Does Outpatient Addiction Treatment Work?

Outpatient treatment, where clients attend sessions in a local office rather than being shipped off to live in a far away treatment center, is the most popular form of addiction treatment available. The advantage to outpatient treatment is that it only costs a fraction of the price of the standard residential rehab program (like those seen on the popular television show Intervention).

But are you really getting a bargain with outpatient treatment? If outpatient treatment is effective, then sure it's a bargain. If not, then outpatient treatment is a loss - and if you come out worse than before you started, as many people do, then outpatient treatment is a downright shameful waste of time and money.

Shockingly, there is very little research on whether or not outpatient treatment really helps people end their addiction, but a recent analysis of the most expensive study of outpatient treatment ever done has revealed that most people who attend outpatient treatment programs probably do no better than if they hadn't received any treatment, whatsoever.

The study in question is Project MATCH, an 8 year long project that ended in 1997, and cost the government 27 million dollars. Previously, many had concluded from this study that briefer outpatient treatment approaches are better than longer, more intensive ones. This was based on the fact that 12 week long treatments were shown to be no more successful than a 4 week long treatment.

There are many valid criticisms of the Project MATCH study of outpatient treatment, but perhaps the most compelling one is that the study Included no control group. A control group would be a group of similarly addicted people who did not receive any outpatient treatment, but were nonetheless followed to see if they reduced or quit their substance use. Only when armed with this data could the researchers reliably determine whether their outpatient treatment methods were effective or not.

It was thought that MATCH had no control group, until a few years ago when a couple of researchers with access to the data uncovered a hidden control group of sorts - let me explain. There were a number of people who signed up to be a part of the study, but failed to attend any of the treatment sessions, and were still nonetheless checked up on to assess their levels of substance use. This data was never publicly released or analyzed in the initial flood of research papers (beginning in 1991) based on Project MATCH - until 2005's Are Alcoholism Treatments Effective? (The Project MATCH Data by Cutler and Fishbain.) In their analysis, these researchers concluded:

The results suggest that current psychosocial treatments for alcoholism are not particularly effective. Untreated alcoholics in clinical trials show significant improvement. Most of the improvement which is interpreted as treatment effect is not due to treatment.

The rate of improvement in drinking habits (% of days abstinent and % of drinks per drinking day) was identical between those who attended 12 sessions and those who attended zero sessions. They also showed that the bulk of improvement occurred in the first week - whether the subject had attended 0,1, or all 12 sessions! As the researchers noted:

Most of the improvement was instantaneous, occurring at week 1, before the participants had received the bulk of their treatment. Although the full treatment group received 11 more therapy sessions, the additional improvement was of small magnitude. For example, at week one, percent days abstinence had Increased by over 60%, and the additional 11 weeks of treatment Increased it by only 4%. If treatment were the causal agent we would expect that the effect would occur over the course of weeks with the administration of treatment.

Moreover, in their most generous estimate, they concluded that 3% of the change in drinking by Project MATCH subjects might be attributed to the actual treatment received! Here's what all of this means: people change their substance use habits when they choose to do so - and they do it themselves, whether they're in a treatment program or not. The agent of change is the individual, and treatment has little if any effect on this. Outpatient treatment doesn't work. What's more, further research we've reviewed suggests that treatment may in fact be counterproductive, and cause people's substance use problems to last longer. We recognize these facts, and accordingly do not attempt to treat anyone - instead, we offer Cognitive Behavioral Education which cuts right to the heart of the matter, teaching people how to make the choice to change from within, without becoming dependent on revolving door outpatient treatment centers.


Drug and Alcohol Counseling Alternative