Reaction from a reader

Dear Stanton:

As ever your article in Int J Drug Policy 9:43-56 1998 was a thought-provoking read for a long time fan of yours. But you are being a little harsh on the Project MATCH team.

Last week I attended a presentation of their findings at which Thomas Babor and William Miller both made clear their belief that treatment was not the major variable in the recovery of the MATCH subjects. The evidence was the extraordinarily rapid improvement before one would have thought treatment would have had an impact (we've also seen that here with respect to drug users in our national treatment evaluation, NTORS) and the fact that treatments designed to be different had roughly the same impact. They concluded that something else was going on, that in asking if treatment works we were asking the wrong question.

Miller and Babor no longer if they ever did saw treatment as a technological fix for a biological or psychological disorder. Rather the active ingredient was the client's decision to put their life in order and the resources available to them to do this. Miller's line was that treatment merely gave people the 'permission to recover' and provided some of those resources. Babor saw it this way: offering any culturally accepted route to recovery would do the same trick - so in traditional societies faith healers, witch doctors or others give their clients the belief that they can get better and the confidence to go ahead and do it - effectively, do it themselves. In the West it's the doctor or counsellor. Miller referred to the common tactic of using waiting-listed clients as a non-treatment control to show that treatment is effective. He said that these clients were doing exactly what was expected of them - waiting. They had not yet given the permission to get better. Give them that in a culturally valid/accepted form, no matter what this might be, and they'd run the treatment group at least a close second was the implication.

By all means reprint my message to you on your web site but I'd prefer you do it anonymously

Dear _____:

If you examine my web site you will see several new discussions I have on MATCH (at least one of which provides a reference to Dawson). I note in my announcement for these the strong resemblance of my views with Miller's, as expressed in his Febuary article in Addiction, based on his David Archibald lecture at ARF.

But the idea that MATCH shows that it is nontreatment factors that dominate the recovery from alcoholism is not well known. You can search official pronouncements in America in vain for the idea, because spin of the MATCH results has been taken over by Gordis and the NIAAA. You might ask how could it be otherwise. They and related agencies have a tremendous stake in (a) showing the NIAAA and alcoholism treatment researchers didn't waste $30 million on a research project about how to tailor effective treatment, (b) treatment agencies should continue to grow and flourish in the U.S.

Your points about Babor and Miller, both involved in MATCH (Babor is a member of the MATCH steering committee) show exactly why I am such a valuable and necessary commentator on the treatment scene. These stalwarts in American research are not going to contradict Gordis's and others' interpretations of MATCH, precisely because they themselves are so well tied in to the entire treatment agency. It remains, oddly enough, for someone outside the agency to carry the arguments that these stalwarts themselves wish to make, but cannot do too forcefully here, meanwhile taking the heat and disparagement of mainstream forces for doing so (see the comments by Zucker and Longabaugh in the recent APA Division 50 Newsletter exchange). Isn't that strange?

Stanton