Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study

The authors examined the relation between therapeutic alliance, retention, and outcome for 308 cocaine-dependent outpatients participating in the Nati onal Institute on Drug Abuse Collaborative Cocaine Treatment Study. High le vels of alliance were observed in supportive-expressive therapy (SE), cogni tive therapy (CT), and individual drug counseling (IDC), and alliance level s increased slightly but significantly from Session 2 to Session 5 in all g roups. In contrast to other studies, alliance was not a significant predict or of drug outcome. However, alliance did predict patient retention differe ntially across the 3 treatments. In SE and IDC, either higher levels of all iance were associated with increased retention or no relationship between a lliance and retention was found, depending on the time alliance was measure d. In CT, higher levels of alliance were associated with decreased retentio n.