The role of the early therapeutic alliance in predicting drug treatment dropout
Drug and Alcohol DependencePublished 18 November 2005
Petra Meier, Michael Donmall, Patrick McElduff, Christine Barrowclough, Richard F Heller
Citations155
SJR quartileQ1
SJR score1.66
SNIP1.35
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TL;DR
The findings of this study stress the importance of treatment professionals attending to the therapeutic alliance in drug treatment, as counsellors' alliance ratings were found to be amongst the strongest predictors of dropout.
Abstract
The findings of this study stress the importance of treatment professionals attending to the therapeutic alliance in drug treatment, as counsellors' alliance ratings were found to be amongst the strongest predictors of dropout. Using alliance measures as clinical tools may help treatment practitioners to become aware of the risk of disengagement early on. Prospective studies are needed to evaluate whether strategies of reallocating clients with poor alliances to different counsellors lead to improvements in retention.
Keywords
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Journal of Personality and Social PsychologyAttachment styles among young adults: A test of a four-category model.
5,658 Citations1991Kim Bartholomew, Leonard M. Horowitz
Journal of Consulting and Clinical PsychologyRelation of the therapeutic alliance with outcome and other variables: A meta-analytic review.
3,269 Citations2000Daniel Martin, John P. Garske +1 more
The results of the meta-analysis indicate that the overall relation of therapeutic alliance with outcome is moderate, but consistent, regardless of many of the variables that have been posited to influence this relationship.
The Journal of Nervous and Mental DiseaseAn Improved Diagnostic Evaluation Instrument for Substance Abuse Patients
3,216 Citations1980A. Thomas McLellan, Lester Luborsky +2 more
The use of the ASI is suggested to match patients with treatments and to promote greater comparability of research findings, suggesting the treatment problems of patients are not necessarily related to the severity of their chemical abuse.
Journal of Counseling PsychologyRelation between working alliance and outcome in psychotherapy: A meta-analysis.
2,577 Citations1991Adam O. Horvath, B. Dianne Symonds
Journal of Personality and Social PsychologyModels of the self and other: Fundamental dimensions underlying measures of adult attachment.
1,660 Citations1994Dale W. Griffin, Kim Bartholomew
Psychological AssessmentFactor structure of the Working Alliance Inventory.
1,424 Citations1989Terence J. G. Tracey, Anna M. Kokotovic
The psychotherapeutic process: A research handbook.
1,397 Citations1986Leslie S. Greenberg, William M. Pinsof
Clinical Psychology ReviewA review of therapist characteristics and techniques positively impacting the therapeutic alliance
1,146 Citations2003Steven A. Ackerman, Mark J. Hilsenroth
Therapist's personal attributes such as being flexible, honest, respectful, trustworthy, confident, warm, interested, and open were found to contribute positively to the alliance.
Addictive BehaviorsInitial motivations for alcohol treatment: Relations with patient characteristics, treatment involvement, and dropout
659 Citations1995Richard M. Ryan, Robert W. Plant +1 more
Results revealed that internalized motivation was associated with greater patient involvement and retention in treatment, and problem severity was also related to a greater degree ofinternalized motivation.
AddictionThe role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature
451 Citations2005Petra Meier, Christine Barrowclough +1 more
The therapeutic alliance plays an important role in predicting drug treatment process outcomes, but too little is known about what determines the quality of the relationship between drug users and counsellors.
AddictionEffects of readiness for drug abuse treatment on client retention and assessment of process
368 Citations1998W. George, Joe D. +2 more
Indicators of intrinsic motivation-especially readiness for treatment-were not only significant predictors of engagement and retention, but were more important than socio-demographic, drug use and other background variables.
Drug and Alcohol DependenceRetention and patient engagement models for different treatment modalities in DATOS
324 Citations1999George W. Joe, D. Dwayne Simpson +1 more
Structural equation models showed there were positive reciprocal effects between therapeutic involvement and session attributes in all three modalities, and these variables had direct positive effects on treatment retention.
Drug and Alcohol DependenceDrug abuse treatment retention and process effects on follow-up outcomes
316 Citations1997D. Dwayne Simpson, George W. Joe +1 more
The findings suggest that more comprehensive models of patient attributes, therapeutic process, and environmental influences are needed, and that treatment enhancement efforts should focus on such during-treatment measures as interim criteria for improving posttreatment outcomes.
AddictionFactors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses
283 Citations2002Michael Gossop, Duncan Stewart +2 more
Despite generally satisfactory drug use outcomes, the lapses and relapses to heroin use give rise to concern and treatment services should develop further and strengthen relapse prevention and relapse coping skills among drug misusers.
Journal of Consulting and Clinical PsychologyTherapeutic Alliance in Depression Treatment: Controlling for Prior Change and Patient Characteristics.
