Matching clients to treatment has been a topic of great interest to clinicians and researchers in the field of alcohol and drug abuse. Currently, several nationwide efforts are attempting to establish central intakes in communities using computerized systems. This article includes a brief literature review to provide an assessment of the current knowledge about matching that can be used to support a matching system guided by expert knowledge. A conceptual framework for the development of an expert-guided system to be used in a central intake or referral agency is then described. A drug treatment referral system that matches drug users to appropriate treatment programs requires several interlinked components: (1) an accurate list of available programs with comprehensive descriptors characterizing the programs, including the nature and kinds of services provided; (2) an assessment instrument that can be easily and routinely administered is needed for determining clients' characteristics and needs; and (3) results of that assessment instrument are used to match clients with the most appropriate available programs according to a set of decisional guidelines, which is the most critical component of the referral system. Component-specific issues that need to be addressed in developing an expert-guided referral system are discussed. The paper concludes that an expert-guided system using profile matching, although constrained by the resources available in a community, is likely to improve client outcomes and program efficiency over the current haphazard utilization practices of unstructured referral. Development of a matching index that can predict client outcome is necessary to provide empirical directions for future research and improved practice.
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References
1.
American Society of Addiction Medicine (ASAM)1993Patient placement criteria for the treatment of psychoactive substance use disorders. The Coalition for National Clinical Criteria on Addiction Treatment.
2.
AnglinM.D.HserY. in press Outcome evaluation research. In Drug abuse and drug abuse research, the Fourth Triennial Report to Congress from the Secretary. Rockville, MD: Department of Health and Human Services.
3.
AnnisH.M.1985Is inpatient rehabilitation of the alcoholic cost effective? Con position. Advances in Alcohol and Substance Abuse, 5: 175–90.
4.
AnnisH.M.1987Effective treatment for drug and alcohol problems: What do we know? Presented at the Annual Meeting of the Institute of Medicine, National Academy of Sciences, Washington, D.C., October 21.
5.
AnnisH.M.ChanD.A.1983The differential treatment model: Empirical evidence from a personality typology of adult offenders. Criminal Justice and Behavior, 10(2): 159–73.
6.
BallJ.C.RossA.1991The effectiveness of methadone maintenance treatment: Patients, programs, services, and outcomes. New York: Springer-Verlag.
7.
BeutlerL. E.1991Have all won and must all have prizes? Revisiting Luborsky, et al.'s verdict. Journal of Consulting and Clinical Psychology, 59(2), 226–32.
8.
ChildressA.R.McLellanA.T.O'BrienC.P.1985Behavioral therapies for substance abuse. International Journal of the Addictions, 20(6 and 7): 947–69.
9.
CooneyN.L.KaddenR.M.LittM.D.GetterH.1991Matching alcoholics to coping skills or interactional therapies: Two-year follow-up results. Journal of Consulting and Clinical Psychology, 59: 598–601.
10.
FinneyJ.W.MoosR.H.1981aCharacteristics and prognoses of alcoholics who become moderate drinkers and abstainers after treatment. Journal of Studies on Alcohol, 42: 994–1005.
11.
FinneyJ.W.MoosR.H.ChanD.A.1981bThe process of recovery from alcoholism: I. Comparing alcoholic patients with matched community controls. Journal of Studies on Alcohol, 42: 383–402.
12.
FinneyJ.W.MoosR.H.1986Matching patients with treatments: Conceptual and methodological issues. Journal of Studies on Alcohol, 47(2): 122–34.
13.
GlaserF.B.SkinnerH.A.1981Matching in the real world: A practical approach. In Matching patient needs and treatment methods in alcoholism and drug abuse, eds. GottheilE.A.McLellanA.T.DruleyK.A., 295–324. Springfield, IL:Charles C. Thomas.
14.
GottheilE.McLellanA.T.DruleyK.A., eds. 1981Matching patient needs and treatment methods in alcoholism and drug abuse. Springfield, IL: Charles C. Thomas.
15.
HartmanL.KrywonisM.MorrisonE.1988Psychological factors and health-related behavior change: Preliminary findings from a controlled clinical trial. Canadian Family Physician, 34: 1045–50.
16.
HoffmanN.G.HalikasJ.A.Mee-LeeD.1987The Cleveland admission, discharge, and transfer criteria: Model for chemical dependency treatment programs. Cleveland, OH: The Great Cleveland Hospital Association.
17.
HubbardR.L.MarsdenM.E.RachalJ.V.HarwoodH.J.CavanaughE.R.GinzburgH. M.1989Drug abuse treatment: A national study of effectiveness. Chapel Hill, NC: The University of North Carolina Press.
18.
InciardiJ.A.McBrideD.C.WeinmanB.A.1993The assessment and referral of criminal justice clients: Examining the focused offender disposition program. In Drug treatment and criminal justice, ed. InciardiJ.A., Newbury Park, CA: Sage Publications.
19.
InciardiJ.A.McBrideD.C.WeinmanB.A.DemboR.1992Drug offender assessment instruments. Washington, D.C.: Bureau of Justice Assistance.
20.
Institute of Medicine (IOM)1989Prevention and treatment of alcohol problems: Research opportunities. Washington, D.C.: National Academy Press.
21.
