THERAPEUTIC ALLIANCE AS A CHANGE MECHANISM IN ALCOHOLISM TREATMENT - DESCRIPTION (provided by applicant): Several distinctive treatments for alcohol use disorders (AUDs) are available that have a supporting empirical foundation, suggesting the operation of one or more common factors that are curative, even though they are not apparently emphasized by the theory of change underlying a particular treatment. In seeking to identify and specify common underlying mechanisms of change, this developmental/exploratory application focuses on the therapeutic alliance between the patient and therapist, a mechanism with considerable potential for furthering our understanding of how behavior change occurs. In this context, the therapeutic alliance represents a collaborative relationship that consists of an emotional bond and shared attitudes regarding the tasks and goals of the treatment endeavor. The participants will be 72 alcohol dependent patients entering a 12-week outpatient alcoholism treatment program. Assessments of the therapeutic alliance and alcohol involvement since the previous treatment session, based on patient self-reports, will be conducted after each treatment session. Assessment of the therapeutic alliance will be gathered from the therapist as well. In this way, a continuous timeline of the therapeutic alliance (assessed from the view of both the patient and therapist) and the patient's alcohol involvement will be available for analysis. In addition, comprehensive research assessments will be conducted with patients at baseline, end of treatment, and 3- and 6-months posttreatment. The project's specific aims are two-fold. The first aim is to examine the within-treatment week-to-week relationship between ratings of the therapeutic alliance (as perceived by the patient and therapist) and alcohol involvement (operationalized as percent days abstinent {PDA} and drinks per drinking day {DDD}) during treatment. The second aim is to examine profiles of the therapeutic alliance (as rated by the patient and therapist) over the course of treatment in relation to alcohol involvement during treatment and during the 6-month follow-up period. The results of these analyses will be used to characterize the interplay of the therapeutic alliance with alcohol involvement during and following an outpatient treatment episode. It is anticipated that the data to be gathered in this project will provide direction and foundation for additional systematic research on the therapeutic alliance as a mechanism of change in AUD treatment.The annual societal and personal consequences associated with alcohol misuse are profound. This study is intended to advance knowledge about the mechanisms of change common to effective treatments for alcohol use disorders. Future research then will be in a position to evaluate whether or how the therapeutic alliance can be mobilized to enhance behavior change.
