The Role of Alliance in Treatment Outcome for People with Alcohol Dependence and Depression

by Deirdre Richardson

Institution: University of Otago
Year: 0
Keywords: alliance; alcohol; depression; treatment
Record ID: 1300849
Full text PDF: http://hdl.handle.net/10523/5019


Introduction: The pantheoretical variable of alliance has consistently been reported to have a moderate yet robust effect on treatment outcome. However, the relationship is less clear in the addiction field where research is more limited. To contextualise the current research, the history and development of the alliance concept and the identification of key methodological issues are provided. Alliance research is then reviewed in two parts: that relating to the concept of alliance, followed by research concerned with the alliance-outcome relationship. This review focuses on the treatment populations under investigation in the current dissertation, those with alcohol dependence and depression, and shows how alliance differs in substance-using treatment populations. Specific areas warranting further investigation are identified. These shape the hypotheses used in the current dissertation. Method: There were three separate components of research: the first study investigated alliance with 69 subjects who received treatment as part of the Brief Treatment Programme (BTP) which had investigated the effectiveness of Motivational Enhancement Therapy (MET) in treating mild to moderate alcohol dependence. The relationship between alliance, based on therapists’ ratings of the therapy, was examined for its association with drinking outcomes, e.g. percent days abstinent (PDA), drinks per drinking day (DDD), level of dependence and alcohol-related problems. The second larger part of the investigation was conducted as part of the Treatment Evaluation of Alcohol and Mood (TEAM) study, a randomized controlled pharmacotherapy trial with supportive clinical case management. Therapist and client ratings were assessed using the Working Alliance Inventory (WAI) for 123 alcohol dependent and depressed client-therapist dyads at 3 weeks. Outcome data was obtained at 3 and 12 weeks (end of treatment). Drinking-related measures included PDA and DDD. Mood outcomes were scores on the Montgomery Asberg Depression Rating Scale (MADRS) and Symptom Checklist-90-item-Revised (SCL-90-R) depression subscale. Alongside this TEAM research, a small qualitative investigation was conducted to assist in giving insight and illumination to interpretations of the quantitative data. Twelve clients were interviewed regarding their perspective of the therapeutic relationship, and what they perceived had assisted in the changes that had occurred in their mood and drinking. Results: The BTP investigation found that the older the client, the greater their level of education and the later the onset of alcohol dependence, the higher the therapist-rated alliance. With regards to outcomes, alliance was positively associated with early change in drinking frequency, alcohol-related problems and the number of sessions attended. In contrast, alliance was not associated with drinking intensity, level of dependence or treatment modality. The findings suggest that when examining the alliance-outcome relationship further attention should be given to clients’…