Does change in alliance impact alcohol treatment outcomes?

BACKGROUND: Although both researchers and practitioners widely recognize therapeutic alliance's importance in general psychotherapy, studies specific to alcohol use treatments have produced mixed results and generally do not investigate if and how alliance changes over course of treatment. METHODS: Using parallel process latent growth curve modeling, the authors examined if increase in alliance was associated with reduced drinking behaviors and a statistical mediator in the relationship between treatment modality and outcome. The authors used data from Project MATCH (J Stud Alcohol. 1997;58:7-29; Addiction. 1997;92:1671-1698), which investigated client-treatment matching effects for alcohol treatment among outpatient (n = 952) and aftercare (n = 774) participants randomized to cognitive behavioral treatment (CBT), 12-step facilitation (TSF), or motivational enhancement therapy (MET). RESULTS: Results indicate therapist-rated alliance increased significantly for CBT and TSF participants, but not MET. Participants across modalities in both samples evidenced the largest decrease in drinking behaviors from baseline to midtreatment and a slight deterioration in treatment gains from midtreatment to 15 months posttreatment. Alliance did not mediate the relationship between treatment modality and outcome, but increase in alliance was significantly related to decrease in drinking frequency. CONCLUSIONS: These findings provide further justification for researchers to specifically design studies to examine change in alliance as a mechanism of change in alcohol treatments.

Psychiatric distress in incarcerated women with recent cocaine and alcohol abuse.

PURPOSE: Women frequently abuse cocaine and alcohol before incarceration. Research indicates that women in criminal justice settings also suffer high rates of psychiatric distress. This study aimed to determine how preincarceration abuse of alcohol and cocaine affected current psychiatric distress among female jail detainees held for 10-14 days. METHODS: A probability sample of women in a large urban jail (n = 469) were assessed for use of alcohol and cocaine during the 6 months before incarceration and for their current psychiatric distress. They were grouped based on their level of alcohol consumption and cocaine use: high cocaine/high alcohol; high cocaine/low alcohol; low cocaine/high alcohol; and low cocaine/low alcohol. Profile analysis was used to examine the relation of psychiatric distress, as measured by the Brief Symptom Inventory, to levels of recent alcohol and cocaine use. RESULTS: Psychiatric distress is highest (and similar) among women in the high cocaine groups, regardless of alcohol use, and psychiatric distress is lowest among those who used both substances infrequently. Characteristics of psychiatric distress differed based on level of alcohol use, but only when cocaine use was low. High alcohol and cocaine use alone and together also predict the likelihood of psychiatric distress reaching a diagnosable level of severity. CONCLUSIONS: High cocaine, alcohol, or combined use is related to higher levels of psychiatric distress among incarcerated women in this jail. Women should be screened at the time of incarceration, and women who have alcohol and other drug problems should receive treatment that includes mental health services.

Correspondence between correctional staff and offender ratings of adaptive behavior.

Although several experts have raised concerns about using correctional officers as informants for adaptive behavior assessments, no studies have compared ratings from correctional officers to those from other informants. We compared Adaptive Behavior Assessment System-Second Edition (ABAS-II; Harrison & Oakland, 2003) scores assigned by correctional staff to those assigned by probationers (N = 56) residing in a community corrections facility. Correctional staff assigned markedly lower scores than did probationers on many ABAS-II scales (d = .59 to 1.41 for ABAS-II composite scores). Although none of the probationers qualified for a diagnosis of intellectual disability, 29% received a staff-report ABAS-II composite score that was more than 2 SDs below the normative sample mean, suggesting significant impairment. Correlations between ABAS-II and intelligence measure scores were lower than expected for both types of informants, although they were somewhat stronger for self-report. Lower staff-report scores were associated with higher levels of probationer-reported psychopathology and need for treatment. Overall, these findings highlight limitations of using correctional staff as informants for adaptive behavior assessments. (PsycINFO Database Record