Therapeutic alliance and psychiatric severity as predictors of completion of treatment for opioid dependence.
OBJECTIVE
The role of patient characteristics and the strength of the therapeutic alliance in predicting completion of treatment by opioid-dependent patients was examined.


METHODS
Information about patient characteristics and scores on subscales of the Addiction Severity Index (ASI) were obtained for 114 patients at intake to a buprenorphine treatment program lasting three to four months. The strength of the therapeutic alliance was assessed by the Helping Alliance Questionnaire (HAQ). Patients were classified as treatment completers or noncompleters, and logistical regression examined predictors of treatment completion.


RESULTS
Only two variables significantly predicted treatment completion: severity of psychiatric symptoms and interaction between HAQ scores and psychiatric severity. Patients with fewer psychiatric symptoms were more likely to complete treatment. The strength of the therapeutic alliance was not related to treatment completion among patients with few psychiatric symptoms, and 62 percent of these patients completed treatment. In contrast, among patients with moderate to severe psychiatric problems, less than 25 percent with weak therapeutic alliances completed treatment, while more than 75 percent with strong therapeutic alliances completed treatment.


CONCLUSIONS
The results underscore the importance of early identification of opioid-dependent patients with moderate to severe levels of psychopathology. In this patient subgroup, a strong therapeutic alliance may be an essential condition for successful treatment.
Substance Abuse Treatment Center and Department of Psychology, University of Vermont, Burlington, USA. petry@psychiatry.uchc.edu
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Petry
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Bickel
D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use; D003299:Cooperative Behavior; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000628:therapy*; D010349:Patient Compliance; D010352:Patient Dropouts / Q000523:psychology*; D011369:Professional-Patient Relations; D011446:Prospective Studies; D013811:Psychotherapeutic Processes; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013223:Statistics as Topic
D009294:Narcotics; D002047:Buprenorphine