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.