BMC Public Health 2005, 5:75 http://www.biomedcentral.com/1471-2458/5/75 select the three treatments used in MATCH included the following: demonstrated clinical effectiveness; applicabil- ity to existing treatment programs and client populations, and distinctiveness from each other [2]. Project MATCH took great care to assure that the therapy was of the highest quality. Therapy was manualized and the three manuals [3-5] were organized into specific treat- ment sessions. Cognitive Behavioral Therapy (CBT) focused on handling thoughts about alcohol, dealing with urges, refusing drinks, avoiding situations that might lead to relapse, etc. Motivational Enhancement Therapy (MET) provided structured feedback about alcohol-related prob- lems, and attempted to motivate commitment to change, to increase individual responsibility, and to enlist per- sonal resources. Twelve Step Facilitation (TSF) was based on principles of Alcoholics Anonymous and it introduced the first three steps of AA and promoted active participa- tion in AA. Therapists were required to have a Masters degree or Certified Addiction Counselor degree, a com- mitment to the particular therapeutic approach that they would provide (i.e., CBT, MET, or TSF), and at least two years experience. Therapist training was centralized at the coordinating center using seminars, required two super- vised training cases, and also included some ongoing supervision of all sessions. Therapists taped their sessions with clients, and the tapes were scored at the coordinating center. In some ways, the results of the MATCH clinical trial were disappointing. At the time it was concluded, in the late 1990s, it was the one of the most expensive clinical trials ever undertaken, costing 27 million dollars; it was con- ducted by the most seasoned alcoholism professional investigators, and it was designed to validate the top "cut- ting-edge" findings which had accumulated the strongest experimental support. Some 504 hypotheses were tested [6]. The final results did not support the hypotheses. There were essentially no matches between the therapeu- tic treatments and the participants above the level of ran- dom probability [6]. An analysis of the problem suggested that too many Type I errors were being made in the alco- holism literature [7]. Type I errors typically occur when an inappropriately large number of statistical tests are performed. In announcing the disappointing MATCH results, the director of the National Institute of Alcohol Abuse and Alcoholism stated "All three treatments evaluated in Project MATCH produced excellent overall outcomes" [8]. That position was given scientific weight most notably by William Miller and colleagues in their paper "How effec- tive is alcoholism treatment in the United States?" [9]. They suggested that treatment is extremely effective by way of presenting the MATCH results, and results of other Table 1: Alcoholism treatment 12 month outcome data cited by Miller to suggest that treatment is effective. Multi-center trial Percent days abstinent Drinks per drinking day Lithium/Placebo Disulfiram/Placebo Relapse prevention MATCH 12 Step/Cognitive Rand Mean 83 84 85 77 82 5 5 8 5 6 large multi-site alcoholism trials. Table 1 shows outcome data abstracted from that paper. In addition to MATCH, the studies consisted of an analysis conducted by the Rand Corporation of treatment programs around the U.S. [10], a study at Veteran's Hospitals that compared disulfiram (Antabuse) to placebo [11], a VA study comparing lithium to placebo [12], a study on relapse [13], and a study com- paring 12-step to cognitive-behavioral treatment [14]. Table 1 shows that the MATCH outcomes were very simi- lar to the outcomes of the other studies. The effectiveness of psychosocial therapy for alcoholism is being challenged in a number of different ways. Evidence is accumulating that extensive therapy may be no more effective that brief intervention [1,15]. Brief interventions are minimal types of therapies that can consist of simple expressions of concern about drinking delivered by a MD in a hospital trauma unit. There is a growing literature on "natural recovery" showing that many, if not most, indi- viduals with serious alcohol consumption problems are able to recover without treatment [16]. A recently pub- lished meta-analysis [17] reported a significant improve- ment in untreated alcoholics enrolled in clinical trials. And there have been a few published trials that have con- cluded that therapy is not particularly effective [18,19]. The present study reports analyses of some overlooked data from Project MATCH. The overall relationship between treatment quantity (number of treatment ses- sions attended) and drinking measures was analyzed. Next, primary outcome data of participants who dropped out of treatment before receiving any therapy was com- pared to that of participants who attended each and every session for the full 12 weeks of therapy. Additionally we identified one anomalous group consisting of those par- ticipants who attended only one session of therapy. The data from this unusual group provides additional clues that help in interpreting the findings. Page 2 of 11 (page number not for citation purposes)