July 22, 2005

Study question effectiveness of alcoholism therapy

NEW YORK (Reuters Health) - 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

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

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

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

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

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.