Institute of Medicine (IOM)1990Matching. In Committee for the study of treatment and rehabilitation for alcoholism and alcohol abuse, Broadening the base of treatment for alcohol problems (Chapter 11, pp. 279–312). Washington, D.C.: National Academy Press.
22.
KaddenR.M.CooneyN.L.GetterH.LittM.D.1989Matching alcoholics to coping skills or international therapies: Post-treatment results. Journal of Consulting and Clinical Psychology, 57: 698–704.
23.
KissinB.PlateA.SuW.H.1970Social and psychological factors in the treatment of chronic alcoholism. Journal of Psychiatric Research, 8: 13–27.
24.
KissinB.PlatzA.SuW.H.1971Selective factors in treatment choice and outcome alcoholics. In Recent advances in studies of alcoholism, eds. MelloN.K.MendelsonJ.K. (NIMH Publ. No. [HSM] 71–9045, 781–802). Washington, D.C.: U.S. Government Printing Office.
25.
McLachlanJ.F.C.1972Benefit from a group therapy as a function of patient-therapist match on a conceptual level. Psychotherapy: Theory, Research, and Practice, 9: 317–23.
26.
McLellanA.T.1994Matching in substance abuse treatment: Policy suggestions from two prospective studies. Presentation at the Health Services Research Conference, San Diego, CA, June 12–14.
27.
McLellanA.T.AltermanA.I.1991Patient treatment matching: A conceptual and methodological review with suggestions for future research. In Improving drug abuse treatment, eds. PickensR.W.LeukefeldC.G.SchusterC.R., (NIDA Research Monograph No. 106, U.S. D.H.H.S. Publ. No. [ADM] 91–1754, 114–35). Rockville, MD: National Institute on Drug Abuse.
28.
McLellanA.T.AltermanA.I.CacciolaJ.MetzgerD.O'BrienC.P.1992A new measure of substance abuse treatment: Initial studies of the treatment services review. Journal of Nervous and Mental Diseases, 180(2): 101–10.
29.
McLellanA.T.KushnerH.MetzgerD.PetersR.SmithI.GrissonG.PettinatiH.ArgeriouM.1992The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9: 199–213.
30.
McLellanA.T.LuborskyL.O'BrienC.P.WoodyG.E.1980An improved evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Diseases, 168: 26–33.
31.
McLellanA.T.LuborskyL.WoodyG.E.O'BrienC.P.DruleyK.A.1983aPredicting response to alcohol and drug abuse treatments: Role of psychiatric severity. Archives of General Psychiatry, 40: 620–5.
32.
McLellanA.T.WoodyG.E.LuborskyL.O'BrienC.P.DruleyK.A.1983bMatching substance abuse patients to appropriate treatment methods: A conceptual and methodological approach. Drug and Alcohol Dependence, 5: 189–95.
33.
MillerW.R.1985Motivation for treatment: A review with special emphasis on alcoholism. Psychological Bulletin, 98: 84–107.
34.
MillerW.R.HesterR.K.1986aInpatient alcoholism: Who benefits?American Psychologist, 41(7): 794–805.
35.
MillerW.R.HesterR.K.1986bMatching problem drinkers with optimal treatments. In Treating addictive behaviors: Processes of change, eds. MillerW.R.HeatherN., 121–74. New York:Plenum.
36.
MillerW.R.RollnickS.1991Motivational interviewing. New York: Guilford Press.
37.
NurcoD.N.ShafferJ.W.HanlonT.E.KinlockW.T.DuszynskiK.R.StephensonP.1988Relationships between client/counselor congruence and treatment outcome among narcotic addicts. Comprehensive Psychiatry, 29(1): 48–54.
38.
OnkenL.S.BlaineJ.D., eds. 1990Psychotherapy and counseling in the treatment of the drug abuse (NIDA Research Monograph 104). Rockville, MD: U.S. D.H.H.S.
39.
OrfordJ.E.OppenheimerE.EdwardsG.1976Abstinence or control: The outcome for excessive drinkers after two years after consultation. Behavioral Research and Therapy, 14: 409–18.
40.
PittelS.M.HoferR.1974A systematic approach to drug abuse treatment referral. Journal of Psychedelic Drugs, 6(2): 253–8.
41.
ProchaskaJ.O.DiClementeC.C.1986Toward a comprehensive model of change. In Treating addictive behaviors: Processes of change, eds. MillerW.R.HeatherN., 3–27. New York:Plenum Press.
42.
Project MATCH1992Project MATCH: Rationale for a multisite clinical trial matching alcoholism patients to treatment. Alcoholism: Clinical and Experimental Research, 17(6): 1130–45.
43.
WoodyG.E.McLellanA.T.LuborskyL.O'BrienC.P.BlaineJ.FoxS.HermanI.BeckA.T.1984Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: The Veterans Administration-Penn study. American Journal of Psychiatry, 141(10): 1172–7.
44.
WoodyG.E.McLellanA.T.LuborskyL.O'BrienC.P.1990Psychotherapy and counseling for methadone-maintained opiate addicts: Results of research studies. In Psychotherapy and counseling in the treatment of drug abuse, eds. OnkenL.S.BlaineJ.D., (NIDA Research Monograph 104, pp. 9–23). Rockville, MD: U.S. D.H.H.S.
