Rewriting the Book on How to Treat Alcoholics

Washington--You can toss out the window any convictions about the best form of psychotherapy to get alcoholics to quit drinking. Contrary to a leading theory, it doesn't seem to matter which kind of technique you use. That's the bottom line of a 6-year, $27 million study whose findings were announced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) at a press conference here today.

In recent years, a number of clinical studies have suggested that "matching" particular types of alcoholics with particular treatments--for example, teaching someone with poor impulse control how to think through actions before taking them--would help them quit drinking. Indeed, that was the premise behind NIAAA's Project MATCH, the most rigorous and extensive clinical trial ever of therapies for alcoholics.

The study involved 25 research institutions and 1726 alcoholics who were randomly assigned to 12 weekly sessions of one of three types of individual psychotherapy: cognitive-behavioral therapy (which seeks to teach new ways of thinking), motivational therapy (in which the patient is encouraged to take responsibility for his own recovery), and a spiritually oriented therapy derived from the philosophy of Alcoholics Anonymous (AA). The researchers' hypothesis was that people with "high cognitive impairment" would benefit from the first therapy, unmotivated people from the second, and "meaning-seeking" people from the third.

All therapies, however, appeared to be equally effective--a year later, the average number of drinking days per month among all participants had declined from 25 to six. "Outcomes were not substantially improved by patient matching," says Gerard J. Connors of the New York State Research Institute on Addictions. The main exception was that patients with few psychiatric problems and "meaning-seekers" did better with the AA-based therapy. They also went to more AA meetings.

The results show that "we're not yet at the core of what the pathophysiological changes are in alcoholism," says NIAAA director Enoch Gordis. Nonetheless, he says, the findings also suggest that "competently run programs" work.