Yale University

Linking process and outcome in the community reinforcement approach for treating cocaine dependence: a preliminary report.

TitleLinking process and outcome in the community reinforcement approach for treating cocaine dependence: a preliminary report.
Publication TypeJournal Article
Year of Publication2004
AuthorsPantalon, Michael V., Marek C. Chawarski, Jean Falcioni, Juliana Pakes, and Richard S. Schottenfeld
JournalThe American journal of drug and alcohol abuse
Date Published2004 May
KeywordsAlcoholism, Cocaine-Related Disorders, Community Mental Health Services, Depressive Disorder, Major, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Interpersonal Relations, Reinforcement (Psychology), Treatment Outcome
AbstractThis preliminary study evaluated the relationship between therapy process variables (mechanistic processes and interpersonal processes), and treatment outcome (i.e., retention and cocaine abstinence) among 16 cocaine-dependent pregnant or postpartum women treated with the Community Reinforcement Approach (CRA). Two new rating scales were developed for this purpose. The Mechanisms of Action Rating Scale (MARS) assesses five CRA mechanistic domains (Big Picture goals, functional analyses of behavior, nondrug-related activities, skills training, and homework). The Interpersonal Variables Rating Scale (IVRS) measures three nonspecific or interpersonal dimensions of psychotherapy (i.e., empathy, response to resistance, and therapeutic alliance). These rating scales were used to rate one, early treatment, videotaped CRA session for each subject. Results indicated that: 1) sessions with patients who achieved three or more consecutive weeks of cocaine abstinence were rated significantly higher on therapist empathy and positive responses to resistance, and total IVRS scores (all of which indicate positive interpersonal processes); and 2) Big Picture goals, positive therapeutic alliance, and total IVRS scores were significantly and positively correlated with number of consecutive weeks of cocaine-negative urine toxicology tests. Only MARS homework scores were significantly and positively associated with number of study weeks completed. Finally, the pattern of interrelationships among the MARS subdomains suggests the coherence of the multifaceted CRA treatment. The findings of this preliminary study suggest the importance of monitoring both mechanistic and interpersonal processes during CRA treatment of cocaine dependence.
Alternate JournalAm J Drug Alcohol Abuse

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