Therapeutic Alliance as a Change Mechanism in Alcoholism Treatment

描述（由申请人提供）：有几种不同的酒精使用障碍（AUDs）治疗方法，它们都有支持的经验基础，表明一种或多种常见因素的作用是可治愈的，即使它们在特定治疗的变化理论中没有明显强调。在寻求识别和明确共同的潜在变化机制的过程中，这种发展性/探索性应用侧重于患者和治疗师之间的治疗联盟，这种机制具有相当大的潜力，可以进一步促进我们对行为改变如何发生的理解。在这种情况下，治疗联盟代表了一种合作关系，包括情感纽带和对治疗任务和目标的共同态度。参与者将是72名酒精依赖患者，他们将参加为期12周的门诊酒精中毒治疗项目。每次治疗结束后，将根据患者的自我报告，对自上次治疗以来的治疗联盟和酒精参与情况进行评估。治疗联盟的评估也将从治疗师那里收集。通过这种方式，治疗联盟的连续时间表（从患者和治疗师的角度进行评估）和患者的酒精参与将可用于分析。此外，将对基线、治疗结束、治疗后3个月和6个月的患者进行全面的研究评估。该项目的具体目标是双重的。第一个目的是检查治疗期间每周治疗联盟评分（由患者和治疗师感知）与酒精参与（以戒酒天数百分比{PDA}和每个饮酒日{DDD}计算）之间的关系。第二个目的是检查治疗联盟（由患者和治疗师评定）在治疗过程中与治疗期间和6个月随访期间的酒精参与有关的概况。这些分析的结果将用于表征治疗联盟与酒精参与在门诊治疗期间和之后的相互作用。预计本项目收集的数据将为进一步系统研究治疗联合作为AUD治疗改变机制提供方向和基础。与酒精滥用相关的年度社会和个人后果是深远的。本研究旨在提高对有效治疗酒精使用障碍的共同变化机制的认识。未来的研究将能够评估是否或如何动员治疗联盟来增强行为改变。

DESCRIPTION (provided by applicant): Several distinctive treatments for alcohol use disorders (AUDs) are available that have a supporting empirical foundation, suggesting the operation of one or more common factors that are curative, even though they are not apparently emphasized by the theory of change underlying a particular treatment. In seeking to identify and specify common underlying mechanisms of change, this developmental/exploratory application focuses on the therapeutic alliance between the patient and therapist, a mechanism with considerable potential for furthering our understanding of how behavior change occurs. In this context, the therapeutic alliance represents a collaborative relationship that consists of an emotional bond and shared attitudes regarding the tasks and goals of the treatment endeavor. The participants will be 72 alcohol dependent patients entering a 12-week outpatient alcoholism treatment program. Assessments of the therapeutic alliance and alcohol involvement since the previous treatment session, based on patient self-reports, will be conducted after each treatment session. Assessment of the therapeutic alliance will be gathered from the therapist as well. In this way, a continuous timeline of the therapeutic alliance (assessed from the view of both the patient and therapist) and the patient's alcohol involvement will be available for analysis. In addition, comprehensive research assessments will be conducted with patients at baseline, end of treatment, and 3- and 6-months posttreatment. The project's specific aims are two-fold. The first aim is to examine the within-treatment week-to-week relationship between ratings of the therapeutic alliance (as perceived by the patient and therapist) and alcohol involvement (operationalized as percent days abstinent {PDA} and drinks per drinking day {DDD}) during treatment. The second aim is to examine profiles of the therapeutic alliance (as rated by the patient and therapist) over the course of treatment in relation to alcohol involvement during treatment and during the 6-month follow-up period. The results of these analyses will be used to characterize the interplay of the therapeutic alliance with alcohol involvement during and following an outpatient treatment episode. It is anticipated that the data to be gathered in this project will provide direction and foundation for additional systematic research on the therapeutic alliance as a mechanism of change in AUD treatment.The annual societal and personal consequences associated with alcohol misuse are profound. This study is intended to advance knowledge about the mechanisms of change common to effective treatments for alcohol use disorders. Future research then will be in a position to evaluate whether or how the therapeutic alliance can be mobilized to enhance behavior change.