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Treatment process, alliance and outcome in brief versus extended treatments for marijuana dependence

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Abstract:

ABSTRACT Aims 

The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome. Design 

Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated. Findings 

Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence. Conclusions 

Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence.

Keywords: Alliance; Marijuana Treatment Project; behavioral treatment; brief treatment; marijuana dependence; treatment process

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1360-0443.2010.03047.x

Affiliations: 1: Yale University, VA CT Healthcare Center (151D), West Haven, CT, USA, 2: University of Connecticut Health Center, Farmington, CT, USA and 3: University of Washington, Seattle, WA, USA

Publication date: October 1, 2010

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