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Problem-Service 'Matching' in Addiction Treatment: A Prospective Study in 4 Programs

Problem-Service 'Matching' in Addiction Treatment: A Prospective Study in 4 Programs Abstract Background: Our initial attempts to "match" substance-abuse patients from an employee assistance program to an optimal setting or program failed. Scientifically, we found no differential predictors of better outcomes by setting or program. From a practical perspective, it was impossible to place patients in the intended programs. This led to a second study, designed to identify specific patient problems and match professional services to those problems within each of the 4 programs. Methods: Ninety-four new patients admitted to 4 substance-abuse treatment programs were randomly assigned to standard treatment and treated in the usual manner or were assigned to "matched" services, in which patients received at least 3 professional sessions directed at their important employment, family, or psychiatric problems. Results: Matched patients stayed in treatment longer, were more likely to complete treatment, and had better posttreatment outcomes than did the standard patients treated in the same programs. Conclusions: For logistical, financial, and clinical reasons, it is improbable that patients will be matched to specific types of programs. However, within any program, it is possible and practical to match appropriate services to patients' specific treatment problems. This strategy was clinically and administratively practical, attractive to patients, and responsible for a 20% to 30% increase in the effectiveness of this substance-abuse treatment system. References 1. McLellan AT, Luborsky L, O'Brien CP, Woody GE, Druley KA. Is treatment for substance abuse effective? JAMA . 1982;247:1423-1427.Crossref 2. Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment . New York, NY: Springer-Verlag NY Inc; 1991. 3. Anglin MD, Speckart GR, Booth MW. Consequences and costs of shutting off methadone . Addict Behav . 1989;14:307-326.Crossref 4. Hubbard RL, Marsden ME, Rachal JV, Harwood HJ, Cavanaugh ER, Ginzburg HM. Drug Abuse Treatment: A National Study of Effectiveness . Chapel Hill, NC: University of North Carolina Press; 1989. 5. Miller WR, Hester RK. Inpatient alcoholism treatment: who benefits? Am Psychol . 1986;41:794-805.Crossref 6. NIAAA Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: project MATCH posttreatment drinking outcomes . J Stud Alcohol . 1997;90:1179-1188. 7. Kadden RM, Cooney NL, Getter H, Litt MD. Matching alcoholics to coping skills or interactional therapies: post treatment results . J Consult Clin Psychol . 1989;57:698-704.Crossref 8. Kadden RM, Cooney NL, Getter H, Litt MD. Matching alcoholics to coping skills or interactional therapies: two-year follow-up results . J Consult Clin Psychol . 1991;59:598-601.Crossref 9. McLachlan J. Therapy strategies, personality orientation, and recovery from alcoholism . Can Psychiatr Assoc J . 1974;19:25-30. 10. McLellan AT, Grissom G, Alterman Al, Brill P, O'Brien CP. Substance abuse treatment in the private setting: are some programs more effective than others? J Subst Abuse Treat . 1993;10:243-254.Crossref 11. McLellan AT, Luborsky L, Woody GE, Druley KA, O'Brien CP. Predicting response to alcohol and drug abuse treatments: role of psychiatric severity . Arch Gen Psychiatry . 1983;40:620-625.Crossref 12. McLellan AT, Luborsky L, Woody GE, O'Brien CP, Druley KA. Increased effectiveness of substance abuse treatment: a prospective study of patient-treatment 'matching.' J Nerv Ment Dis . 