EXAMINING MEDIATORS OF CHANGE IN TRADITIONAL CHEMICAL DEPENDENCY TREATMENT

Objective: Few studies have examined processes that mediate positive o utcomes in the treatment of substance use disorders. The present study used a theory-driven approach to assess mechanisms hypothesized as cu rative by the traditional chemical dependency treatment approach. Seve ral specific disease model processes such as accepting powerlessness o ver alcohol and two processes common to both the disease model and oth er treatment approaches (commitment to abstinence and intention to avo id high-risk situations) were studied. It was hypothesized that patien ts entering treatment would manifest high levels of denial, that there would be significant reduction of denial and increased endorsement of disease model and common processes as a result of treatment and that processes would mediate outcome. Method: Patients (N = 79; 54 men) in intensive traditional alcohol/drug treatment were assessed at entry in to treatment, at the end of treatment and 1 month following treatment Both self-report and clinician ratings of processes were assessed Resu lts: Overall, results provided little support for study hypothesis. Su bjects showed low levels of denial at treatment entry. Specific diseas e model, but not common processes, increased during treatment. Common processes, but not disease model processes, predicted relapse. Patient s with higher levels of commitment to abstinence and greater intention s to avoid high-risk situations were at lower risk for relapse. Howeve r, greater commitment to Alcoholics Anonymous and belief in a Higher P ower predicted reduced severity of relapse among those who did relapse . Conclusions: Findings do not support prevailing practitioner views r egarding how traditional treatment works and suggest that intervention s in these treatments may be mismatched to patient needs.