268 Citations2003Daniel N. Klein, Joseph E. Schwartz +15 more
The early alliance significantly predicted subsequent improvement in depressive symptoms after controlling for prior improvement and 8 prognostically relevant patient characteristics, and neither early level nor change in symptoms predicted the subsequent level or course of the alliance.
AddictionVariations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review
241 Citations1994Lisa M. Najavits, Roger D. Weiss
The main conclusions are that therapists show diverse rates of effectiveness, and that such differences appear independent of both therapists' professional background and of patient factors at the start of therapy.
Journal of Substance Abuse TreatmentMeasuring patient attributes and engagement in treatment
225 Citations2002George W. Joe, Kirk M. Broome +2 more
The Texas Christian University (TCU) Client Evaluation of Self and Treatment (CEST)(1) is a 144-item self-rating instrument that includes 16 scales measuring patient functioning and treatment perceptions, and psychosocial functioning was generally reported and construct validity was demonstrated.
Psychological AssessmentToward the validation of the California Therapeutic Alliance Rating System.
189 Citations1989Charles R. Marmar, Daniel S. Weiss +1 more
Drug and Alcohol DependenceTreatment retention and 1 year outcomes for residential programmes in England
185 Citations1999Michael Gossop, John Marsden +2 more
Substantial improvements were found in terms of abstinence from opiates, psychostimulants and benzodiazepines, and longer stays in treatment were predictive of better 1 year outcomes.
PubMedPerspective is everything: the predictive validity of six working alliance instruments.
153 Citations2001L R Fenton, John J. Cecero +3 more
The predictive validity of instruments commonly used to measure the therapeutic alliance was evaluated, using 46 sessions drawn from a clinical trial comparing manual-guided therapies for substance use to suggest that the different observer-rated instruments are minimally different with respect to predictive validity.
Journal of Consulting and Clinical PsychologyTherapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.
150 Citations2001Jacques P. Barber, Lester Luborsky +9 more
High levels of alliance were observed in supportive-expressive therapy, cognitive therapy, and individual drug counseling, and alliance levels increased slightly but significantly from Session 2 to Session 5 in all groups, but alliance was not a significant predictor of drug outcome.
Psychotherapy ResearchTherapeutic alliance as a predictor of outcome in treatment of cocaine dependence
145 Citations1999Jacques P. Barber
British Journal of AddictionAn Instrument for Measuring Coping Behaviours in Hospitalized Alcoholics: Implications for Relapse Prevention Treatment
135 Citations1983Gloria K. Litman, John Stapleton +2 more
The results indicate that the factor structure of the Coping Behaviours Inventory is stable over time and with different alcoholic patient populations.
American Journal of OrthopsychiatryThe power of the therapeutic relationship.
122 Citations1991Elsa Marziali, Leslie B. Alexander
A review of the psychotherapy research literature of the last decade shows that considerable advances of clinical significance have been made toward defining and measuring components of the treatment relationship.
PubMedMethadone treatment practices and outcome for opiate addicts treated in drug clinics and in general practice: results from the National Treatment Outcome Research Study.
110 Citations1999Michael Gossop, John Marsden +3 more
Results demonstrate the feasibility of treating opiate addicts using methadone in primary health care settings, and show that treatment outcomes for such patients can be as satisfactory as for patients in specialist drug clinics.
Drug and Alcohol DependenceThe relationship of counseling and self-help participation to patient outcomes in DATOS
106 Citations1999Rose M. Etheridge, S. Gail Craddock +2 more
The strong after-treatment self-help effect in the two residential and inpatient modalities suggests these programs can improve treatment outcomes by making referral to after- treatment self- help participation a standard practice and installing mechanisms to increase the likelihood of attendance at least twice weekly during the year after treatment.
The American Journal of Drug and Alcohol AbuseDetermining predictors of attrition in an outpatient substance abuse program
105 Citations2002Shelly L. Sayre, Joy M. Schmitz +4 more
Examination of the relationship of demographic, drug use severity, and psychosocial factors with treatment attrition and the time of dropout in an outpatient cocaine abuse program found that participants with higher education levels and those with poorer psychiatric functioning tended to remain in treatment longer.
AddictionPredicting the early therapeutic alliance in the treatment of drug misuse
99 Citations2005Petra Meier, Michael Donmall +3 more
Clients who had better motivation, coping strategies, social support and a secure attachment style were more likely to develop good alliances, and counsellors' professional experience and ex-user status were not clear cut.
Drug and Alcohol DependencePatient histories, retention, and outcome models for younger and older adults in DATOS
98 Citations1999Christine E. Grella, Yih‐Ing Hser +2 more
There was a stronger positive relationship between treatment retention and abstinence at follow-up for younger adults in both treatment modalities and for older adults in ODF, and clinical implications of age-related differences in these relationships are discussed.
