Therapeutic alliance and psychiatric severity as predictors of completion of treatment for opioid dependence

Objective: The role of patient characteristics and the strength of the ther apeutic alliance in predicting completion of treatment by opioid-dependent patients was examined, Methods; Information about patient characteristics a nd scores on subscales of die Addiction Severity Index (ASI) were obtained for 114 patients at intake to a buprenorphine treatment program lasting thr ee to four months. The strength of the therapeutic alliance was assessed by the Helping Alliance Questionnaire (HAQ). Patients were classified as trea tment completers or noncompleters, and logistical regression examined predi ctors of treatment completion. Results: Only two variables significantly pr edicted treatment completion: severity of psychiatric symptoms and interact ion between HAQ scores and psychiatric severity. Patients with fewer psychi atric symptoms are more likely to complete treatment. The strength of the t herapeutic alliance was not related to treatment completion among patients with few psychiatric symptoms, and 62 percent of these patients completed t reatment. In contrast, among patients with moderate to severe psychiatric p roblems, less than 25 percent with weak therapeutic alliances completed tre atment, while more than 75 percent with strong therapeutic alliances comple ted treatment. Conclusions: The results underscore the importance of early identification of opioid-dependent patients with moderate to severe levels of psychopathology. In this patient subgroup, a strong therapeutic alliance may be an essential condition for successful treatment.