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VOLUME 1, ISSUE 5 PSYCHNEWS INTERNATIONAL August/September 1996
SELLING WATER BY THE RIVER
THE PROJECT MATCH COVER-UP
Jeffrey A. Schaler, Ph.D.
"These contradictions are not accidental, nor do they
result from ordinary hypocrisy: they are deliberate exercises
in doublethink. For it is only by reconciling contradictions
that power can be retained indefinitely." (Orwell, 1981, Pp. 176-
"'This world is not this world.' What I think he meant was that,
after Auschwitz, the ordinary rhythms and appearances of life,
however innocuous or pleasant, were far from the truth of human
experience." (Lifton, 1986, p. 3)
On June 25, 1996, I attended a symposium entitled "Project MATCH:
Treatment Main Effects and Matching Results." That public presentation
was sponsored by the 1996 Joint Scientific Meeting of the Research
Society on Alcoholism (RSA) and the International Society for Biomedical
Research on Alcoholism in Washington, D.C. Project MATCH (Matching
Alcoholism Treatment to Client Heterogeneity) cost American taxpayers
approximately $25 million. It is described here by Dr. Enoch Gordis,
director of the National Institute on Alcohol Abuse and Alcoholism
This study is the first national, multisite trial of
patient-treatment matching and one of the two largest current
initiatives of NIAAA. Established under a cooperative
agreement that allows direct collaboration between the
Institute and the researcher, the project involves nine
geographically representative clinical sites and a data
coordinating center. Researchers in Project MATCH are among
the most senior and experienced treatment scientists in the
field. Both public and private treatment facilities, as well
as hospital and university outpatient facilities, are
represented. (Gordis, 1995, p. vii)
The National Academy of Sciences Institute of Medicine
report entitled _Broadening the Base of Treatment for Alcohol
Problems_ (1990) appears to have been the impetus for this ambitious
project. That report described heavy drinkers as a heterogeneous
population. Hypothetically, said the authors, a single treatment
approach, e.g. Alcoholics Anonymous-based treatment, to helping heavy
drinkers is not therapeutic for everyone. (1) Since drinkers vary,
treatment should vary.
Matching treatment protocol to the heterogeneous nature of the
heavy-drinker population makes sense. Project MATCH studied whether
three treatment approaches varied in effectiveness when clients were
matched accordingly (treatment deemed most appropriate). The three
independent variables were twelve-step facilitation (TSF) therapy
(Nowinski et al., 1995), cognitive-behavioral coping skills therapy (CBT)
(Kadden et al., 1995), and motivational enhancement therapy (MET)
(Miller et al., 1995). "Because the three treatments can be readily
taught and incorporated into a variety of treatment settings, the study
could have a major impact on delivery of treatment services" (Project
MATCH Research Group, 1993, p. 1142). The generalizability of findings
appeared strong. The dependent measures included percentage levels of
abstinence and drinks per day.
The findings presented by the Project MATCH Research Group at the
symposium in Washington, D.C., include the following:
1. There were excellent overall outcomes, which means that a
substantial number of subjects became abstinent or reduced
their daily consumption of beverage alcohol.
2. There were few differences in the effectiveness of
the three treatment approaches, and any differences were not
statistically significant. Those assigned to TSF did slightly
better than those assigned to the CBT group. The MET group did the
least well. Again, those differences were attributable to
3. Matching clients to particular treatments has no effect. Mismatches
are not a major obstacle.
4. TSF is associated with better outcomes (based on the dependent
measures used). But, again, the difference is attributable to chance
I reported those findings on several Internet mail lists at St.
John's University in Jamaica, N.Y., and discussion ensued. The accuracy
of my report was confirmed (at my public suggestion) by Alex Taylor, a
reporter from the Drug Policy Foundation (DPF) in Washington, D.C. Mr.
