The role of the working alliance in psychological treatment of substance use disorder outpatients

Figures & data

Table I. Therapist ratings of patients’ problems/concerns at treatment start (from mild = 1 to severe = 4). For all 99 patients included in this study and also for the 20 patients that agreed to participate but did not complete the forms required to be included.

Problem/concern (1–4)	% of n = 99	% of n = 20
Anxiety/stress	48	55
Depression	39	50
Physical problems	34	30
Self-esteem	28	25
Interpersonal relationships	24	35
Trauma/abuse	10	15
Eating disorder	10	0
Bereavement/loss	9	5
Psychosis	8	0
Personality problems	7	5
Cognitive/learning	6	5
Work/studies	27	25
Living/welfare	20	20

Table II. Patients’ educational level at treatment start for the 99 patients included in this study and also for the 20 patients that agreed to participate but did not complete the forms required to be included.

Educational level	% of n 99	% of n = 20
University degree	4	0
Upper secondary diploma^(*)	56	65
Compulsory school graduation^(**)	31	35
Incomplete compulsory school	9	0

Note. ^(*) 3 or 4 years of studies ^(**) 9 years of studies.

Figure 1. Bivariate parallel process growth curve model for CORE-OM and WAI, with regressions among random intercepts and slopes. The observed variables WAI and CORE are predicted by random intercepts and slopes. The random slopes are, in turn, regressed on random intercepts, representing the relationships between initial values and changes over time in each variable. ε₁ and ε₂ are the within-patient error terms, while ε₃ and ε₄ are the between-patient residual terms.

Figure 2. Path diagram of Bivariate Dynamic Structural Equation Model of the relationship between alliance (WAI) and psychological distress (CORE). Between-patient components (B_CORE and B_WAI) are estimated as latent variables (random intercepts). Within-patient components are estimated as latent deviation scores (W_WAI and W_CORE), and lagged versions of within-patient components are also estimated as latent variables (W_WAI_lag1 and W_CORE_lag1). Finally, ε₁ and ε₂ are the within-patient error terms.

Table III. Initial and final mean scores on WAI-P, WAI-T, CORE-OM, AUDIT-C, DUDIT-C (for those patients rating above cutoff on AUDIT and DUDIT at treatment start) and ECR-S anxiety and avoidance, and t-tests of differences between initial and final scores.

	N	Initial score (SD)	Final score (SD)	T (p)	Cohen’s d [95% CI]
WAI-P	99	5.59 (0.92)	6.03 (1.01)	4.20 (<.001)	0.42 [0.22, 0.62]
WAI-T	97	5.65 (0.85)	5.92 (1.01)	3.24 (.002)	0.33 [0.13, 0.53]
CORE-OM	99	14.15 (6.62)	11.22 (6.63)	5.65 (<.001)	0.57 [0.37, 0.77]
AUDIT-C (>cutoff)	48	7.83 (3.14)	3.77 (3.50)	6.73 (<.001)	0.97 [0.68, 1.26]
DUDIT-C (>cutoff)	28	8.36 (4.30)	3.39 (5.27)	5.50 (<.001)	1.04 [0.65, 1.43]
ECR-S anxiety	60	3.57 (1.71)	3.27 (1.81)	1.42 (.16)	0.18 [−0.08, 0.44]
ECR-S avoidance	60	3.00 (1.31)	2.88 (1.42)	.68 (.50)	0.09 [−0.17, 0.35]

Note. CORE-OM = Clinical Outcomes in Routine Evaluation – Outcome Measure, WAI = Working Alliance Inventory (P = patient rated, T = therapist rated), ECR-S = Experiences in Close Relationship Scale—Short form, AUDIT-C = Alcohol Use Disorders Identification Test: 3 first items measuring present consumption, DUDIT-C = Drug Use Disorders Identification Test: 4 first items measuring present drug use.

Table IV. Pearson’s correlations between WAI-P, WAI-T and CORE-OM variables (n = 97–99).

	CORE-OM initial	CORE-OM final	CORE-OM mean	CORE-OM gain score
WAI-P initial	−.14	−.10	−.15	−.06
WAI-P final	−.11	−.17	−.13	.08
WAI-P mean	−.21*	−.24*	−.28**	.03
WAI-T initial	−.07	−.08	−.09	.01
WAI-T final	−.04	−.14	−.06	.13
WAI-T mean	−.10	−.11	−.13	.02

Note. *significant at the 0.05 level (2-tailed) **significant at the 0.01 level (2-tailed).