Relationships between counseling rapport and drug abuse treatment outcomes

Objective: This study examined the association between counseling rapport and drug abuse treatment outcomes. Methods: Two cohorts of outpatients who were being treated with methadone in four cities were studied. Cohort 1 comprised 354 patients in community-based nonprofit programs, and cohort 2 comprised 223 patients from a private for-profit program. Logistic regression analyses were used to assess the importance of counseling rapport as a predictor of drug use and criminality relative to treatment retention in the index treatment, satisfaction with treatment, and whether additional treatment was received after the index treatment. Results: In both cohorts, ratings made by counselors, during treatment, of therapeutic involvement and relationships with patients provided a useful measure of counseling rapport. A lower level of rapport during treatment predicted worse post-index treatment outcomes, including more cocaine use and criminality, both by itself and after adjustment for treatment retention, satisfaction with treatment, and post-index treatment status. Counseling strategies were associated with the development of counseling rapport. Conclusions: Counseling rapport is a vital part of the therapeutic process and helps explain why and when treatment is effective. It contributes explicitly to the prediction of outcomes, apart from treatment retention, and accounts in part for the usual association between treatment retention and outcomes.