Taylor wrote a story on the MATCH report for the _Drug Policy Letter_
(News item, 1996). He telephoned Margaret E. Mattson, Ph.D., Project
MATCH staff collaborator and monograph series editor, Division of
Clinical and Prevention Research at NIAAA. She consented to have her
conversation with him tape-recorded for his story. Taylor read my report
of findings to Dr. Mattson and she confirmed them as accurate on June 28,
Strangely, on July 19, 1996, Dr. Mattson posted a letter sent to me
via certified mail from Dr. Ronald Kadden, chair of the Project MATCH
Steering Committee, on firstname.lastname@example.org (a public Internet mail
list described as "Academic & Scholarly discussion of addiction related
topics"). She also posted a private letter I had not yet received in the
mail on a public list of which I am not a member. Dr. Gerard Connors, a
principal investigator with the Project MATCH Research Group at the
Research Institute on Addictions, Buffalo, N.Y., did the same thing. He
posted the letter on a recovery-based, controlled-drinking mail list
(email@example.com), one I created. They each prefaced the posted
letter with the following statement: "Ron Kadden, in his capacity as
Chair of the Project MATCH Research Group, has asked me to post this
message. The actual letter has been mailed to Dr. Schaler." Here is the
first part of the letter:
Dear Dr. Schaler:
It has come to the attention of the Project MATCH
Research Group that there has been considerable discussion
on the Internet regarding the results of the trial.
Unfortunately, several of the communications that we have been
shown contain a number of inaccuracies and thus do not
adequately represent the trial nor its results as presented at
RSA. Further, none of the results or interpretations that are
being circulated have been confirmed by Dr. Margaret Mattson
or anyone else in the Project MATCH Research Group, despite
assertions they were.
I forwarded a copy of the posted letter to the DPF reporter
(Taylor), as he had informed me that Mattson had confirmed my report of
the findings as accurate. Taylor immediately telephoned Mattson, Gordis,
Kadden, and Anne Bradley (the press secretary for NIAAA), to discuss
Kadden's public assertion that "none of the results or interpretations
that are being circulated have been confirmed by Dr. Margaret Mattson or
anyone else in the Project MATCH Research Group, despite assertions they
were." Mattson, Gordis, and Kadden did not return Taylor's messages.
Dr. Thomas F. Babor (another principal investigator of the MATCH project)
and Ms. Bradley returned Taylor's call. (Note: Taylor never called
Babor.) Babor refused to have his conversation with Taylor taped. He
confirmed my report of the findings to Taylor as accurate but claimed
that the TSF variable was different from Alcoholics Anonymous (AA)-based
treatment, i.e. he asserted that the MATCH study did not test the
effectiveness of AA.
NIAAA Press Secretary Anne Bradley consented to having her
conversation with Taylor taped. He informed her that Mattson's
confirmation was taped with consent. Bradley stated in her official
capacity (on tape with her consent) that Mattson HAD confirmed my report
of the MATCH findings as accurate. NIAAA thereby contradicted Drs.
Mattson and Kadden and the Project MATCH Research Group. Apparently,
Drs. Mattson, Connors, and Kadden, in their official capacities as
members and representatives of the Project MATCH Research Group, were
lying. They used their federally funded professional positions to
publicly state I was untruthful when in fact THEY were untruthful.
Clearly, they acted unethically. Will they be reprimanded or censured
for doing so? Is such unethical behavior sanctioned by federal research
funds? What motivated their duplicitous behavior?
THIS AA IS NOT THIS AA
Dr. Kadden's letter to me continued:
Some of the inaccuracies involve the treatments. For example,
the Twelve Step Facilitation treatment is NOT a test of
Alcoholics Anonymous. It would be useful for interested
parties to refer to the treatment manuals, which are available
from the National Clearinghouse for Alcohol and Drug
When is AA not AA? Apparently, when psychologists working for the
government call it TSF. Kadden's assertion that TSF and AA are
substantively different is patently absurd. However, I suggest readers
judge this for themselves. For example, here is why the TSF variable,
referred to as "the Twelve-Step approach of AA," was selected: "The
Twelve-Step approach of AA was selected because of widespread belief in
the effectiveness of this approach....Given the widespread popularity of
the AA Twelve-Step approach, any matching effects found for it would be
highly transportable" (Project MATCH Research Group, 1993, p. 1132).
