Study question effectiveness of alcoholism therapy
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An alcoholic’s desire to quit drinking, rather than the effects of therapy, may be what determines success, according to a new report.
The report, based on a reanalysis of a major study of three approaches to alcoholism, concludes that none of the strategies is particularly effective if the patient is not motivated to quit.
However, the researchers caution, that doesn’t mean alcoholism treatment should be abandoned.
“We are not suggesting that alcoholism treatment should be discontinued and even reduced,” write Drs. Robert B. Cutler and David A. Fishbain of the department of psychiatry and behavioral sciences at the University of Miami.
“People with alcohol problems clearly need all the help our society can give them.”
However, they conclude that the findings suggest that alcoholism research and treatment need to shift the focus away from the components of therapy itself and toward patients’ “characteristics and beliefs,” which includes finding ways to boost their motivation to quit.
The report was recently published in the online journal BMC Public Health.
Cutler and Fishbain reanalyzed data from a clinical trial known as Project MATCH, which included 1,726 alcohol-dependent volunteers who each received one of three alcoholism approaches.
Treatment included cognitive behavioral therapy, which focused on things like dealing with thoughts about alcohol and urges to drink or motivational enhancement therapy, which aimed to strengthen patients’ commitment to change and feelings of personal responsibility. The third approach was a program that introduced the first few “steps” of the Alcoholics Anonymous 12-step approach.
At the time the original study results were reported in the late 1990s, they were hailed as demonstrating the success of all three strategies, because there were no clear differences in patients’ outcomes regardless of which therapy they received.
But Culter and Fishbain looked at the data in a different way, comparing the outcomes of participants who immediately dropped out of treatment with those of men and women who completed treatment.
They found that in the months following treatment, study participants who attended no therapy sessions did nearly as well as those who went to all sessions. On average, those who received no treatment were abstinent for 72 percent of the days the original investigators followed them.
Cutler and Fishbain found that patients who stuck with treatment made most of their improvement in the first week, before they had received the bulk of their therapy.
All of this, according to the researchers, suggests that motivated people entered the trial and that’s why all the treatment approaches were successful.
Enrolling in a study, they write, “suggests that the alcoholic has crystallized a decision to reduce or abstain from drinking.”
Once in a trial, they add, the monitoring and support of healthcare providers can help them further.
“While this study shows that three of the best treatments currently available for addiction were not very effective,” Cutler and Fishbain write, “it remains likely than many severely dependent alcoholic individuals benefit from external help.”
Still, if patients’ motivations and beliefs are the “critical issues,” they conclude, it will be important to find ways to measure and influence these factors, and possibly improve the effectiveness of therapy itself.
SOURCE: BMC Public Health, online July 13, 2005.
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