Jeffrey A. Schaler, Ph.D.






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                     SELLLING 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
    chance only.
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 (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
(, 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?


     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 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?
Cui bono?


     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
heterogeneous population.

     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
hold up.

     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)


     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
"treatment works."

     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).


     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:
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
    like addiction.
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
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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
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     psychology of genocide.  New York:  Basic Books.
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News item.  (1996).  "Free Advice on Treating Alcoholics" in Summer
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Nowinski, J., Baker, S., and Carroll, K.  (1995).  Twelve Step
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Orwell, G.  (1981).  Nineteen eighty-four.  New York:  New American
Project MATCH Research Group.  (1993).  Project MATCH:  Rationale and
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     Research, 17, 1130-1145.
Schaler, J.A. (in press).  Spiritual thinking in addiction treatment
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Sobell, L.C., Cunningham, J.A., and Sobell, M.B.  (1996).  Recovery from
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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,