Consider the following quotations from the TSF manual that Kadden
suggests "interested parties" refer to, especially in light of Kadden's
and Babor's assertions that the TSF variable is not synonymous with the
approach of AA:
Twelve Step Facilitation Approach. This therapy is grounded
in the concept of alcoholism as a spiritual and medical
disease. The content of this intervention is consistent with
the 12 Steps of Alcoholics Anonymous (AA), with primary
emphasis given to Steps 1 through 5. In addition to
abstinence from alcohol, a major goal of the treatment is to
foster the patient's commitment to participation in AA. During
the course of the program's 12 sessions, patients are actively
encouraged to attend AA meetings and to maintain journals of
their AA attendance and participation. Therapy sessions are
highly structured, following a similar format each week that
includes symptoms inquiry, review and reinforcement for AA
participation, introduction and explication of the week's
theme, and setting goals for AA participation for the next
week. Material introduced during treatment sessions is
complemented by reading assignments from AA literature (p.
x)....The therapeutic approach underlying this manual is
grounded in the principles and 12 Steps of AA (p. xi)....The
program described here is intended to be consistent with
active involvement in Alcoholics Anonymous....It adheres to the
concepts set forth in the "Twelve Steps and Twelve Traditions"
of Alcoholics Anonymous....The overall goal of this program is
to facilitate patients' active participation in the fellowship
of AA. It regards such active involvement as the primary
factor responsible for sustained sobriety ("recovery") and
therefore as the desired outcome of participation in this
program (p. 1)....This treatment program has two major goals
which relate directly to the first three steps of Alcoholics
Anonymous (p. 2)....The two major treatment goals are reflected
in a series of specific objectives that are congruent with the
AA view of alcoholism (p. 3)....Central to this approach is
strong encouragement of the patient to attend several AA
meetings per week of different kinds and to read the "Big
Book" ("Alcoholics Anonymous") as well as other AA
publications throughout the course of treatment (p. 4)....The
goal of the conjoint sessions is to educate the partner
regarding alcoholism and the AA model, to introduce the
concept of enabling, and to encourage partners to make a
commitment to attend six Al-Anon meetings of their choice (p.
5)....[P]atients should be consistently encouraged to turn to
the resources of AA as the basis for their recovery (p.
6)....Suggestions made by the 12-Step therapist should be
consistent with what is found in AA-approved publications such
as those that are recommended to patients (p. 8)....Encouraging
patients to actively work the 12 Steps of Alcoholics Anonymous
is the primary goal of treatment, as opposed to any skill that
the therapist can teach (p. 10)....The therapist acts as a
resource and advocate of the 12-Step approach to recovery (p.
11)....In this program, the fellowship of AA, and not the
individual therapist, is seen as the major agent of change (p.
14)....The 12-Step therapist should not only be familiar with
many AA slogans but should actively use them in therapy to
promote involvement in AA and advise patients in how to handle
difficult situations (p. 15)....In approaching alcoholic
patients using this program...[t]here is...no cure for
alcoholism; rather, there is only a method for arresting the
process, which is active participation in the 12-Step program
of Alcoholics Anonymous (p. 33). (Nowinski et al., 1995)
Once again, Drs. Babor and Kadden and the Project MATCH Research
Group have contradicted themselves. Why would they try to obscure the
fact that TSF is essentially the same as AA? Would their obvious attempt
at cover-up change had the findings been different, e.g. if a
statistically significant difference in treatment effects had been found?
Dr. Kadden concluded his letter with the following:
We recognize that there is some impatience in the field
to draw inferences from our findings. However, we believe
that this can only be done in a scientifically valid way once
the entire field has access to the findings. We therefore
respectfully request that you and others wait for the paper
that is to be published in the Journal of Studies on Alcohol in
Jan. 1997 before drawing any conclusions, or implications
regarding policy issues.
Thank you for your consideration of this request.
For the Project MATCH Research Group,
Ronald Kadden, Ph.D.
