Working alliance and outcome in adolescents and adults in treatment for substance abuse.

摘要

The purpose of the current study is to conduct a meta-analysis of the relationship between working alliance and substance abuse treatment outcomes for adults and adolescents. Several meta-analyses (e.g., Horvath & Symonds, 1991; Martin, Garske, & Davis, 2000; Shirk & Karver, 2003) have confirmed the importance of working alliance in treatment outcomes among adults and adolescents across a variety of problem areas, as well as treatment types. The present study expands upon these findings by focusing specifically on substance abuse treatment. The primary hypothesis is that among adolescents and adults receiving substance abuse treatment, working alliance will be negatively related to substance use. The secondary hypothesis is that a stronger working alliance will be positively related to more time spent in treatment. A related research question is the extent to which working alliance is related to lower levels of comorbid internalizing and externalizing symptoms. Of the 134 articles identified using keywords such as alliance, therapeutic relationship, engagement, retention, substance use/abuse/dependence, and adolescent, 24 published studies were included in the meta-analysis. The first hypothesis was supported by the data and indicated that a stronger working alliance was related to decreases in substance use at post treatment and follow-up assessments. The secondary hypothesis was also supported in that a stronger working alliance was positively related to a longer time spent in treatment. Working alliance was related to lower levels of internalizing problems, but higher levels of externalizing problems. Several moderating variables impacted the relationship between alliance and outcome. The current study highlights the importance of alliance for adolescents and the specific effect of alliance in treatments for substance abuse.;KEY WORDS: Alliance. Substance Abuse, Treatment, Adolescent, Adult