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Pre-Treatment Expectations in Clients: Impact on Retention and Effectiveness in Outpatient Substance Abuse Treatment

Published online by Cambridge University Press:  14 April 2011

Katja Kuusisto*
University of Tampere, Finland
Vesa Knuuttila
University of Tampere, Finland
Pekka Saarnio
University of Tampere, Finland
Reprint requests to Katja Kuusisto, School of Social Sciences and Humanities, University of Tampere, Tampere 33014, Finland. E-mail:


Background: Common factors are important for the therapy outcome and also mediate the specific factors of therapy. As one of the common factors, client's expectations towards treatment have been understudied. Aims: The aim was to examine the pre-treatment expectations of outpatient substance abuse treatment clients (N = 327, 111 females, 216 males) and its impact on retention, effectiveness and satisfaction at 6-month follow-up. Method: Dependent variables included the clients’ attitudes towards the twelve-step principles and participation, medical treatment and therapists’ role. Results: An emphasis on the importance of medical treatment at baseline predicted dropping out. Similarly, it predicted a lower percent days abstinent (PDA6) at 6 months follow-up in comparison to those who did not consider medical treatment important for recovery. Percent days abstinent increased with a more positive attitude to mutual support. At follow-up, those who had assessed the therapist's role in recovery to be most important at the baseline were most satisfied with the treatment. Conclusions: The client's pre-treatment expectations have an impact on treatment retention and effectiveness. Further effort should be made to study how clients’ image of treatment could be improved and also how the commitment of the clients with multiple problems could be improved.

Empirically Grounded Clinical Interventions
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2011

