Does treatment fidelity predict client outcomes in 12-step facilitation for stimulant abuse?
Open accessAbstract
Objective This study examined the relationships between treatment fidelity and treatment outcomes in a community-based trial of a 12-Step Facilitation (TSF) intervention.Method In a prior multi-site randomized clinical trial, 234 participants in 10 outpatient drug treatment clinics were assigned to receive the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12) intervention. A secondary analysis reviewed and coded all STAGE-12 sessions for fidelity to the protocol, using the Twelve Step Facilitation Adherence Competence Empathy Scale (TSF ACES). Linear mixed-effects models tested the relationship between three fidelity measures (adherence, competence, empathy) and six treatment outcomes (number of days of drug use and five Addiction Severity Index (ASI) composite scores) measured at 3 months post-baseline.Results Adherence, competence and empathy were robustly associated with improved employment status at follow up. Empathy was inversely associated with drug use, as was competence in a non-significant trend (p=.06). Testing individual ASI drug composite score items suggested that greater competence was associated with fewer days of drug use and, at the same time, with an increased sense of being troubled or bothered by drug use.Conclusions Greater competence and empathy in the delivery of a TSF intervention were associated with better drug use and employment outcomes, while adherence was associated with employment outcomes only. Higher therapist competence was associated with lower self-report drug use, and also associated with greater self-report concern about drug use. The nature of TSF intervention may promote high levels of concern about drug use even when actual use is low.
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Competence and adherence differ in their impact on outcomes.
“While competence and adherence undoubtedly share features, there is some evidence that they differ in their impact on outcomes (e.g., Guydish et al., 2014).”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as Guydish et al., 2014
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- Authors
- Guydish, J., Campbell, B. K., Manuel, J. K., Delucchi, K. L., Le, T., Peavy, K. M., & McCarty, D.
- Affiliations
- University of California, San Francisco (US)
- Oregon Health & Science University (US)
- University of Washington (US)
- Corresponding author
- Guydish, Joseph
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 134
- Pages
- 330-336
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC3914731
- OpenAlex
- W1988871846
- Cited by
- 26
- References
- 46
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 4 · 2016: 1 · 2015: 6 · 2014: 3 · 2013: 1
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Drug Abuse (R01 DA025600, U10 DA015815)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- intervention fidelity, 12-step facilitation, stimulant abuse, cocaine use, therapist empathy, therapist competence, medication adherence, Addiction Severity Index, employment effects, drug use
- MeSH terms
- Adult, Empathy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Self-Help Groups, Substance Abuse Treatment Centers, Treatment Outcome, Substance-Related Disorders
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