Therapeutic alliance as a predictor of outcome in treatment of cocaine dependence

Cocaine dependent outpatients (N = 252) were randomly assigned to one of th ree individual treatments (cognitive, dynamic therapy, or drug counseling) as part of the training phase of the National Institute of Drug Abuse Cocai ne Collaborative Treatment Study. Patients and therapists completed the Hel ping Alliance (HAq-II) and the California Alliance Scale (CALPAS), which do cumented generally high alliance. Although patient reports of the alliance did not predict outcome on drug related measures at the sixth month assessm ent, it did at the one month assessment. Alliance, however, predicted impro vement in depressive symptoms at six months. Overall, therapist ratings of the alliance were less often predictive of outcome than patient ratings. Re sults were similar across the completer and the intent-to-treat samples. Th e CALPAS, but-not the HAq-II, predicted attrition. There was preliminary ev idence that higher alliance predicted more change in depressive symptoms in patients who remained for a longer time in treatment than for those who re mained for a shorter time in treatment.