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Adamson, S. J., Sellman, J. D. and Frampton, C. M. A. (2009). Patient predictors of alcohol treatment outcome: a systematic review. Journal of Substance Abuse Treatment, 36, 7586.CrossRefGoogle ScholarPubMed
Allsop, S., Saunders, B., Phillips, M. and Carr, A. (1997). A trial of relapse prevention with severely dependent male problem drinkers. Addiction, 92, 6173.CrossRefGoogle ScholarPubMed
Anton, R. F., O'Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., et al. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: a randomized controlled trial. Journal of the American Medical Association, 295, 20032017.CrossRefGoogle ScholarPubMed
Arnkoff, D. B., Glass, C. R. and Shapiro, S. J. (2002). Expectations and preferences. In Norcross, J. C. (Ed.), Psychotherapy Relationships that Work. therapist contributions and responsiveness to patients (pp. 335356). New York: Oxford University Press.Google Scholar
Babor, T. F. and Del Boca, F. K. (Eds.) (2003). Treatment Matching in Alcoholism. Cambridge: Cambridge University Press.Google Scholar
Baldwin, A. R., Oei, T. P. and Young, R. (1993). To drink or not to drink: the differential role of alcohol expectancies and drinking refusal self-efficacy in quantity and frequency of alcohol consumption. Cognitive Therapy and Research, 17, 511530.CrossRefGoogle Scholar
Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall.Google ScholarPubMed
Bergmark, A. (2008a). On treatment mechanisms: what can we learn from the COMBINE study? Addiction, 103, 703705.CrossRefGoogle ScholarPubMed
Bergmark, A. (2008b). Specific and contextual treatment mechanisms. Nordic Studies on Alcohol and Drugs, 25, 285293.Google Scholar
Beutler, L. E. (2002). The dodo bird is extinct. Clinical Psychology: Science and Practice, 9, 3034.Google Scholar
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., et al. (2004). Therapist variables. In Lambert, M. (Ed.), Handbook of Psychotherapy and Behavior Change (pp. 227306). New York: Wiley.Google Scholar
Carroll, K. M. (2001). Constrained, confounded and confused: why we really know so little about therapists in treatment outcome research. Addiction, 96, 203206.CrossRefGoogle ScholarPubMed
Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R. and Donovan, D. M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65, 588598.CrossRefGoogle ScholarPubMed
Cooney, N. L., Babor, T. F., DiClemente, C. C. and Del Boca, F. K. (2003). Clinical and scientific implications of project MATCH. In Babor, T. F. and Del Boca, F. K. (Eds.), Treatment Matching in Alcoholism. (pp. 222237). Cambridge: Cambridge University Press.Google Scholar
Edwards, G. and Grant, M. (Eds.) (1980). Alcoholism Treatment in Transition. London: Croom Helm.Google Scholar
Frank, J. D. (1959). The dynamics of the psychotherapeutic relationship: determinants and effects of the therapist's influence. Psychiatry: Journal for the Study of Interpersonal Processes, 22, 1739.CrossRefGoogle ScholarPubMed
Frank, J. D. (1983). The placebo is psychotherapy. Behavioral and Brain Sciences, 6, 291292.CrossRefGoogle Scholar
Greenberg, R. P., Constantino, M. J. and Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26, 657678.CrossRefGoogle ScholarPubMed
Hubble, M., Duncan, B. and Miller, S. (1999). The Heart and Soul of Change: what works in therapy. New York: American Psychological Association.CrossRefGoogle Scholar
Imel, Z. E., Wampold, B. E., Miller, S. D. and Fleming, R. R. (2008). Distinctions without a difference: direct comparisons of psychotherapies for alcohol use disorders. Psychology of Addictive Behaviors, 22, 533543.CrossRefGoogle ScholarPubMed
Janis, I. L. and Mann, L. (1977). Decision Making: a psychological analysis of conflict, choice, and commitment. New York: Free Press.Google Scholar
Jones, B. T. and McMahon, J. (1994a). Negative alcohol expectancy predicts post-treatment abstinence survivorship: the whether, when and why of relapse to a first drink. Addiction, 89, 16531665.CrossRefGoogle ScholarPubMed
Jones, B. T. and McMahon, J. (1994b). Negative and positive alcohol expectancies as predictors of abstinence after discharge from a residential treatment program: a one-month and three-month follow-up study in men. Journal of Studies on Alcohol, 55, 543548.CrossRefGoogle ScholarPubMed
Karno, M. P. and Longabaugh, R. (2007). Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment. Addiction, 102, 587596.CrossRefGoogle ScholarPubMed
Kelly, J. F., Yeterian, J. D. and Myers, M. G. (2008). Treatment staff referrals, participation expectations, and perceived benefits and barriers to adolescent involvement in twelve-step groups. Alcoholism Treatment Quarterly, 26, 427449.CrossRefGoogle Scholar
Kirshenbaum, A. P., Olsen, D. M. and Bickel, W. K. (2009). A quantitative review of the ubiquitous relapse curve. Journal of Substance Abuse Treatment, 36, 817.CrossRefGoogle ScholarPubMed
