The goal of this project is to test the idea that treatment outcomes can be improved by prospectively matching alcoholic clients to one of two widely used treatment modalities. Our prior research, using random assignment to treatment, found that those alcoholics who were relatively impaired on the dimensions of sociopathy or global psychopathology had better outcomes when given aftercare group therapy that had a cognitive- behavioral (CB) focus than when given interactional group therapy. However, those clients who were not impaired on either of these two dimensions had better outcomes with interactional than with CB aftercare groups. The research in the present proposal would test a treatment matching strategy derived from that earlier random assignment study, using prospective assignment to interactional or CB outpatient groups. The prospective assignment strategy would form homogeneous groups by matching alcoholics who score high on the dimensions of sociopathy to CB group therapy, and alcoholics who score low on these dimensions to interactional group therapy. Heterogeneous control groups would be formed by randomly assigning subjects to these two therapies. All treatments will be provided on an outpatient basis by therapists who are kept blind as to the basis on which clients were assigned to treatment. Comprehensive pretreatment assessments will provide baseline data for making prospective assignments to treatment and against which to compare treatment outcome data. Follow-up assessments will be conducted at the conclusion of treatment and 3, 6, 9 and 12 months later. A variety of data-analytic techniques, including linear regression and survival analysis, will be used to evaluate the treatment matching hypothesis. It is anticipated that the matching findings of our prior research will be confirmed, that the matching effect will be enhanced by the use of outpatient treatment rather than aftercare treatment, and that the prospective assignment strategy will prove to be practical for clinical application. We will also test possible """"""""causal chains"""""""" that may explain the means by which the treatments exert differential effects on clients.
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