1983;171:597-605.Crossref 13. McLellan AT, Alterman AI, Metzger DS, Grissom G, Woody GE, Luborsky L, O'Brien CP. Similarity of outcome predictors across opiate, cocaine and alcohol treatments: role of treatment services . J Clin Consult Psychol . 1994;62:1141-1158.Crossref 14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised . Washington, DC: American Psychiatric Association; 1987. 15. McLellan AT, Luborsky L, Cacciola J, Griffith J. New data from the Addiction Severity Index: reliability and validity in three centers . J Nerv Ment Dis . 1985;173:412-423.Crossref 16. McLellan AT, Cacciola J, Kushner H, Peters F, Smith I, Pettinati H. The fifth edition of the Addiction Severity Index: cautions, additions and normative data . J Subst Abuse Treat . 1992;9:261-275.Crossref 17. Havassy BE, Hall SM, Wasserman D. Social support and relapse: commonalities among alcoholics, opiate users and cigarette smokers . Addict Behav . 1989;16:233-246. 18. Rounsaville BJ, Dolinsky ZS, Babor TF, Meyer RE. Psychopathology as a predictor of treatment outcome in alcoholics . Arch Gen Psychiatry . 1987;44:505-513.Crossref 19. Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems . Washington, DC: National Academy Press; 1990. 20. McLellan AT, Alterman Al, Woody GE, Metzger D. A quantitative measure of substance abuse treatments: the Treatment Services Review . J Nerv Ment Dis . 1992;180:101-110.Crossref 21. Zanis D, McLellan AT, Randall M. Can you trust the self reports of drug users during treatment? Drug Alcohol Depend . 1995;38:121-125. 22. Ehrman RN, Robbins SJ. Reliability and validity of 6-month timeline reports of cocaine and heroin use in a methadone population . J Consult Clin Psychol . 1994;62:843-850.Crossref 23. McLellan AT, Woody GE, Metzger D, McKay J, Alterman Al, O'Brien CP. Evaluating the effectiveness of treatments for substance use disorders: reasonable expectations, appropriate comparisons . Milbank Q . 1996;74:51-85.Crossref 24. McLellan AT, Woody GE, Luborsky L, O'Brien CP. Is the counselor an 'active ingredient' in substance abuse treatment? J Nerv Ment Dis . 1988;176:423-430.Crossref 25. Luborsky L, Crits-Cristoph P, McLellan AT, Woody GE. Do psychotherapists vary much in their effectiveness? the answer within four outcome studies . Am J Orthopsychiatry . 1986;56:211-223.Crossref 26. McCrady BS, Noel NE, Abrams DB, Stout RL, Nelson HF, Hay WM. Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment . J Stud Alcohol . 1986;47:459-467. 27. Stanton MD, Todd T. The Family Therapy of Drug Abuse and Addiction . New York, NY: Guilford Press; 1982. 28. Carroll KM, Rounsaville BJ, Gordon LT, Nich C, Jatlow P, Bisighini RM, Gawin FH. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers . Arch Gen Psychiatry . 1994;51:177-187.Crossref 29. Woody GE, Luborsky L, McLellan AT, O'Brien CP. Psychotherapy for opiate addicts: does it help? Arch Gen Psychiatry . 1983;40:639-645.Crossref 30. French MT, Rachal JV, Harwood HJ, Hubbard RL. Does drug abuse treatment affect employment and earnings of clients? Benefits Q . 1990;6:58-67. 31. French MT, Dennis ML, McDougal GL, Karountzos GT, Hubbard RL. Training and employment programs in methadone treatment: client needs and desires . J Subst Abuse Treat . 1992;9:293-303.Crossref 32. Schonberg SK, ed. Substance Abuse: A Guide for Health Professionals . Elk Grove Village, III; American Academy of Pediatrics Press; 1988. 33. Fleming MF, Barry KL, eds. Addictive Disorders . St Louis, Mo: Mosby—Year Book Inc; 1992. 34. McLellan AT, Arndt IO, Woody GE, Metzger D. Psychosocial services in substance abuse treatment? a dose-ranging study of psychosocial services . JAMA . 1993;269:1953-1959.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Problem-Service 'Matching' in Addiction Treatment: A Prospective Study in 4 Programs