Litman, G. K. (1980). Relapse in alcoholism: traditional and current approaches. In Edwards, G. and Grant, M. (Eds.), Alcoholism Treatment in Transition. London: Croom Helm.Google Scholar
Luborsky, L., Rosenthal, R., Diguer, L., Andrusyna, T. P., Berman, J. S., Levitt, J. T., et al. (2002). The dodo bird verdict is alive and well – mostly. Clinical Psychology: Science and Practice, 9, 212.Google Scholar
Martin, D. J., Garske, J. P. and Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438450.CrossRefGoogle ScholarPubMed
McLellan, A. T. (2002). Have we evaluated addiction treatment correctly? implications from a chronic care perspective. Addiction, 97, 249252.CrossRefGoogle ScholarPubMed
Messer, S. B. and Wampold, B. E. (2002). Let's face facts: common factors are more potent than specific therapy ingredients. Clinical Psychology: Science and Practice, 9, 2125.Google Scholar
Moos, R. H. (2008). Active ingredients of substance use-focused self-help groups. Addiction, 103, 387396.CrossRefGoogle ScholarPubMed
Najavits, L. M., Crits-Christoph, P. and Dierberger, A. (2000). Clinicians’ impact on the quality of substance use disorder treatment, 35, 21612190.Google ScholarPubMed
Orford, J. (2006). Is treatment-matching dead? Comments on Bühringer (2006). Addiction, 101, 653654.Google ScholarPubMed
Orford, J., Hodgson, R., Copello, A., John, B., Smith, M., Black, R., et al. (2006). The clients’ perspective on change during treatment for an alcohol problem: qualitative analysis of follow-up interviews in the UK alcohol treatment trial. Addiction, 101, 6068.CrossRefGoogle ScholarPubMed
Orford, J., Hodgson, R., Copello, A., Wilton, S. and Slegg, G. (2009). To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK alcohol treatment trial. Journal of Substance Abuse Treatment, 36, 4958.CrossRefGoogle ScholarPubMed
Saarnio, P. (2002). Factors associated with dropping out from outpatient treatment of alcohol-other drug abuse. Alcoholism Treatment Quarterly, 20, 1733.CrossRefGoogle Scholar
Saarnio, P. and Knuuttila, V. (2007). A study of readiness to change profiles in alcohol and other drug abusers. Journal of Addictions Nursing, 18, 117122.CrossRefGoogle Scholar
Saarnio, P. and Knuuttila, V. (2008). Readiness to change profiles in two different groups of Alcohol/Other drug abusers in the United States and Finland. Alcoholism Treatment Quarterly, 26, 333346.CrossRefGoogle Scholar
Schneider, U., Kroemer-Olbrisch, T., Wedegartner, F., Cimander, K. F. and Wetterling, T. (2004). Wishes and expectations of alcoholic patients concerning their therapy. Alcohol and Alcoholism, 39, 141145.CrossRefGoogle ScholarPubMed
Shapiro, D. A. (1981). Comparative credibility of treatment rationales: three tests of expectancy theory. British Journal of Clinical Psychology, 20, 111122.CrossRefGoogle ScholarPubMed
Stout, R., Del Boca, F. K., Carbonari, J., Rychtarik, R., Litt, M. D. and Cooney, N. (2003). Primary treatment outcomes and matching effects: outpatient arm. In Babor, T. F. and Del Boca, F. K. (Eds.), Treatment Matching in Alcoholism (pp. 105134). Cambridge: Cambridge University Press.Google Scholar
UKATT Research Team (2005a). Effectiveness of treatment for alcohol problems: findings of the randomized UK alcohol treatment trial (UKATT). British Medical Journal, 331, 541543.CrossRefGoogle Scholar
UKATT Research Team (2005b). Cost effectiveness of treatment for alcohol problems: findings of the randomized UK alcohol treatment trial (UKATT). British Medical Journal, 331, 544548.CrossRefGoogle Scholar
Wampold, B. E. (2001). The Great Psychotherapy Debate: models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
Wampold, B. E., Imel, Z. E. and Minami, T. (2007). The story of placebo effects in medicine: evidence in context. Journal of Clinical Psychology, 63, 379390.CrossRefGoogle ScholarPubMed
Wampold, B. E., Minami, T., Tierney, S. C., Baskin, T. W. and Bhati, K. S. (2005). The placebo is powerful: estimating placebo effects in medicine and psychotherapy from randomized clinical trials. Journal of Clinical Psychology, 61, 835854.CrossRefGoogle ScholarPubMed
Weinberger, J. (1995). Common factors aren't so common: the common factors dilemma. Clinical Psychology: Science and Practice, 2, 4569.Google Scholar
Weinberger, J. and Eig, A. (1999). Expectancies: the ignored common factor in psychotherapy. In Kirsch, I. (Ed.), How Expectancies Shape Experience (pp. 357383). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Weiss, R. D., O'Malley, S. S., Hosking, J. D., LoCastro, J. S. and Swift, R. (2008). Do patients with alcohol dependence respond to placebo? Results from the COMBINE study. Journal of Studies on Alcohol and Drugs, 69, 878884.CrossRefGoogle ScholarPubMed
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