Prior to the disappointing findings of PROJECT MATCH, patient-treatment matching was viewed as a promising paradigm for increasing alcohol treatment effectiveness. The paucity of findings to support matching treatment modality to patient attribute in MATCH has led researchers to largely abandon this paradigm. However, further study has used observer ratings of therapist interventions from one MATCH aftercare site to successfully identify 3 patient attribute matching hypotheses. Specifically, (1) therapist directiveness in response to patient trait reactance, (2) therapist directiveness in response to patient trait anger, and (3) the emotion focus of therapy in response to patient depressive symptoms before treatment significantly predicted drinking frequency during the year after treatment. The first objective of this proposed continuation is to replicate these findings in a sample of patients selected from an additional MATCH aftercare site (N=138). Additionally, the project will determine the generalizability of these matching effects to an outpatient population by testing for them among a sample of patients from MATCH outpatient sites (N=138). The second objective of the project is to test the predictive validity of an a priori multi-dimensional typology for matching therapist interventions to patient attributes. Analysis of variance will be used to test for ? differences in post-treatment drinking among patients who had a matched or mismatched therapy profile. ? ? The third objective is to test hypothesized mediators of the matching effects. It is hypothesized that for ? patients at medium or high levels of reactance or anger, the working alliance mediates the relationship ? between therapist directiveness and drinking. It is further hypothesized that for patients high in depressive symptoms, distress mediates the relationship between therapy emotion focus and drinking. Examination of indirect effects will be used to test for mediation. For all three objectives the primary outcome variable will be frequency of drinking during the year after treatment. We will analyze drinks per drinking day and the frequency of heavy drinking as secondary outcomes. If positive, the results of this study will (1) re-establish patient-treatment matching as a valuable paradigm for enhancing patient drinking outcomes, (2) provide clinicians with practical techniques to significantly improve their patients' outcomes, and (3) contribute to theory and methodology for studying alcohol treatment effectiveness. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA012155-06
Application #
7106389
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Mattson, Margaret
Project Start
2000-08-01
Project End
2008-07-31
Budget Start
2006-08-01
Budget End
2007-07-31
Support Year
6
Fiscal Year
2006
Total Cost
$386,550
Indirect Cost
Name
University of California Los Angeles
Department
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Karno, Mitchell P; Longabaugh, Richard; Herbeck, Diane (2010) What explains the relationship between the therapist structure × patient reactance interaction and drinking outcome? An examination of potential mediators. Psychol Addict Behav 24:600-7
Karno, Mitchell P; Longabaugh, Richard; Herbeck, Diane (2009) Patient reactance as a moderator of the effect of therapist structure on posttreatment alcohol use. J Stud Alcohol Drugs 70:929-36
Longabaugh, Richard (2007) The search for mechanisms of change in behavioral treatments for alcohol use disorders: a commentary. Alcohol Clin Exp Res 31:21s-32s
Karno, Mitchell P (2007) A case study of mediators of treatment effectiveness. Alcohol Clin Exp Res 31:33s-39s
Karno, Mitchell P; Longabaugh, Richard (2007) Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment. Addiction 102:587-96
Karno, Mitchell P; Longabaugh, Richard (2005) An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use. J Stud Alcohol 66:825-32
Karno, Mitchell P; Longabaugh, Richard (2005) Less directiveness by therapists improves drinking outcomes of reactant clients in alcoholism treatment. J Consult Clin Psychol 73:262-7
Longabaugh, Richard; Donovan, Dennis M; Karno, Mitchell P et al. (2005) Active ingredients: how and why evidence-based alcohol behavioral treatment interventions work. Alcohol Clin Exp Res 29:235-47
Karno, Mitchell P; Longabaugh, Richard (2004) What do we know? Process analysis and the search for a better understanding of Project MATCH's anger-by-treatment matching effect. J Stud Alcohol 65:501-12
Karno, Mitchell P; Longabaugh, Richard (2003) Patient depressive symptoms and therapist focus on emotional material: a new look at Project MATCH. J Stud Alcohol 64:607-15

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