Motivational Enhancement More Effective than Cognitive Behavioral Therapy for Alcoholics with Low Motivation

This study re-examined patient motivation data from Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a 1993 multi-site trial that assessed how patient-treatment interactions relate to outcomes. Although the original analysis did not find motivation enhancement treatment (MET) worked better than cognitive behavioral therapy (CBT) at reducing drinking days for subjects with low motivation, it did not adequately consider potential moderating influences such as severity of alcohol dependence or sex. This analysis used growth-mixture modeling to reevaluate the motivation-matching hypothesis.

• In the outpatient sample (n=617), 69% of individuals assigned to MET with below-average motivation at baseline had a lower increase in their drinking during follow-up than similar individuals assigned to CBT. Similar effects were seen among aftercare patients (n=527) but only for women.

• Conversely, aftercare patients assigned to MET with the most severe alcohol dependence and the least motivation at baseline had the greatest increases in drinking frequency over time.

Comments:

Although these are post-hoc adjusted subgroup analysis findings in a selected sample, and the effects varied by factors seemingly unconnected to severity or motivation (e.g., sex), MET may have effects depending on alcohol dependence severity, and motivation. This analysis suggests MET has differential effects depending on patient sex, alcohol dependence severity, and motivation. It also suggests “low motivation” is not monolithic. This work supports other studies that found MET worked well for patients with low readiness and low dependence severity. However, other techniques might be more effective for treatment-experienced patients with low self-efficacy and high dependence severity.

Peter D. Friedmann, MD, MPH

Reference:

Witkiewitz K, Hartzler B, Donovan D. Matching motivation enhancement treatment to client motivation: re-examining the Project MATCH motivation matching hypothesis. Addiction. 2010;105(8):1403–1413.