title: Recovery benefits of the "therapeutic alliance" among 12-step mutual-help organization attendees and their sponsors.
abstract: BACKGROUND
  The "therapeutic alliance" between clinicians and patients has been associated with treatment response and outcomes in professionally-delivered psychotherapies. Although 12-step mutual help organizations (MHOs), such as Alcoholics Anonymous, are the most commonly sought source of support for individuals with substance use disorder (SUD), little is known about whether a stronger alliance in comparable MHO relationships between 12-step sponsors and those they help ("sponsees") confers benefits similar to those observed in professional contexts. Greater knowledge could inform clinical recommendations and enhance models that explain how individuals benefit from 12-step MHOs.
  
  
  METHODS
  Young adults (N=302) enrolled in a prospective, clinical effectiveness study of residential SUD treatment were assessed at treatment entry, and 3, 6, and 12 months after discharge on whether they had a sponsor, contact with a sponsor, and degree of sponsor alliance. Hierarchical linear models (HLM) tested their effects on 12-step MHO attendance, involvement, and percent days abstinent (PDA).
  
  
  RESULTS
  Approximately two-thirds of the sample (n=208, 68.87%) reported having a sponsor at one or more follow-up time points. Both having sponsor contact and stronger sponsor alliance were significantly associated with greater 12-step participation and abstinence, on average, during follow-up. Interaction results revealed that more sponsor contact was associated with increasingly higher 12-step participation whereas stronger sponsor alliance was associated with increasingly greater abstinence.
  
  
  CONCLUSIONS
  Similar to the professional-clinical realm, the "therapeutic alliance" among sponsees and their sponsors predicts better substance use outcomes and may help augment explanatory models estimating effects of MHOs in SUD recovery.
authors.affiliation: Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital Department of Psychiatry, United States. Electronic address: jkelly11@mgh.harvard.edu.
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.affiliation: Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital Department of Psychiatry, United States.
authors.forename: M Claire
authors.initials: MC
authors.lastname: Greene
authors.affiliation: Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital Department of Psychiatry, United States.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Bergman
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012657:Self-Help Groups; D019966:Substance-Related Disorders / Q000628:therapy*; D055815:Young Adult
keywords: 12-step mutual-help organizations; Sponsorship; Therapeutic alliance; Young adults