One of the largest and most widely quoted studies to support the ‘AA works’ philosophy is Project MATCH, published in 1998. This federal effort was supported by the National Institute on Alcohol Abuse and Alcoholism.
The study’s title captures its aim: finding ways to match people with the kind of addiction treatment best suited to them. Doing this means looking for ‘client attributes’ – personal characteristics – that reliably predict how well people will do when assigned to specific kinds of treatment. Examples of those attributes are anger and readiness to change. Project MATCH examined 21 such attributes.
In addition, Project MATCH compared three kinds of treatment, each delivered via individual outpatient therapy:
Twelve Step Facilitation Therapy, grounded in AA’s concepts of alcoholism as a disease of the mind, body, and spirit and lifelong abstinence as the only sane response. This form of treatment guides clients through AA’s first five steps. It also actively encourages people to attend AA meetings, keep a journal of their experiences at meetings, read AA literature, and practice AA principles ‘in all our affairs.’
Cognitive Behavioral Therapy, which helps people master skills that are essential to staying sober, in particular, relapse prevention. This means learning to identify cravings for alcohol and respond to those cravings in ways other than drinking. Some of those skills include challenging the thoughts used to rationalize drinking and avoiding the ‘people, places, and things’ linked to alcohol or other drug use.
Motivational Enhancement Therapy, designed to help clients discover and act on their personal reasons for staying sober. Motivational enhancement therapists help clients move through six specific stages of change: pre-contemplation (not considering a behavior change), contemplation (considering a change), preparation, action, maintaining the change, and coping with relapse.
Researchers could hardly have chosen three approaches that differ so much.
Cognitive Behavioral Therapy offers technique after technique for helping people change their thinking (cognition) and action (behavior). It’s true that the Twelve Steps also guide people to release ‘stinking thinking’ and change behavior. However, AA members put these attempts to change in the context of surrender to a higher power. Cognitive Behavioral Therapists, ground in social learning theory, make no such assumptions about the need for ‘conscious contact’.
Motivational Enhancement Therapy also differs from the Twelve Steps. In this form of therapy, counselors make no attempt to guide clients through a step-based program of recovery. Instead, counselors offer non-judgmental feedback on clients’ behavior, emphasize personal responsibility for change, and offer a menu of options for new behaviors. Sometimes Motivational Enhancement Therapists offer outright advice.
Among these three approaches, Twelve Step Facilitation is the only one that specifically encourages people to reach out to other recovering alcoholics. Helping clients to actively work the Twelve Steps is the primary goal, as opposed to learning skills that the therapist teaches or responding to therapist feedback.
For Project MATCH, 806 clients in five outpatient treatment centers were randomly assigned to these three treatments. Researchers also interviewed and assessed clients to rate them on relevant attributes.
The overall results were reported in 1998: Almost 30 percent of these clients were abstinent three years after treatment. And even those who drank during those three years abstained, on average, two-thirds of the time. Of the 21 client attributes, two were the most powerful predictors of longterm drinking outcome: readiness-to-change and self-efficacy (clients’ confidence in their ability to abstain).
Project MATCH found few differences in outcomes among the three treatments. This means that Twelve Step Facilitation held its own, working as well as Cognitive Behavioral Therapy and Motivational Enhancement Therapy. In fact, Twelve Step Facilitation offered a statistically significant advantage when total abstinence was the desired outcome.