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Drug Rehab and Alcoholism
Treatment
Drug Rehab
Patient-Treatment Matching
For several decades it has been
suggested that matching alcoholic patients to drug rehabs based on their
particular characteristics may have the potential to improve alcoholism
treatment outcomes. This idea developed from observations that alcoholics
differ and that while many benefit from treatment, no single treatment has been
shown to be effective for all. In fact, in many areas of medicine, matching
patients to treatments on the basis of patient characteristics is widely
practiced; for example, patients with a cancer diagnosis may be matched to
surgery, radiation, or chemotherapy.
Interest in matching for
alcoholism treatment accelerated as evidenced from more than 30 studies
accumulated in the literature. These studies examined the interaction between a
number of treatment approaches (e.g., coping-skills training, interactional
therapy, or relationship enhancement) and patients with particular
characteristics to determine whether certain patients would benefit more from
one type of treatment than another. Examples of the patient characteristics
that were matched to particular treatments included psychiatric severity,
sociopathy, cognitive impairment, and high or low social support.
These
studies indicated that some treatment approaches were more effective than
others for patients with certain characteristics. For example, Kadden and
colleagues found that coping-skills training was more effective than
interactional therapy at the end of 6 months of treatment in preventing relapse
among patients with more psychiatric problems or higher in a rating of
sociopathy. These patients were followed for an additional 18 months after
treatment, and these matches were still present at the end of this followup
period. Contrary to their expectations, the researchers found that patients
with cognitive impairment had better outcomes when treated with interactional
therapy than with coping-skills training. In addition, Kadden and colleagues
found that patients who reported less anxiety and fewer urges to drink during
their first skills training session experienced better outcomes with
interactional therapy than with coping-skills training. Conversely, those who
reported more anxiety or more urges to drink experienced better outcomes with
coping-skills training than with interactional therapy.
Longabaugh and
associates studied patients randomly assigned to individually focused
cognitive-behavioral treatment (a treatment in which patients are taught to
cope with drinking-related stresses) or a combination of couples therapy and
brief cognitive-behavioral treatment. They found that those patients with high
social support did well with either drug rehab treatment, and those with low
support did better with cognitive-behavioral therapy. In this same study, they
also found that patients who met DSM-III criteria for antisocial personality
(ASP) drank less per drinking day if treated with cognitive-behavioral therapy
than with relationship enhancement therapy. Both treatments were equivalent for
patients without ASP. |
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