Chairman, Project MATCH Steering Committee
Whose impatience? How do they "recognize" this impatience? What
inferences? It's a simple statement of fact that the findings were
Remember, the Project MATCH Research Group (employee) works for the
American taxpayer (employer). We are confronted with a situation here in
which a group of employees tell a select group called "scientists" about
the results of their publicly funded project. Then, the employer is told
by the employees not to talk about the findings, i.e. the employees
dictate employer behavior! Clearly, such gerrymandering (masquerading as
science) protects the interests of a few in the name of the welfare of
Base rhetoric is a bad habit among addiction-treatment and -research
professionals. (2) Dr. Stanton Peele, a renowned expert on the
interpretation of addiction research, wrote this about the Project MATCH
Research Group's shameless attempts at spin doctoring:
The MATCH researchers and NIAAA administrators have
insisted that interested professionals not discuss the results
they announced at an open conference until they can spin them
in their uncontested presentations and articles. They are
acting like the military officials who embargoed their reports
on missile hits during the Gulf War (and perhaps with the
same aim of covering up exaggerated claims of success). But
isn't a research organization, unlike a military one, supposed
to encourage open discussion of ideas and data? Not,
apparently, when the principals are nervous about spending
multimillions while failing to support the patient-treatment
matching approach that they have been touting for years!
(Personal communication, August 1996). (3)
The Project MATCH Research Group's "respect[ful] request" is a
euphemism for state-sanctioned restrictions on freedom of speech. NIAAA
tried to pressure the Drug Policy Foundation into not publishing the news
item by Alex Taylor. One reason for doing so is suggested above by Dr.
Peele: The results of the $25 million project "[fail] to support the
patient-treatment matching approach that they have been touting for
years." In other words, according to the researchers' findings, it makes
no difference whether heavy drinkers are treated as a homogeneous or as a
They didn't get the results they were hoping for, so they began to
backpedal. They tried to implement damage control by drawing the
inference that "treatment works." That claim, by Dr. Gordis, did not
There is another possible reason for the Project MATCH Research
Group's cover-up, one that is potentially far more damaging to the
researchers and the addiction-treatment industry, one that members of the
self-help movement, as well as health-insurance and health-management
corporations, will be most interested in (not to mention American
taxpayers and their legitimate representatives in Congress). (4)
SELLING WATER BY THE RIVER
What might the Project MATCH Research Group's motivation for cover-
up be? Note there was no statistically significant difference among
cognitive-behavioral coping skills, motivational enhancement therapy, and
twelve-step facilitation therapy in terms of achieving abstinence or
reducing drinking. CBT and MET are generally part of professional-
treatment programs. TSF is based in a self-help program, i.e. Alcoholics
Anonymous. The reasonable answer to the question posed is this: The
Project MATCH Research Group is afraid its findings will support the
abolition of professional treatment for heavy drinking. There's no
reason to pay for professional treatment when free self-help programs
such as AA (or free self-help programs based on CBT or MET) are equally
effective. Paying for treatment when a consumer can get it free simply
doesn't make sense.
Here's another way of considering the Project MATCH findings as
presented at the conference in Washington: Contemporary, cognitive-
based, "scientifically proven effective" approaches to helping heavy
drinkers such as CBT and MET appear to be no more effective than the
essence of one based on old-time religion, i.e. the essence of AA
principles and philosophy. Whether the clients are matched or not
matched to the most appropriate treatment, the effectiveness is the same
insofar as achieving abstinence or reducing the number of drinks consumed
(Schaler, in press)! Again, since the TSF variable represents the
essential features of AA, and there's no difference between TSF and the
other two variables in terms of achieving abstinence or reducing
drinking, why pay for CBT- or MET-based treatment when AA is free?
Health-management organizations, insurance companies, and Congress
should consider that interpretation carefully. It could be used to
justify major (if not complete) cutbacks in funding for treatment of
heavy drinking. That would be a wise policy. Moreover, the self-help
movement is growing steadily and continues to meet the diverse needs of
heavy drinkers. In addition to AA there is now SMART Recovery, a
secular, cognitive-behavior-therapy approach that is abstinence oriented.
Diverse secular-based controlled-drinking programs are growing in number,
too. (5) All these programs are autonomous and free.
The Project MATCH findings support the idea that selling treatment
for heavy drinking alongside free self-help programs such as AA is like
selling water by the river, to coin a Zen saying. Why buy when the river
gives it for free? Yes, this would likely destroy the economic
foundations of the addiction-treatment industry. So what? If the
members of that industry sincerely care about heavy drinkers seeking help
(as they so often claim to), why wouldn't they welcome the lifting of an
economic burden for these people, i.e. having to pay for treatment?
