Two new articles have just been released online in-press at Psychology of Addictive Behaviors, providing the latest information about National Drug Abuse Treatment Clinical Trials Network (CTN) protocol CTN-0031, Stimulant Abuser Groups to Engage in 12-Step (STAGE-12).
The first paper, by Suzanne Doyle and Dennis Donovan of the Pacific Northwest Node, the Lead Node for this project, describes the application of an “ensemble classification tree approach” to the prediction of completion from the 12-Step Facilitation intervention used in the study.
The application of an emsemble subsampling regressions tree method utilizes the fact that classification trees are unstable but, on average, produce an improved prediction of the completion of drug abuse treatment. The results of this analysis support the notion that there are early indicators of treatment completion that may allow for modification of approaches more tailored to fitting the needs of individuals, and potentially provide more successful treatment engagement and improved outcomes. For example, the number of types of self-help activity involvement prior to treatment was the predominant predictor, with other effective predictors including better coping self-efficacy, more days of prior meeting attendance, greater acceptance of the disease model, higher confidence for not resuming use following discharge, lower ASI Drug and Alcohol composite scores, negative urine screens for cocaine or marijuana, and fewer employment problems.
Citation: Doyle SR, Donovan DM. Applying an Ensemble Classification Tree Approach to the Prediction of Completion of a 12-Step Facilitation Intervention with Stimulant Abusers. Psychology of Addictive Behaviors 2014 (in press).
The second paper, by Barbara Campbell, Joseph Guydish, and colleagues, reports on an examination of associations of therapeutic alliance and treatment delivery fidelity with treatment retention in STAGE-12. Stronger therapeutic alliance and higher therapist competence in the delivery of TSF intervention were associated with better treatment retention, whereas treatment adherence was not. Training and fidelity monitoring of TSF should focus on general therapist skills and therapeutic alliance development to maximize treatment retention.
Notably, this was the first study to show a relationship between therapeutic alliance and retention in TSF with substance abusers, and to identify a significant fidelity-retention relationship for manual-guided TSF treatment, a finding that has important implications for treatment delivery.
Citation: Campbell BK, Guydish JR, et al. The Relationship of Therapeutic Alliance and Treatment Delivery Fidelity with Treatment Retention in a Multisite Trial of Twelve-Step Facilitation. Psychology of Addictive Behaviors 2014 (in press).