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1997.01830200062008
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Abstract

Abstract Background: Our initial attempts to "match" substance-abuse patients from an employee assistance program to an optimal setting or program failed. Scientifically, we found no differential predictors of better outcomes by setting or program. From a practical perspective, it was impossible to place patients in the intended programs. This led to a second study, designed to identify specific patient problems and match professional services to those problems within each of the 4 programs. Methods: Ninety-four new patients admitted to 4 substance-abuse treatment programs were randomly assigned to standard treatment and treated in the usual manner or were assigned to "matched" services, in which patients received at least 3 professional sessions directed at their important employment, family, or psychiatric problems. Results: Matched patients stayed in treatment longer, were more likely to complete treatment, and had better posttreatment outcomes than did the standard patients treated in the same programs. Conclusions: For logistical, financial, and clinical reasons, it is improbable that patients will be matched to specific types of programs. However, within any program, it is possible and practical to match appropriate services to patients' specific treatment problems. This strategy was clinically and administratively practical, attractive to patients, and responsible for a 20% to 30% increase in the effectiveness of this substance-abuse treatment system. References 1. McLellan AT, Luborsky L, O'Brien CP, Woody GE, Druley KA. Is treatment for substance abuse effective? JAMA . 1982;247:1423-1427.Crossref 2. Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment . New York, NY: Springer-Verlag NY Inc; 1991. 3. Anglin MD, Speckart GR, Booth MW. Consequences and costs of shutting off methadone . Addict Behav . 1989;14:307-326.Crossref 4. Hubbard RL, Marsden ME, Rachal JV, Harwood HJ, Cavanaugh ER, Ginzburg HM. Drug Abuse Treatment: A National Study of Effectiveness . Chapel Hill, NC: University of North Carolina Press; 1989. 5. Miller WR, Hester RK. Inpatient alcoholism treatment: who benefits? Am Psychol . 1986;41:794-805.Crossref 6. NIAAA Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: project MATCH posttreatment drinking outcomes . J Stud Alcohol . 1997;90:1179-1188. 7. Kadden RM, Cooney NL, Getter H, Litt MD. Matching alcoholics to coping skills or interactional therapies: post treatment results . J Consult Clin Psychol . 1989;57:698-704.Crossref 8. Kadden RM, Cooney NL, Getter H, Litt MD. Matching alcoholics to coping skills or interactional therapies: two-year follow-up results . J Consult Clin Psychol . 1991;59:598-601.Crossref 9. McLachlan J. Therapy strategies, personality orientation, and recovery from alcoholism . Can Psychiatr Assoc J . 1974;19:25-30. 10. McLellan AT, Grissom G, Alterman Al, Brill P, O'Brien CP. Substance abuse treatment in the private setting: are some programs more effective than others? J Subst Abuse Treat . 1993;10:243-254.Crossref 11. McLellan AT, Luborsky L, Woody GE, Druley KA, O'Brien CP. Predicting response to alcohol and drug abuse treatments: role of psychiatric severity . Arch Gen Psychiatry . 1983;40:620-625.Crossref 12. McLellan AT, Luborsky L, Woody GE, O'Brien CP, Druley KA. Increased effectiveness of substance abuse treatment: a prospective study of patient-treatment 'matching.' J Nerv Ment Dis . 1983;171:597-605.Crossref 13. McLellan AT, Alterman AI, Metzger DS, Grissom G, Woody GE, Luborsky L, O'Brien CP. Similarity of outcome predictors across opiate, cocaine and alcohol treatments: role of treatment services . J Clin Consult Psychol . 1994;62:1141-1158.Crossref 14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised . Washington, DC: American Psychiatric Association; 1987. 15. McLellan AT, Luborsky L, Cacciola J, Griffith J. New data from the Addiction Severity Index: reliability and validity in three centers . J Nerv Ment Dis . 1985;173:412-423.Crossref 16. McLellan AT, Cacciola J, Kushner H, Peters F, Smith I, Pettinati H. The fifth edition of the Addiction Severity Index: cautions, additions and normative data . J Subst Abuse Treat . 1992;9:261-275.Crossref 17. Havassy BE, Hall SM, Wasserman D. Social support and relapse: commonalities among alcoholics, opiate users and cigarette smokers . Addict Behav . 1989;16:233-246. 18. Rounsaville BJ, Dolinsky ZS, Babor TF, Meyer RE. Psychopathology as a predictor of treatment outcome in alcoholics . Arch Gen Psychiatry . 1987;44:505-513.Crossref 19. Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems . Washington, DC: National Academy Press; 1990. 20. McLellan AT, Alterman Al, Woody GE, Metzger D. A quantitative measure of substance abuse treatments: the Treatment Services Review . J Nerv Ment Dis . 1992;180:101-110.Crossref 21. Zanis D, McLellan AT, Randall M. Can you trust the self reports of drug users during treatment? Drug Alcohol Depend . 1995;38:121-125. 22. Ehrman RN, Robbins SJ. Reliability and validity of 6-month timeline reports of cocaine and heroin use in a methadone population . J Consult Clin Psychol . 1994;62:843-850.Crossref 23. McLellan AT, Woody GE, Metzger D, McKay J, Alterman Al, O'Brien CP. Evaluating the effectiveness of treatments for substance use disorders: reasonable expectations, appropriate comparisons . Milbank Q . 1996;74:51-85.Crossref 24. McLellan AT, Woody GE, Luborsky L, O'Brien CP. Is the counselor an 'active ingredient' in substance abuse treatment? J Nerv Ment Dis . 1988;176:423-430.Crossref 25. Luborsky L, Crits-Cristoph P, McLellan AT, Woody GE. Do psychotherapists vary much in their effectiveness? the answer within four outcome studies . Am J Orthopsychiatry . 1986;56:211-223.Crossref 26. McCrady BS, Noel NE, Abrams DB, Stout RL, Nelson HF, Hay WM. Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment . J Stud Alcohol . 1986;47:459-467. 27. Stanton MD, Todd T. The Family Therapy of Drug Abuse and Addiction . New York, NY: Guilford Press; 1982. 28. Carroll KM, Rounsaville BJ, Gordon LT, Nich C, Jatlow P, Bisighini RM, Gawin FH. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers . Arch Gen Psychiatry . 1994;51:177-187.Crossref 29. Woody GE, Luborsky L, McLellan AT, O'Brien CP. Psychotherapy for opiate addicts: does it help? Arch Gen Psychiatry . 1983;40:639-645.Crossref 30. French MT, Rachal JV, Harwood HJ, Hubbard RL. Does drug abuse treatment affect employment and earnings of clients? Benefits Q . 1990;6:58-67. 31. French MT, Dennis ML, McDougal GL, Karountzos GT, Hubbard RL. Training and employment programs in methadone treatment: client needs and desires . J Subst Abuse Treat . 1992;9:293-303.Crossref 32. Schonberg SK, ed. Substance Abuse: A Guide for Health Professionals . Elk Grove Village, III; American Academy of Pediatrics Press; 1988. 33. Fleming MF, Barry KL, eds. Addictive Disorders . St Louis, Mo: Mosby—Year Book Inc; 1992. 34. McLellan AT, Arndt IO, Woody GE, Metzger D. Psychosocial services in substance abuse treatment? a dose-ranging study of psychosocial services . JAMA . 1993;269:1953-1959.Crossref

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Archives of General Psychiatry – American Medical Association

Published: Aug 1, 1997

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