Abstract

Objective: The main objective of this study was to explore the relationship between alliance and treatment outcome of substance use disorder (SUD) outpatients in routine care. Attachment, type of substance use, and treatment orientation were analyzed as potential moderators of this relationship.

Method: Ninety-nine SUD outpatients rated their psychological distress before every session. Patients and therapists rated the alliance after every session. At treatment start and end, the patient completed the Alcohol Use Disorders Identification Test (AUDIT), the Drug Use Disorders Identification Test (DUDIT), and the Experiences in Close Relationships (ECR-S). Data were analyzed using multilevel growth curve modeling and Dynamic Structural Equation Modeling (DSEM).

Results: The associations between alliance and outcome on psychological distress and substance use were, on average, weak. Within-patient associations between patient-rated alliance and outcome were moderated by self-rated attachment. Type of abuse moderated associations between therapist-rated alliance and psychological distress. No moderating effect was found for treatment orientation.

Conclusions: Patients’ attachment style and type of abuse may have influenced the association between alliance and problem reduction. A larger sample size is needed to confirm these findings.

摘要

目的：本研究的主要目的是探讨常规护理中药物滥用障碍（SUD）门诊病人的结盟与治疗结果之间的关系。依恋，物质使用的类型和治疗取向被分析为这种关系的潜在调节者。

方法： 99名SUD门诊患者在每次治疗前对其心理困扰进行评估。每次治疗后，患者和治疗师都会对联盟进行评估。在治疗开始和结束时，患者完成了酒精使用障碍识别测试（AUDIT），药物使用障碍识别测试（DUDIT）和亲密经历（ECR-S）。使用多级增长曲线建模和动态结构方程建模（DSEM）对数据进行了分析。

结果：联盟与心理困扰和药物滥用结局之间的关联平均较弱。通过自我评估的依恋度，可以调节患者评估的联盟与结局之间的患者内部关联。虐待的类型调节了治疗师级联盟与心理困扰之间的联系。没有发现治疗方向的调节作用。

结论：患者的依恋方式和虐待类型可能影响联盟与减少问题之间的关联。需要更大的样本量来确认这些发现。