American Journal on AddictionsRetention in Psychosocial Treatment of Cocaine Dependence: Predictors and Impact on Outcome
97 Citations2002Lynne Siqueland, Paul Crits‐Christoph +10 more
This report describes retention in treatment in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study (CCTS), a multi-site trial of four psychosocial treatments for 487 cocaine dependent patients.
Behavioural and Cognitive PsychotherapyTHE THERAPY RELATIONSHIP IN COGNITIVE THERAPY: A REVIEW
92 Citations2002Louise Waddington
This assumption that the therapy relationship provides a necessary context for intervention but is insufficient alone to produce therapeutic change is reviewed in the light of up-to-date evidence from research studies of cognitive therapy and recommendations are made for further research.
Drug and Alcohol DependencePredictors of dropout from psychosocial treatment of cocaine dependence
85 Citations1998Lynne Siqueland, Paul Crits‐Christoph +6 more
Journal of Substance Abuse TreatmentRetention in substance dependence treatment: the relevance of in-treatment factors
82 Citations2001G.H. de Weert-van Oene, Gerard M. Schippers +2 more
The objective of this paper is to analyze the predictive role of repeated measures of treatment readiness and behavioral intention, and of patients' perception of the therapeutic alliance, while controlling for fixed patient-oriented variables.
Drug and Alcohol DependenceRetention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage
80 Citations1998Daniela D’Ippoliti, Marina Davoli +3 more
For patients in maintenance, methadone dosage and clinic policy were the most important factors for retention, and patients intenance-oriented clinics were 30% more likely to remain in treatment than those in abstinence-oriented centres.
Clinical Psychology ReviewThe therapeutic relationship in behavior therapy
76 Citations1984Andrew A. Sweet
Psychiatric ServicesTherapeutic Alliance and Psychiatric Severity as Predictors of Completion of Treatment for Opioid Dependence
75 Citations1999Nancy M. Petry, Warren K. Bickel
The results underscore the importance of early identification of opioid-dependent patients with moderate to severe levels of psychopathology and suggest a strong therapeutic alliance may be an essential condition for successful treatment.
Clinical Psychology ReviewAlliance and technique in short-term dynamic therapy
53 Citations1999Paul Crits‐Christoph, Mary Beth Connolly
Despite the methodological limitations of research, the fact that there are some consistent findings relating techniques to outcome suggests that nonspecific relationship factors do not by themselves account for the changes found over the course of STDP.
Substance Use & MisuseMeasurements, Instruments, Scales, and Tests: The Helping Alliance Questionnaire: Psychometric Properties in Patients with Substance Dependence
53 Citations1999G.H. de Weert-van Oene, C.A.J. de Jong +2 more
The HAQ seems to be a "quick scan" instrument to give a quick and global impression of the patients' perception of the quality of the working alliance with the therapist.
PubMedTreatment outcomes of stimulant misusers: one year follow-up results from the national treatment outcome research study (NTORS).
53 Citations2001Michael Gossop, John Marsden +1 more
Drug and Alcohol DependenceAssessing the helping alliance and its impact in the treatment of opiate dependence
52 Citations1997Mark A. Belding, Martin Y. Iguchi +2 more
Evaluation of the patient-counselor helping alliance's unique contribution to the prediction of outcome suggests that the development of a positive HA may be more a marker of treatment progress than a necessary precursor of positive outcomes in the methadone maintenance treatment setting.
Psychiatric ServicesA Randomized Controlled Study of the Effectiveness of Intensive Outpatient Treatment for Cocaine Dependence
46 Citations1998Edward Gottheil, Stephen P. Weinstein +3 more
Patients who completed the intensive program showed significant improvement from intake to end-of-treatment scores on the Addiction Severity Index, the Beck Depression Inventory, and the Symptom Checklist, and patients who remained in treatment were more likely to be attending self-help meetings, continuing in outpatient treatment, or attending school.
Personal RelationshipsDo you remember?: Recollections of adult attachment patterns
38 Citations1998Elaine Scharfe, Kim Bartholomew
Addictive BehaviorsThe relationship of counselor and peer alliance to drug use and HIV risk behaviors in a six-month methadone detoxification program
32 Citations1995Sandra L. Tunis, Kevin Delucchi +3 more
Examination of treatment outcomes in opioid detoxification to levels of counselor and peer alliance suggests that treatment outcome may be improved through approaches that address a patient's alliance with both counselor and peers.
PubMedBack to basics: fundamental cognitive therapy skills for keeping drug-dependent individuals in treatment.
19 Citations1997Bruce S. Liese, A T Beck
Journal of Substance Abuse TreatmentDrug use, HIV-related risk behaviors and dropout status of new admissions and re-admissions to methadone treatment
18 Citations2001Sherry Deren, Marjorie F. Goldstein +4 more
Differences between 211 re-admissions and 128 new admissions to a NYC MMTP are assessed, finding those new to MMTP were found to be less likely to have ever injected drugs, have used more types of drugs, and used heroin at higher frequencies in the 30 days prior to admission.