Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment

Addiction (OnlineEarly Articles).

Published article online: 19 Feb 2007

RESEARCH REPORT

• Mitchell P. Karno¹
• ¹Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA and Mitchell P. Karno, Integrated Substance Abuse Programs, UCLA-ISAP, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA 90025, USA. E-mail: karno@ucla.edu &
• Richard Longabaugh²
• ²Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

• ¹Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA and ²Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

Mitchell P. Karno, Integrated Substance Abuse Programs, UCLA-ISAP, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA 90025, USA. E-mail: karno@ucla.edu

ABSTRACT

Aims This study assessed the predictive validity of the level of matching and mismatching between patients' personal attributes and aspects of outpatient psychotherapy they received.

Design and participants On the basis of patient-by-treatment interactions observed for this sample in previous research, patients with alcohol abuse or dependence (n = 137) were designated retrospectively as being matched, unmatched or mismatched on each of four patient and treatment variable pairings. These pairings included (1) patient depressive symptoms and therapy emotion focus, (2) patient trait anger and therapy confrontation, (3) patient interpersonal reactance and therapy confrontation and (4) patient interpersonal reactance and therapy structure.

Measurements Analyses of variance and logistic regression were used to assess the individual and additive effects of being matched and mismatched on the percentage of abstinent days (PDA) and recovery status in the year after treatment.

Findings Being mismatched on any of the four patient–treatment pairings was a significant predictor of more frequent alcohol use post-treatment. Being matched on only two pairings predicted less frequent alcohol use, namely matches on therapy emotion focus with patient depressive symptoms and therapy structure with patient reactance. Matches appeared to optimize otherwise good outcomes, while mismatches had larger effect sizes and tended to predict relatively poor outcomes. The data supported the presence of an additive effect for mismatches on post-treatment PDA. The group with the most mismatches fared considerably worse than a group with fewer mismatches. Several matches and mismatches also predicted recovery status, with some support found for additive effects.

Conclusions Mismatches between patient attributes and treatment appear to have serious consequences, and this effect is magnified with multiple mismatches. Matches, on the other hand, while beneficial, may not be necessary to achieve good outcomes.