The role of the early therapeutic alliance in predicting drug treatment dropout

Abstract

Background: To investigate the role of the therapeutic alliance in predicting length of retention in residential drug treatment. Methods:The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and the average total scores of client and counsellor ratings on the WAI-S (obtained during weeks 1 to 3) were use as the alliance measure. Length of retention and treatment completion (stay beyond 90 days) were used as measures of retention.Results: Clients with weak counsellor rated alliances dropped out of treatment significantly sooner than clients with strong counsellor-rated therapeutic alliances, whether or not the model adjusted for individual counsellor effects and potential confounders including psychological wellbeing, treatment motivation and readiness, coping strategies, and attachment style. The client rated alliance did not predict length of retention. Apart from the alliance, pre-treatment crack use, secure attachment style and better coping strategies were associated with shorter retention, whereas greater confidence in treatment, older client age and better education predicted treatment completion. Counsellors with greater experience of delivering drug counselling retained clients longer. Conclusions: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.

Evaluation of a Patient Activation and Empowerment Intervention in Mental Health Care

“…These findings are consistent with work that found that a collaborative relationship is related to treatment retention for drug abuse, 38,39 alcohol abuse, 40 and family therapy. 41 Implementing such interventions in safety net hospitals can help decrease the problems of no-shows and increase retention in care of minority populations that have been linked to service disparities.…”

Patient satisfaction with treatments and outcomes in residential addiction institutions

“…Confidence in professional competence may occur when there is a good quality patient-counsellor relationship. The beneficial effect of the therapeutic alliance in the treatment of substance abuse has been documented in previous research (Allen & Olson, 2015;Meier, Barrowclough, & Donmall, 2004;Meier, Donmall, McElduff, Barrowclough, & Heller, 2006;Urbanoski, Kelly, Hoeppner, & Slaymaker, 2012). Direct comparisons of satisfaction scores between studies are problematic due to the diversity of patient populations and treatment settings and the use of overall satisfaction measures.…”

Why don't patients attend their appointments? Maintaining engagement with psychiatric services

“…stronger predictor of drop-out than patient-rated therapeutic alliance (Meier et al, 2006). Willingness to discuss mental health issues with a doctor is also predicted largely by the perceived helpfulness of that doctor, and in turn trust in the doctor and the medical profession.…”