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Therapist Effects in a NIDA CTN Intervention Trial with Pregnant Substance Abusing Women: Findings from RCT and Provider Settings.

Poster presented at the College on Problems of Drug Dependence (CPDD) annual meeting, San Juan, Puerto Rico, June 14-19, 2008.

Sarah J. Erickson, PhD, J. Scott Tonigan, PhD, Michael P. Bogenschutz, MD (all from University of New Mexico, SW Node).

Two robust findings in substance abuse research are that evidence-based treatments produce relatively positive outcomes and, even in manual-guided therapies, therapist effects are generally large. In the absence of treatment main effects, this study, part of CTN-0013, "Motivational Enhancement Therapy to Improve Treatment Utilization and Outcome in Pregnant Substance Users," investigated whether treatment outcomes (treatment-as-usual (TAU) versus Motivational Enhancement Therapy (MET)) among pregnant substance abusers could be attributed to therapist effects. Two hundred outpatient pregnant substance abusers were randomized to TAU or MET for pregnant substance users (MET-PS). The active treatment phase of the study lasted 4 weeks (n = 162 completed), and assessments were conducted at baseline, 4 weeks, 1 month follow-up (FU), and 3 months FU. Seven therapists (4 TAU, 3 MET-PS) had 10 or more clients assigned to them, a minimum number of clients deemed essential for deriving stable estimates of therapist effects.

Controlling for baseline substance use frequency, a repeated measures MANOVA including all 7 therapists indicated that at the end of treatment and at 1 and 3 month FU, client substance use was not associated with therapist assignment. Within therapy group analyses produced similar null findings. HLM analyses were then conducted on the full sample to determine if the substance use reduction rate over FU was homogeneous, both by individual and therapist. Overall, in the unconditional model, the rate of decline in days substance use was strong, but such declines did not follow a common trajectory. Inclusion of therapist assignment as a level-2 variable in the conditional model was significant. Findings are atypical in that the researchers did not observe large differences in the effectiveness of therapists. Perhaps this may be partially explained by the nature of this population: pregnant substance abusing women may be particularly motivated to change their substance use because of their pregnancy status. (Poster, PDF, English, 2008)

Keywords: Behavior therapy | Counselors | CTN platform/ancillary study | Gender-specific interventions | Motivational Enhancement Therapy (MET) | Motivational interviewing (MI) | Pregnant women | Women | College on Problems of Drug Dependence (CPDD) annual meeting, 2008

Document No: 302

Submitted by Sarah Erickson, PhD, University of New Mexico, SW Node, 9/2008.

Bogenschutz, Michael P. search mail
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