Effect of Therapeutic Alliance of Clients on Methadone Maintenance Treatment Outcomes.

摘要

Opioid abuse costs affect the majority of the adult population in our society directly or indirectly. The current prevailing medical treatment for opioid addiction is methadone maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use, criminal activity, and overdose potential. MMT is only as effective as the length of time a client remains active and compliant with the program. In previous studies, therapeutic alliance (TA) has been shown to positively influence the effectiveness of substance abuse treatment. However, a gap exists in research in regards to the impact of TA on the effectiveness of MMT outcomes. The theoretical framework of this study is based on therapeutic alliance, which guided an examination on whether therapeutic alliance (as measured by the Session Rating Scale) influenced MMT retention and compliance (drug screens and session attendance). Archival data from 264 clients receiving MMT for opioid dependence were reviewed from a nonprofit community-based agency in Arizona. Logistic regression results revealed that TA did not significantly affect retention or compliance. However, issues were noted such as how the SRS was administered, a lack of understanding by clients regarding scoring the SRS, and unique social desirability demands when clients are in MMT. The finding that TA alone did not significantly affect retention and compliance does not decrease the need to find effective means to improve MMT outcomes. Rather, the findings suggest a critical need to identify and utilize measures more appropriate for clients receiving MMT. In doing so, positive social change may be achieved by assisting clinical staff in developing a strong therapeutic alliance with MMT clients as they focus on problem solving as a joint venture when challenges in the recovery process arise.