Whose interests are really being served here?
Dr. Enoch Gordis, director of the NIAAA, appears to have realized
these implications. He began the discussion at the RSA symposium by
claiming the Project MATCH findings showed that "treatment works." This,
he asserted, was because so many people became abstinent or reduced their
drinking through all three treatment approaches. At least four members
of the audience moved quickly to the microphone and delivered essentially
the same rejoinder. I was one of them and made the following statement:
"I would like to reiterate what has just been said. There was no
control group. With all due respect, Dr. Gordis, there is no evidence in
this study to show that treatment is effective. In fact, there are
studies showing no treatment is as effective as treatment" (Edwards et
al., 1977; Chick et al., 1988; Sobell et al., 1996).
The MATCH study findings could mean the end of the addiction-
treatment industry--and be a boon to the self-help movement. Dr. Gordis
tried to avoid this conclusion by attempting to divert discussion to
Question: Why didn't the Project MATCH Research Group challenge Dr.
Gordis on that idea? It is clear that AA-type self-help is as effective
as cognitive-behavioral coping skills and motivational enhancement
therapy. The whole idea of treatment effectiveness is suspect. Stanton
Peele suggests the following study: "Divide the money spent on MATCH by
the number of alcoholics MATCH treated, then give this amount to each of
a new group of alcoholics and see how much they improve without any
professionals in sight" (Personal communication, August 1996).
THIS SCIENCE IS NOT THIS SCIENCE
In summary, Dr. Margaret Mattson confirmed my report of the MATCH
findings as accurate and then posted a letter by the Project MATCH
Research Group claiming she had never confirmed them. That's the first
contradiction. NIAAA contradicted the assertions in Dr. Kadden's letter.
That's the second contradiction. The claim by Drs. Kadden and Babor that
twelve-step facilitation therapy and Alcoholics Anonymous are
substantively different from one another is contradicted by the official
manuals they recommend. That's the third contradiction. On the one
hand, the Project MATCH Research Group findings were presented at an open
symposium. On the other hand, it asks that those findings not be
discussed. That's the fourth contradiction. Dr. Enoch Gordis asserted
that the MATCH study findings show "treatment works." Yet a control
group was not used for comparison. That's the fifth contradiction.
These contradictions expressed by NIAAA and the Project MATCH
Research Group "are not accidental, nor do they result from ordinary
hypocrisy: they are deliberate exercises in doublethink." They are not
acts of aggression directed toward any one individual but toward
individualism and autonomy (in the form of self-help groups such as AA,
for example) as general forces threatening the authority of the state.
They are directed toward people who dare to oppose the sanctity of a
"therapeutic state" and the economic interests of the treatment industry.
There will undoubtedly be attempts to reconcile these
contradictions: "For it is only by reconciling contradictions that power
can be retained indefinitely." (Orwell) We will likely hear how $25
million and the failed cover-up were committed on the behalf of "people
in need." But that's a smoke screen, a cloud of obscurantism. When that
means of evasion fails, indignation will surely follow: How dare we
question their motives! How dare we hold NIAAA and the Project MATCH
Research Group accountable for duplicity! How dare we question
But this science is not this science. The "ordinary rhythms and
appearances of [science], however innocuous or pleasant, [are] far from
the truth of human experience." (Lifton)
1. See generally Donovan, D.M., and Mattson, M.E. (Eds.) (1994).
Alcoholism treatment matching research: Methodological and clinical
approaches. Journal of Studies on Alcohol, Supplement No. 12,
2. See Peele, S. (1986). Denial--of reality and freedom--in
addiction research and treatment. Bulletin of the Society of
Psychologists in Addictive Behaviors, 5, 149-166 (available at
Stanton Peele's Web site: http://www.frw.uva.nl/cedro/peele/).
3. See also Peele, S. (1996). Recovering from an all-or-nothing
approach to alcohol. Psychology Today, Sept./Oct., 35-43 & 68-70.
