A MULTISITE MATCHING OF TREATMENT FOCUS TO DYSFUNCTION

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Recent research has begun to support the hypothesis that by matching treatments to patient profiles, treatment outcomes can be enhanced Elaboration of this concept is needed what aspects of treatment are active in enhancing the effects on what dimensions of outcome for what kinds of patients? Given the fact of a "matching effect" it becomes even more important to test the generalizability of such effects. Does matching occur, irrespective of treatment program and setting? Do matching effects occur as much for poor and good prognosis patients alike? Can matching effects be observed in patient populations not volunteering for randomized clinical trials? The proposed study tests the hypothesis that the focus of two treatment modalities will enhance outcomes of patients when matched to predominant area of dysfunction. Patients characterized primarily by psychological dysfunction will benefit more when matched to an individually focused cognitive-behavioral therapy; patients whose dysfunction is predominantly social will benefit more from a Community Reinforcement Approach to treatment. The hypotheses are tested across three levels of treatment setting- inpatient. partial hospital and outpatient. Matching effects are examined for good and poor prognosis patients ' for clinically assigned patients as well as for those agreeing to random assignment. Different provider organizations are involved as performance sites: an HMO, a general hospital, and a community hospital specializing in chemical dependencies and addictions. To examine the active ingredients involved in treatment enhancement, theoretically focused measures of treatment are collected, and analyzed in relation to their effects upon relevant patient characteristics. Patients are followed for two years and outcome is measured i.n a multidimensional way. It is anticipated that results will have impact upon the everyday clinical setting It is also anticipated that the collaboration between a Clinical Research Center and clinical performance sites can serve as a model for future collaborations between these complementary resources.