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Objective: Dialectical behavior therapy Skills Training (DBT-ST) is an effective group intervention for alcohol use disorder (AUD) and concurrent substance use disorders. However, no studies have empirically investigated group relationships within DBT-ST programs. Therefore, this research aims at investigating changes in positive work relationships (PWR) and negative relationships (NR) among members, as well as between members and leaders, during a 3-month DBT-ST program for AUD and other substance use disorders. Furthermore, the research explores the associations between these group processes in the early stages of intervention and primary treatment outcomes (i.e., continuous days of abstinence [CDA], length of stay in treatment). Method: The study included 75 individuals with a primary diagnosis of AUD (male: 52.0%; female: 48%; mean age: 48.48 (10.15); White). This observational study administered the Group Questionnaire weekly in order to assess the changes of PWR and NR during the treatment. CDA were evaluated using random toxicological screens at least twice a week. Linear mixed models were performed. Intention to treat analysis was based on multiple imputation method. Partial correlation analyses were conducted to test the associations between group relationships and primary treatment outcomes. Results: PWR and NR showed linear improvements during the treatment, especially considering member–member relationships. The levels of NR were inversely associated with CDA at the end of treatment. Conclusions: DBT-ST strategies might address relevant therapeutic processes in a group setting. Future controlled and process-outcome studies are recommended to empirically demonstrate the effects of DBT therapeutic techniques on group relationships, and their impact on primary treatment outcomes.

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