4. I urge readers to bring these issues to the attention of their
congressional representatives, e.g. request a congressional
investigation into possible mismanagement of federal funds. Ask your
representative to consider the issues raised here in light of
insurance bills requiring parity for treatment coverage between
real diseases like cancer, heart disease, and diabetes and fake ones
5. I do not recommend Moderation Management, Inc. (MM), a nonprofit
organization whose founders appear (in my opinion) to be jockeying
for financial gain, i.e. profit status. I was a founding member
of the MM Board of Directors and resigned, severing all relations
with that organization on August 16, 1996.
Chick, J., Rison, B., Connaughton, J., Stewart, A., and Chick, J.
(1988). Advice versus extended treatment for alcoholism: A
controlled study. British Journal of Addiction, 83, 159-170.
Edwards, G., Orford, J., Egert, S., Guthrie, S., Hawker, A., Hensman, C.,
Mitcheson, M., Oppenheimer, E., and Taylor, C. (1977). Alcoholism:
A controlled trial of "treatment" and "advice." Journal of Studies
on Alcohol, 38, 1004-1031.
Gordis, E. (1995). Foreword. In Nowinski, J., Baker, S., and
Carroll, K. Twelve Step Facilitation Therapy manual. A
clinical research guide for therapists treating individuals
with alcohol abuse and dependence. National Institute on
Alcohol Abuse and Alcoholism Project MATCH Monograph Series
Volume I. U.S. Department of Health and Human Services,
Institute of Medicine. (1990). Broadening the base of treatment
for alcohol problems. Washington, D.C.: National Academy of
Kadden, R., Carroll, K., Donovan, D., Cooney, N., Monti, P., Abrams,
D., Litt, M., and Hester, R. (1995). Cognitive-Behavioral Coping
Skills Therapy manual. A clinical research guide for
therapists treating individuals with alcohol abuse and
dependence. National Institute on Alcohol Abuse and Alcoholism
Project MATCH Monograph Series Volume III. U.S. Department of
Health and Human Services, Rockville, Md.
Lifton, R.J. (1986). The Nazi doctors: Medical killing and the
psychology of genocide. New York: Basic Books.
Miller, W.R., Zweben, A., DiClemente, C.C., and Rychtarik, R.G.
(1995). Motivational Enhancement Therapy manual. A clinical
research guide for therapists treating individuals with alcohol
abuse and dependence. National Institute on Alcohol Abuse and
Alcoholism Project MATCH Monograph Series Volume II. U.S.
Department of Health and Human Services, Rockville, Md.
News item. (1996). "Free Advice on Treating Alcoholics" in Summer
1996 issue of the Drug Policy Letter (p. 5). To subscribe,
call the Drug Policy Foundation in Washington, D.C.: (202)
537-5005 or write firstname.lastname@example.org.
Nowinski, J., Baker, S., and Carroll, K. (1995). Twelve Step
Facilitation Therapy manual. A clinical research guide for
therapists treating individuals with alcohol abuse and
dependence. National Institute on Alcohol Abuse and Alcoholism
Project MATCH Monograph Series Volume I. U.S. Department of
Health and Human Services, Rockville, Md.
Orwell, G. (1981). Nineteen eighty-four. New York: New American
Project MATCH Research Group. (1993). Project MATCH: Rationale and
methods for a multisite clinical trial matching patients to
alcoholism treatment. Alcoholism: Clinical and Experimental
Research, 17, 1130-1145.
Schaler, J.A. (in press). Spiritual thinking in addiction treatment
providers: The Spiritual Belief Scale. Alcoholism Treatment
Sobell, L.C., Cunningham, J.A., and Sobell, M.B. (1996). Recovery from
alcohol problems with and without treatment: Prevalence in two
population surveys. American Journal of Public Health, Vol.
86, No. 7, 966-972.
Jeffrey A. Schaler, Ph.D., is an adjunct professor of justice, law and
society at American University's School of Public Affairs in Washington,
D.C.; an adjunct professor of psychology at Montgomery College in
Rockville, Md.; and a member of the part-time faculty (psychology) at
Johns Hopkins University in Baltimore, Md. He lives in Silver Spring,
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