Outline
- Process Predictors of the Outcome of Group Drug Counseling
- Method
- Participants
- Patients
- Counselors
- Group Drug Counseling Treatment
- Outcome Measures
- Monthly Cocaine Use
- Weekly Cocaine Use
- Sustained Abstinence
- Endorsement of the Philosophy and Behaviors Advocated by 12-Step Programs
- Dysfunctional Beliefs About Substance Use
- Treatment Process Measures
- Therapeutic Alliance
- Feedback
- Self-Disclosure
- Advice
- Participation
- Group Cohesion
- Raters and Procedures
- Alliance, Feedback, Advice, and Self-Disclosure
- Cohesion
- Participation
- Statistical Analysis
- Results
- Baseline Demographic and Clinical Characteristics of Sample
- Prediction of Outcome from Average Session Process Scores
- Prediction of Outcome from Linear Trend over Sessions Process Scores
- Prediction of Proximal Cocaine Use Outcomes
- Discussion
- References
رئوس مطالب
- چکیده
- روش
- شرکت کنندگان
- درمان با روش مشاوره دارویی گروهی
- اندازه های نتایج
- اندازه گیری های فرایند درمان
- اتحاد درمانی
- بازخورد
- خود افشایی
- نصیحت
- مشارکت
- انسجام گروهی
- ارزیابان و روش ها
- یافته ها
- خط مبنای ویژگی های بالینی و جمعیت شناختی نمونه
- اتحاد، بازخورد، نصیحت و خود افشایی
- انسجام
- مشارکت
- پیش بینی نتایج از میانگین امتیازات فرایندهای جلسه
- پیش بینی نتایج از روندی خطی در امتیازات فرایند جلسات
- پیش بینی نتایج مصرف تقریبی کوکایین
- بحث
Abstract
This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method: Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure, as well as positive and non-positive feedback and advice during the 6-month treatment of cocaine dependence. Average, session-level, and slopes of process scores were evaluated. Primary outcomes were monthly cocaine use (days using out of 30), next session cocaine use, and duration of sustained abstinence from cocaine. Secondary outcomes were endorsement of 12-step philosophy and beliefs about substance abuse. Results: More positive alliances (with counselor) were associated with reductions in days using cocaine per month and next-session cocaine use and increases in endorsement of 12-step philosophy. Patient self-disclosure about the past and degree of participation in the group were generally not predictive of group drug counseling outcomes. More advice from counselor and other group members were consistently associated with poorer outcomes in all categories. Individual differences in changes in process variables over time (linear slopes) were generally not predictive of treatment outcomes. Conclusions: Some group behaviors widely believed to be associated with outcome, such as self-disclosure and participation, were not generally predictive of outcomes of group drug counseling, but alliance with the group counselor was positively associated, and advice giving was negatively associated, with the outcome of treatments for cocaine dependence.
Keywords: cocaine dependence - group drug counseling - predictors - process ratingsConclusions
In this study, we failed to find evidence that certain process variables, central to the concepts of group therapy and found to predict outcome in studies of group therapy, were associated with the outcomes of treatment for cocaine dependence. In particular, measures of self-disclosure and participation in group sessions were unrelated to sustained abstinence, monthly days using cocaine, next session cocaine use, and change in endorsement of 12-step philosophy; more turns-at-talk was actually related to less improvement in dysfunctional substance use beliefs. However, a positive alliance with the group counselor was found to be associated with both longer-term (over 6 months) reductions in cocaine use and proximal (next session) cocaine use, and increases in the endorsement of 12-step philosophy. In addition, we found that giving advice to patients was a negative predictor: Patients who received more advice (from the counselor or other patients) had worse monthly, weekly, and long-term drug use outcomes and showed relatively less change on two important mediators of outcome (endorsement of 12-step philosophy and beliefs about substance abuse). Receiving non-positive learning statements from the counselor was also associated with less improvement in endorsement of 12-step philosophy (though this variable was highly correlated with advice statements from counselor: r .65).
Our finding of a positive association between average alliance scores across sessions and more positive outcomes are consistent with the general literature on the alliance in group (Johnson et al., 2008) and individual psychotherapy (Horvath, Del Re, Flückiger, & Symonds, 2011). However, alliance with individual therapy counselors in the NIDA CCTS was not found to predict drug use outcomes (Barber et al., 2001). Alliance with the group counselor may have been more important to outcomes than alliance with individual counselors because urine drug screens and weekly drug use assessment measures took place at group counseling sessions, making the group counselors’ reactions to clients’ behavior more salient. Furthermore, the counselor’s reactions to a client’s behavior occurred in front of a group of peers, potentially also making the group counselors’ reactions more salient. The fact that the alliance with the GDC counselor did predict drug use outcomes adds further support to the conclusion that GDC was an important aspect of the overall treatment package, at least for some patients, in the NIDA CCTS.