The role of predisposing client characteristics in predicting response to treatment among substance abusing individuals

In recent years, many authors have argued that psychotherapeutic outcomes may be improved through the use of systematic treatment selection or the matching of clients to particular types of treatment. Beutler and his colleagues propose that five predisposing patient variables (problem severity, motivational distress, problem complexity, reactance level, and coping style) play a key role in determining how an individual will respond to treatment. Assessment of patients along these dimensions is thought to provide clinicians with information as to the treatment dimensions likely to be most conducive to positive outcomes. lt follows that clinicians should be able to characterize the type of patients most likely to benefit from a given treatment program if that program can be defined in terms of relevant treatment dimensions. The current study sought to examine whether an assessment of these predisposing client characteristics would facilitate predictions about which patients were most likely to benefit from a structured treatment program. Participants in the study were 97 individuals seeking treatment for long-term substance dependence in a 21-day, inpatient program at a Veterans Affairs hospital. Participants were predominantly male and from an ethnic minority background. Individuals who participated in the study were assessed upon admission, and outcome was examined through rating scales completed by patients and their treatment coordinators at the time of discharge. Correlational analyses found no relationship between patients\u27 scores on the assessment measures and either therapists\u27 or patients\u27 ratings of response to treatment. These results suggest that Beutler\u27s model may not be applicable in an inpatient setting where many practitioners are involved in treatment delivery and the patient population is low functioning and fairly homogenous. The treatment needs of ethnic minority clients may also differ from those of the larger population. The findings of the current study need to be qualified, however, due to the method used to assess outcome. The very positive outcomes reported by patients at the time of their discharge, for example, may reflect transient feelings of security and inclusion, as well as a high degree of optimism in the early stages of a treatment process