The impact of worker values on client outcomes within a drug treatment service

Abstract

Background: Little attention has been paid to understanding the impact of values, attributes and characteristics of drugs workers on therapeutic relationships and treatment outcomes. Interaction of values with other variables is considered to be of importance since values play a role in determining attitudes and behaviours. This exploratory study investigates the impact of drug workers' personal values on client outcomes within a drug treatment service. Methods: 8 drug workers and 58 clients were recruited at a UK charity working with problematic drug users who are also socially excluded. Drug workers completed a validated questionnaire (Schwartz, 1992) to elicit their personal values. Client outcomes were assessed using the Christo Inventory for Substance Misuse Services (Christo et al., 2000). The relationship between client outcomes and worker values were analysed using Spearman's rank test of association. Results: Drug workers prioritising stimulation, self-direction and hedonism value types experienced more positive client outcomes compared with those prioritising security, conformity, benevolence, tradition and universalism types. The value types associated with positive outcomes fall within Schwartz's 'openness to change' superordinate dimension, whereas those related to more negative outcomes fall within the 'conservation' dimension. Conclusion:The study suggests that drug workers' personal values may have a significant impact upon client outcomes in the treatment of substance misuse. Reasons for this finding are explored, as are limitations of this study and suggestions for future research.Despite the substantial proportion of drugs agencies' funding allocated to human resources, little attention has been paid to the important contribution that drug workers bring to the treatment of those experiencing problematic drug use. The focus of research thus far has tended toward examining models or styles of treatment. Yet, given the complex issues usually associated with problem drug users, drug worker attributes including skills, values, beliefs and adaptability are likely to have some effect in the outcome of treatments.One area where attention has been paid to the contribution of the worker is in the impact of the 'therapeutic alliance' (e.g. Luborsky et al., 1995;Belding et al., 1997;Connors et al., 2000;Joe et al., 2001), conceptualised as the degree to which the therapist and client develop a positive, collaborative relationship (Bordin, 1979;Horvarth, 2001). Within drug treatment settings it is generally accepted that establishing a therapeutic alliance is important, not least because of the difficulties of engaging and retaining clients in treatment (Simpson et al., 1997;Gossop et al., 1999). This view is supported by research that finds that establishing the alliance early on is a "consistent predictor of engagement and retention in drug treatment" (Meier et al., 2005: 313).Despite the importance of retention as a prerequisite for positive treatment outcomes, few studies follow the course of t...

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