J Stud Alcohol. 1997 Jan;58(1):7-29.
To assess the benefits of matching alcohol dependent clients to three different treatments with reference to a variety of client attributes.
Two parallel but independent randomized clinical trials were conducted, one with alcohol dependent clients receiving outpatient therapy (N = 952; 72% male) and one with clients receiving aftercare therapy following inpatient or day hospital treatment (N = 774; 80% male). Clients were randomly assigned to one of three 12-week, manual-guided, individually delivered treatments: Cognitive Behavioral Coping Skills Therapy, Motivational Enhancement Therapy or Twelve-Step Facilitation Therapy. Clients were then monitored over a 1-year posttreatment period. Individual differences in response to treatment were modeled as a latent growth process and evaluated for 10 primary matching variables and 16 contrasts specified a priori. The primary outcome measures were percent days abstinent and drinks per drinking day during the 1-year posttreatment period.
Clients attended on average two-thirds of treatment sessions offered, indicating that substantial amounts of treatment were delivered, and research follow-up rates exceeded 90% of living subjects interviewed at the 1-year posttreatment assessment. Significant and sustained improvements in drinking outcomes were achieved from baseline to 1-year posttreatment by the clients assigned to each of these well-defined and individually delivered psychosocial treatments. There was little difference in outcomes by type of treatment. Only one attribute, psychiatric severity, demonstrated a significant attribute by treatment interaction: In the outpatient study, clients low in psychiatric severity had more abstinent days after 12-step facilitation treatment than after cognitive behavioral therapy. Neither treatment was clearly superior for clients with higher levels of psychiatric severity. Two other attributes showed time-dependent matching effects: motivation among outpatients and meaning-seeking among aftercare clients. Client attributes of motivational readiness, network support for drinking, alcohol involvement, gender, psychiatric severity and sociopathy were prognostic of drinking outcomes over time.
The findings suggest that psychiatric severity should be considered when assigning clients to outpatient therapies. The lack of other robust matching effects suggests that, aside from psychiatric severity, providers need not take these client characteristics into account when triaging clients to one or the other of these three individually delivered treatment approaches, despite their different treatment philosophies.
参照多种客户属性，评估为酒精依赖患者匹配三种不同治疗方法的益处。
开展了两项平行但独立的随机临床试验，一项试验中酒精依赖患者接受门诊治疗（N = 952；72%为男性），另一项试验中患者在住院或日间医院治疗后接受后续护理治疗（N = 774；80%为男性）。患者被随机分配到三种为期12周、有手册指导、个体化实施的治疗方法之一：认知行为应对技能疗法、动机强化疗法或十二步促进疗法。然后在治疗后的1年期间对患者进行监测。将治疗反应的个体差异建模为潜在增长过程，并针对10个主要匹配变量和16个事先指定的对比进行评估。主要结局指标为治疗后1年期间的戒酒天数百分比和饮酒日的饮酒量。
患者平均参加了所提供治疗课程的三分之二，表明提供了大量治疗，且研究随访率超过了治疗后1年评估时接受访谈的在世受试者的90%。接受这些明确且个体化实施的心理社会治疗的患者，从基线到治疗后1年，饮酒结局均取得了显著且持续的改善。不同治疗类型的结局差异不大。只有一个属性，即精神疾病严重程度，显示出治疗与属性的显著交互作用：在门诊研究中，精神疾病严重程度较低的患者在接受十二步促进治疗后比接受认知行为治疗后的戒酒天数更多。对于精神疾病严重程度较高的患者，两种治疗方法均未明显更具优势。另外两个属性显示出时间依赖性匹配效应：门诊患者的动机和后续护理患者的意义寻求。动机准备程度、饮酒的网络支持、饮酒参与度、性别、精神疾病严重程度和反社会人格等客户属性可预测随时间推移的饮酒结局。
研究结果表明，在为患者分配门诊治疗时应考虑精神疾病严重程度。缺乏其他显著的匹配效应表明，除精神疾病严重程度外，尽管这三种个体化实施的治疗方法理念不同，但在将患者分诊到其中一种治疗方法时，提供者无需考虑这些客户特征。
