Effect of early working alliance on retention in outpatient substance abuse treatment

Knuuttila, Vesa; Kuusisto, Katja; Saarnio, Pekka; Nummi, Tapio

doi:10.1080/09515070.2012.707116

Cited by 13 publications

(9 citation statements)

References 38 publications

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“…In recent studies, these therapist‐related variables are seen as important and should be taken into account in future research (Artkoski, Kuusisto & Saarnio, 2012; Baldwin et al, 2007). According to a study using the same data, the therapist's rating of the first session significantly predicted treatment retention (Knuuttila, Kuusisto, Saarnio & Nummi, in press). In the present study, the client ratings of the alliance after the first and third sessions predicted client satisfaction, as was expected.…”

Section: Discussionmentioning

confidence: 99%

Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction

Knuuttila¹,

Kuusisto²,

Saarnio³

et al. 2012

Clinical Psychologist

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Background: The study examined the effect of the early working alliance on outcome in outpatient substance abuse treatment. Methods: A total of 327 clients and 33 therapists participated in the study. Data were collected in southern and western Finland in outpatient treatment units (N = 7). The dependent variables were percentage of days abstinent and client satisfaction at six‐month follow‐up. The independent variables were both client and therapist alliance ratings of the first and third sessions. The client's percentage of days abstinent for the month preceding treatment was used as a covariate. Intra‐class correlation was used to measure between‐therapist variation. Results: The main finding was that there was considerable between‐therapist variation in both the frequency of clients’ substance use and client satisfaction at follow‐up. The client's earlier substance use frequency was a significant predictor of the substance use frequency at follow‐up. Client satisfaction was significantly predicted by the client's rating of the early alliance. Conclusions: More research on therapists is needed because between‐therapist differences seem to be associated with patient outcomes over differences within therapists. While the study confirmed that good early working alliance improves outcome during treatment without being linked to post‐treatment recovery, more research is needed also in that area.

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Section: Discussionmentioning

confidence: 99%

Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction

Knuuttila¹,

Kuusisto²,

Saarnio³

et al. 2012

Clinical Psychologist

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“…Meier et al (2006) found that therapist alliance ratings predicted dropout for SUD patients, but the patient alliance ratings did not. Knuuttila et al (2012) found an association among SUD outpatients between the working alliance as rated by the therapist in the first session and the patient's percentage of abstinent days at baseline, together predicting treatment retention. The therapists' alliance ratings were higher for patients whose treatment continued than for those whose treatment was discontinued.…”

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confidence: 89%

The role of the working alliance in psychological treatment of substance use disorder outpatients

Gidhagen

Holmqvist

Philips

et al. 2020

Psychotherapy Research

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The main objective of this study was to explore the relationship between alliance and treatment outcome of substance use disorder (SUD) outpatients in routine care. Attachment, type of substance use, and treatment orientation were analyzed as potential moderators of this relationship. Method: Ninety-nine SUD outpatients rated their psychological distress before every session. Patients and therapists rated the alliance after every session. At treatment start and end, the patient completed the Alcohol Use Disorders Identification Test (AUDIT), the Drug Use Disorders Identification Test (DUDIT), and the Experiences in Close Relationships (ECR-S). Data were analyzed using multilevel growth curve modeling and Dynamic Structural Equation Modeling (DSEM). Results: The associations between alliance and outcome on psychological distress and substance use were, on average, weak. Within-patient associations between patient-rated alliance and outcome were moderated by self-rated attachment. Type of abuse moderated associations between therapist-rated alliance and psychological distress. No moderating effect was found for treatment orientation. Conclusions: Patients' attachment style and type of abuse may have influenced the association between alliance and problem reduction. A larger sample size is needed to confirm these findings.

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“…Psychosocial well‐being has been shown to improve during completed substance use treatment (Cabello et al., 2019); however, more research is needed on the role of treatment outcomes for later criminality. Future research should address treatment processes, such as treatment alliance (Knuuttila et al., 2012) and treatment setting (McKellar et al., 2006).…”

Section: Discussionmentioning

confidence: 99%

Association between the discontinuation of substance use inpatient treatment and the risk of committing a crime leading to imprisonment: A Finnish registry‐based 5‐year follow‐up

Kaskela

Pitkänen

2021

Criminal Behav Ment Health

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Background Discontinuation of substance use inpatient treatment is common, generally due to dropout and rule breaking. In turn, this is associated with worse long‐term substance use outcomes. Aim To investigate whether people who discontinued voluntary inpatient substance use treatment have a higher risk of imprisonment for a crime within 5 years of discontinuance than those who completed treatment. Methods This registry‐based follow‐up study focused on all inpatient treatment episodes between 2002 and 2009 (N = 2893) in a Finnish hospital for treating addictions. Data from national registers on criminality, hospitalisations and education were linked. Cox regression analysis was used. Results Discontinued treatment episodes were 1.4 times more likely to be followed by criminality leading to imprisonment during the 5‐year follow‐up period compared with completed treatment periods, after adjusting for age, gender, education, substance use diagnoses, earlier mental health disorders and prior imprisonments. Conclusions Our findings strengthen the argument for ensuring completion of substance use treatment episodes; better completion rates could decrease the harm caused by serious criminality. Indeed, we recommend that crime reduction should be included to the long‐term goals of substance use treatment.

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Effect of early working alliance on retention in outpatient substance abuse treatment

Cited by 13 publications

References 38 publications

Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction

Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction

The role of the working alliance in psychological treatment of substance use disorder outpatients

Association between the discontinuation of substance use inpatient treatment and the risk of committing a crime leading to imprisonment: A Finnish registry‐based 5‐year follow‐up

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