Carroll K M, Kadden R M, Donovan D M, Zweben A, Rounsaville B J
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519.
J Stud Alcohol Suppl. 1994 Dec;12:149-55. doi: 10.15288/jsas.1994.s12.149.
Treatment matching research is predicated on heterogeneity among subjects and their differential response to treatments. The sine qua non of a treatment matching study is the integrity of the treatment variable, since detection of client-treatment interactions requires delivery of treatments that are highly specific, consistent and distinct. Matching research thus presents particular challenges in treatment implementation, as greater heterogeneity in subjects may generate a broader array of problems than study treatments are designed to address, leading to several potential threats to treatment integrity. Moreover, as practiced outside of research settings, treatments for alcoholism are marked by ideological heterogeneity and a lack of purity across approaches. In this article we describe the strategies used in Project MATCH to protect treatment integrity while treating a large and heterogeneous sample of alcoholics in a number of geographically distant sites. These include: strategies for treating a variety of alcoholics within a single treatment approach; development of clinical care guidelines and clinical deterioration criteria; specification of treatments in manuals with minimization of overlapping active ingredients; selection criteria for therapists intended to enhance both generalizability of findings as well as treatment integrity; and extensive therapist training and monitoring.
治疗匹配研究基于个体之间的异质性以及他们对治疗的不同反应。治疗匹配研究的必要条件是治疗变量的完整性，因为检测来访者与治疗的相互作用需要提供高度特定、一致且独特的治疗。因此，匹配研究在治疗实施方面提出了特殊挑战，因为个体中更大的异质性可能产生比研究治疗设计要解决的问题更广泛的一系列问题，从而对治疗完整性造成若干潜在威胁。此外，在研究环境之外实施的治疗中，酗酒治疗的特点是存在意识形态上的异质性以及各种方法缺乏纯粹性。在本文中，我们描述了“匹配计划”（Project MATCH）中使用的策略，即在多个地理位置分散的地点治疗大量异质性酗酒者样本时保护治疗的完整性。这些策略包括：在单一治疗方法内治疗各种酗酒者的策略；制定临床护理指南和临床恶化标准；在手册中明确治疗方法，尽量减少重叠的有效成分；选择治疗师的标准，旨在提高研究结果的普遍性以及治疗的完整性；以及广泛的治疗师培训和监督。
