title: Does treatment fidelity predict client outcomes in 12-Step Facilitation for stimulant abuse?
abstract: OBJECTIVE
  This study examined the relationships between treatment fidelity and treatment outcomes in a community-based trial of a 12-Step Facilitation (TSF) intervention.
  
  
  METHODS
  In a prior multi-site randomized clinical trial, 234 participants in 10 outpatient drug treatment clinics were assigned to receive the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12) intervention. A secondary analysis reviewed and coded all STAGE-12 sessions for fidelity to the protocol, using the Twelve Step Facilitation Adherence Competence Empathy Scale (TSF ACES). Linear mixed-effects models tested the relationship between three fidelity measures (adherence, competence, empathy) and six treatment outcomes (number of days of drug use and five Addiction Severity Index (ASI) composite scores) measured at 3 months post-baseline.
  
  
  RESULTS
  Adherence, competence and empathy were robustly associated with improved employment status at follow up. Empathy was inversely associated with drug use, as was competence in a non-significant trend (p=.06). Testing individual ASI drug composite score items suggested that greater competence was associated with fewer days of drug use and, at the same time, with an increased sense of being troubled or bothered by drug use.
  
  
  CONCLUSIONS
  Greater competence and empathy in the delivery of a TSF intervention were associated with better drug use and employment outcomes, while adherence was associated with employment outcomes only. Higher therapist competence was associated with lower self-report drug use, and also associated with greater self-report concern about drug use. The nature of TSF intervention may promote high levels of concern about drug use even when actual use is low.
authors.affiliation: University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118, United States. Electronic address: Joseph.Guydish@ucsf.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Guydish
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR 97239, United States.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Campbell
authors.affiliation: University of California, San Francisco, Department of Psychiatry, Building 20, Suite 2100, Room 2127, 1001 Potrero Avenue, San Francisco, CA 94110, United States.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Manuel
authors.affiliation: University of California, San Francisco, Department of Psychiatry, Box 0984-TRC, 401 Parnassus Avenue, San Francisco, CA 94143, United States.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
authors.affiliation: University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California Street, Suite 265, San Francisco, CA 94118, United States.
authors.forename: Thao
authors.initials: T
authors.lastname: Le
authors.affiliation: University of Washington, Alcohol and Drug Abuse Institute, Seattle, WA 98105, United States.
authors.forename: K Michelle
authors.initials: KM
authors.lastname: Peavy
authors.affiliation: Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, OR 97239, United States.
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D000328:Adult; D004645:Empathy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012657:Self-Help Groups / Q000592:standards; D016320:Substance Abuse Treatment Centers / Q000379:methods* / Q000592:standards; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Adherence; Drug abuse; Fidelity; Twelve Step Facilitation