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Problem-Service 'Matching' in Addiction Treatment A Prospective Study in 4 Programs

A. Thomas McLellan, PhD; Grant R. Grissom, PhD; David Zanis, PhD; Mary Randall, MA; Peter Brill, MD; Charles P. O'Brien, MD, PhD
Arch Gen Psychiatry. 1997;54(8):730-735. doi:10.1001/archpsyc.1997.01830200062008.
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Background:  Our initial attempts to "match" substance-abuse patients from an employee assistance program to an optimal setting or program failed. Scientifically, we found no differential predictors of better outcomes by setting or program. From a practical perspective, it was impossible to place patients in the intended programs. This led to a second study, designed to identify specific patient problems and match professional services to those problems within each of the 4 programs.

Methods:  Ninety-four new patients admitted to 4 substance-abuse treatment programs were randomly assigned to standard treatment and treated in the usual manner or were assigned to "matched" services, in which patients received at least 3 professional sessions directed at their important employment, family, or psychiatric problems.

Results:  Matched patients stayed in treatment longer, were more likely to complete treatment, and had better posttreatment outcomes than did the standard patients treated in the same programs.

Conclusions:  For logistical, financial, and clinical reasons, it is improbable that patients will be matched to specific types of programs. However, within any program, it is possible and practical to match appropriate services to patients' specific treatment problems. This strategy was clinically and administratively practical, attractive to patients, and responsible for a 20% to 30% increase in the effectiveness of this substance-abuse treatment system.


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