross tolerant with alcohol at all.

We do, however, very strongly recommend that if you are an ex drug user who is choosing to drink in moderation that you track your drinks by charting. Keeping a drinking chart will help you keep your drink numbers under control and let you know if you are starting to slip out of bounds. If you find your drinking is showing a tendency to “creep” up more and more you might wish to opt to return to abstinence from alcohol. We also strongly suggest that you do your experimenting within the safety net of a HAMS group and that you write out a Cost Benefit Analysis.

Another group who may tend to succeed with drinking again are those who were sowing a lot of wild oats in high school or college and wound up in rehab or an abstinence program in their teens or early twenties. If you are now in your forties you might have matured a great deal and no longer be interested in being the wild man. If you now find that moderate drinking is appealing to you but the thought of being a drunk teenager throwing up on your date’s shoes at a party is repulsive to you then you may well find success at becoming a moderate drinking. Again we suggest that you do your experimenting within the safety of a HAMS group and that you chart and do a Cost Benefit Analysis.

If you had a long drinking career and a long history of alcohol related problems then the odds of returning to controlled drinking are greatly reduced. The longer the drinking career and the more problems the lower the chances of successful controlled drinking.

If you think that you have a shot at becoming a successful controlled drinker, then write down what it is that has changed in your situation that you believe will make you a successful controlled drinker this time around. If nothing has changed then it may well be excruciatingly difficult to try to use the HAMS harm reduction and moderate drinking tools to become a controlled drinker. Not only may you find that your odds of success are low, but you may also find that staying within the moderate drinking limits you have set for yourself is a form of torture and that abstinence is far simpler and more pleasant.

HAMS harm reduction strategies are not a magic bullet which can turn everyone into a successful controlled drinker. For many, many people abstinence remains the best choice. Abstinence is simple and clear cut and avoids the problem of shades of gray

And whether you opt to continue to abstain or you choose to drink again, always remember that you and no one but you are responsible for your choices.

REFERENCES:

Denning P, Little J. (2011). Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions. The Guilford 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

  Copyright © 2012, The HAMS Harm Reduction Network

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To Abstain, or Not To Abstain

Choosing your goal:

The main choice is between an abstinence goal and a non-abstinence goal. Goals of safer drinking and reduced drinking are not really at odds with each other very much. You will have to be honest with yourself about successes and failures you have had with a goal of controlled drinking in the past as well as be honest with yourself about successes and failures you have had with a goal of abstinence in the past. It is worth writing down two lists—one of successes and failures with the abstinence goal and one with successes and failures with the non-abstinence goal.

If you are currently abstaining and are considering experimenting with controlled drinking, we suggest that you follow each drinking session the following day with a written evaluation of what worked and what didn’t.

We also suggest that yo write out a Cost Benefit Analysis of the pros and cons of adopting an abstinence goal and the pros and cons of adopting a non-abstinence goal.

Harm reduction is aimed at those who are unwilling or unable to abstain—it is not a magic bullet to allow successful abstainers to drink again as much as they want with no consequences.

If you choose abstinence as your goal then we suggest that many people may find it helpful to participate in an abstinence-based group as well as in HAMS. If HAMS is the only group that you use then you might find that constantly hearing others talk about controlled drinking strategies is a temptation to pull you away from your abstinence goal.

HAMS always supports abstinence as a goal. However, the evidence shows that the traditional notion of “hitting bottom” is erroneous. People often use alcohol or drugs to cope with trauma, and increasing the trauma increases the drug or alcohol use. The more resources that people have intact, the more likely they are to succeed in either a goal of abstinence or in non-abstinent recovery. Stripping people of all they own  in an attempt to force then into AA is less successful than doing nothing at all. After all, research tells us that the normal outcome of addiction is recovery without AA and without treatment.

Many people find that their first step towards abstinence is through harm reduction.

 Copyright © 2012, The HAMS Harm Reduction Network

 

 

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The Way to Stop DUI Is to Stop People from Driving

The way to prevent fatalities due to impaired driving is to stop people from driving. This means building workable public transportation in every city in the US and penalizing people for driving instead of using public transportation in all ways possible. The way to fund public transportation is with prohibitively high taxes on gasoline as well as instituting toll roads everywhere as well as closing many city streets to private automobiles. We also need to pass a law against bars having parking lots and we should make the breathalyzer ignition interlock standard on every automobile in the US just like seatbelts.

In Japan in 1993 there were 525 drunk driving fatalities for a population of 124.7 million people. In other words, 0.000004210104 drunk driving fatalities per capita. Compare this to the US. In 1991 in the US there were 22,083 drunk driving fatalities for a population of 252,127,402 people. In other words 0.000087586672 drunk driving fatalities per capita.

In other words, there are 20.8039212 times as many deaths caused by drunk driving in the US than there are in Japan!

The reasons why are pretty damn obvious to anyone who has ever lived in Japan. Japanese bars do not have parking lots. The drunks are all on the subway and not in automobiles. In Japan public transportation is the norm for everything and driving is the exception.

In Japan only five percent of traffic fatalities are caused by drunk driving, in the US this number is fifty percent.

Isn’t it pretty obvious what we need to do to stop drunk driving in the US?

But don’t expect MADD to start campaigning for better public transportation any time soon. MADD is funded by DaimlerChrysler, General Motors and Nissan. Can you spell conflict of interest, boys and girls?

REFERENCES:

Mothers Against Drunk Driving: A Crash Course in MADD by David J. Hanson, Ph.D. http://alcoholfacts.org/CrashCourseOnMADD.html

Drunk Driving in Japan http://www.dui.com/dui-library/foreign/dui-japan

Copyright © 2012, The HAMS Harm Reduction Network

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Project MATCH Proves That Harm Reduction Works And 12 Step Programs Don’t

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.

REFERENCES

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

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