Response of Native American clients to three treatment methods for alcohol dependence.

OBJECTIVE: It is well-documented that American Indians suffer disproportionately high rates of alcohol use disorders as well as correspondingly high rates of alcohol based mortality, health, and social problems. Despite these health disparities, anecdotal evidence continues to guide alcohol treatment approaches in Indian Country, in part due to a dearth of clinical trials with Native Americans. Project MATCH, a multisite clinical trial, included 25 Native Americans (1.4% of the total sample) who were randomized to three psychosocial treatments. Based on cultural compatibility, our a priori hypothesis was that Native Americans in Motivational Enhancement Therapy (MET) would fare better than those assigned either to Cognitive Behavioral Therapy (CBT) or to Twelve-step Facilitation (TSF). METHOD: Of 25 Native Americans in Project MATCH, 23 (92%) were interviewed at all six assessment points. Four ANOCOVA's were computed to investigate possible differential treatment response. RESULTS: Despite a small sample, Native Americans assigned to MET reported significantly less drinking intensity relative to those assigned to CBT or TSF, with the highest proportion of abstinent days and lowest drinking intensity at both proximal and distal follow-ups. CONCLUSIONS: These findings suggest a differentially better response to MET than to TSF or to CBT among Native Americans with alcohol dependence. Although this is, to date, the largest randomized trial of treatments for alcohol dependence in Native Americans, the findings require replication.