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Does Treatment Fidelity Predict Client Outcomes in 12-Step Facilitation for Stimulant Abuse?

Drug and Alcohol Dependence 2014;134(1):330-336. [doi: 10.1016/j.drugalcdep.2013.10.020]

Joseph R. Guydish, PhD (University of California, San Francisco, WS Node), Barbara K. Campbell, PhD (Oregon Health & Science University, WS Node), Jennifer Knapp Manuel, PhD (University of California, San Francisco, WS Node), Kevin L. Delucchi, PhD (University of California, San Francisco, WS Node), Thao Le (University of California, San Francisco, WS Node), Michelle Peavy, PhD (Alcohol & Drug Abuse Institute, PN Node), Dennis McCarty, PhD (Oregon Health & Science University, WS Node).

This study examined the relationships between treatment fidelity and treatment outcomes in a community-based trial of the 12-Step Facilitation (TSF) intervention. In a prior multi-site randomized clinical trial, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031, 234 participants in 10 outpatient drug treatment clinics were assigned to receive the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12) intervention. This 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. 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. This study is suggestive, but not conclusive, that higher fidelity intervention is associated with improved treatment outcome. (Article (Peer-Reviewed), PDF, English, 2013)

Keywords: Adoption of interventions | Behavior therapy | Clinical supervision | Community health services | Counselors | CTN platform/ancillary study | Fidelity of implementation | Group therapy | Stimulant abuse | Twelve-Step Facilitation (TSF) | Twelve Step Facilitation Adherence Competence Empathy Scale (TSF-ACES) | Drug and Alcohol Dependence (journal)

Document No: 1032, PMID:24286966, PMCID: PMC3914731.

Submitted by CTN Dissemination Librarians, 11/14/2013.

Campbell, Barbara K. search mail
Delucchi, Kevin L. search
Guydish, Joseph R. search mail
Le, Thao search  
Manuel, Jennifer Knapp search mail
McCarty, Dennis search mail
Peavy, Michelle search
NIDA-CTN-0031-A-3 search www
Western States (Lead) search www

Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
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