Relationships between counseling rapport and drug abuse treatment outcomes

Objective: This study examined the association between counseling rapport a nd drug abuse treatment outcomes. Methods: Two cohorts of outpatients who w ere being treated with methadone in four cities were studied. Cohort 1 comp rised 354 patients in community-based nonprofit programs, and cohort 2 comp rised 223 patients from a private for-profit program. Logistic regression a nalyses were used to assess the importance of counseling rapport as a predi ctor of drug use and criminality relative to treatment retention in the ind ex treatment, satisfaction with treatment, and whether additional treatment was received after the index treatment. Results: In both cohorts, ratings made by counselors, during treatment, of therapeutic involvement and relati onships with patients provided a useful measure of counseling rapport. A lo wer level of rapport during treatment predicted worse post-index treatment outcomes, including more cocaine use and criminality, both by itself and af ter adjustment for treatment retention, satisfaction with treatment, and po st-index treatment status. Counseling strategies were associated with the d evelopment of counseling rapport. Conclusions: Counseling rapport is a vita l part of the therapeutic process and helps explain why and when treatment is effective. It contributes explicitly to the prediction of outcomes, apar t from treatment retention, and accounts in part for the usual association between treatment retention and outcomes.