Use your browser's back button to choose another title or click here for a New Search.

How to Get the Article

 Email CTN Library (free)

PubMed Central (free)

Journal subscriber access




Bookmark and Share



The Relationship of Therapeutic Alliance and Treatment Delivery Fidelity with Treatment Retention in a Multisite Trial of Twelve-Step Facilitation.

Psychology of Addictive Behaviors 2015;29(1):106-113. [doi: 10.1037/adb0000008]

Barbara K. Campbell, PhD (Oregon Health & Science University, WS Node), Joseph R. Guydish, PhD (University of California, San Francisco, WS Node), Thao Le (University of California, San Francisco, WS Node), Elizabeth A. Wells, PhD (Alcohol & Drug Abuse Institute, University of Washington, PN Node), Dennis McCarty, PhD (Oregon Health & Science University, WS Node).

This study examined associations of therapeutic alliance and treatment delivery fidelity with treatment retention in Stimulant Abusers to Engage in Twelve-Step (STAGE-12), a community-based trial of 12-Step Facilitation (TSF) conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN). The STAGE-12 trial randomized 234 stimulant abusers enrolled in 10 outpatient drug treatment programs to an eight-session, group and individual TSF intervention. During the study, TSF participants rated therapeutic alliance using the Helping Alliance questionnaire-II (HAq-II). After the study, independent raters evaluated treatment delivery fidelity of all TSF sessions on adherence, competence, and therapist empathy. Poisson regression modeling examined relationships of treatment delivery fidelity and therapeutic alliance with treatment retention (measured by number of sessions attended) for 174 participants with complete fidelity and alliance data. Therapeutic alliance (p=.005) and therapist competence (p=.010) were significantly associated with better treatment retention. Therapist adherence was associated with poorer retention in a nonsignificant trend (p=.061).

Conclusions: Stronger therapeutic alliance and higher therapist competence in the delivery of TSF intervention were associated with better treatment retention whereas treatment adherence was not. Training and fidelity monitoring of TSF should focus on general therapist skills and therapeutic alliance development to maximize treatment retention. This is the first study to show a relationship between therapeutic alliance and retention in TSF with substance abusers, and to identify a significant fidelity-retention relationship for manual-guided TSF treatment, a finding that has important implications for treatment delivery. (Article (Peer-Reviewed), PDF, English, 2014)

Keywords: Behavior therapy | CTN platform/ancillary study | Fidelity of implementation | Group therapy | Retention - Treatment | Stimulant abuse | Therapeutic Alliance | Twelve-Step Facilitation (TSF) | Twelve-step programs | Psychology of Addictive Behaviors (journal)

Document No: 1090, PMID: 25134056, PMCID: PMC4739723.

Submitted by CTN Dissemination Librarians, 8/25/2014.


Campbell, Barbara K. mail
Guydish, Joseph R. mail
Le, Thao mail
McCarty, Dennis mail
Wells, Elizabeth A. search mail
NIDA-CTN-0031 www
Pacific Northwest (Lead) www
Appalachian Tri-State www
Florida Node Alliance www
Ohio Valley www
Pacific Region www
Southern Consortium www
Texas www
Western States www

dark blue line
Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
The materials on this site have neither been created nor reviewed by NIDA.
Updated 3/2016 --
dark blue line