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

Cocaine dependent outpatients (N = 252) were randomly assigned to one of three individual treatments (cognitive, dynamic therapy, or drug counseling) as part of the training phase of the National Institute of Drug Abuse Cocaine Collaborative Treatment Study. Patients and therapists completed the Helping Alliance (HAq-II) and the California Alliance Scale (CALPAS), which documented generally high alliance. Although patient reports of the alliance did not predict outcome on drug related measures at the sixth month assessment, it did at the one month assessment. Alliance, however, predicted improvement in depressive symptoms at six months. Overall, therapist ratings of the alliance were less often predictive of outcome than patient ratings. Results were similar across the completer and the intent-to-treat samples. The CALPAS, but-not the HAq-II, predicted attrition. There was preliminary evidence that higher alliance predicted more change in depressive symptoms in patients who remained for a longer time in treatment than for those who remained for a shorter time in treatment.