Coping, spirituality, motivation to change, and the working alliance: The associations with substance abuse treatment outcomes

Substance abuse detrimentally affects millions of Americans every year; however, despite treatment availability, relapse is considerably common. The effects are proximal to the individual and family, but also distal in terms of community and societal effects. Since the problem is complex, over the years researchers have examined various factors associated with treatment outcomes. The purpose of this study was to investigate the relationship between coping (adaptive and maladaptive), spirituality, motivation to change, and the working alliance (bond, goals, and tasks) with treatment outcomes. In addition, the study investigated if coping skills, spirituality, and the working alliance mediated the relationship between motivation to change and treatment outcomes. Treatment outcome was defined as whether a client reported substance use during the past 30 days. The sample included 211 clients participating in outpatient substance abuse treatment. All participants reviewed and initialed an informed consent form and completed a demographic questionnaire, coping strategies form and a survey comprised of five measures (BriefCOPE, Spiritual Involvement and Beliefs Scale, the Working Alliance Inventory, The University of Rhode Island Change Assessment form, and the Timeline Followback Calendar). Correlation analyses revealed significant positive relationships between treatment outcome and adaptive coping, spirituality, the working alliance and a negative relationship between maladaptive coping and treatment outcome. The results of a logistic regression analyses indicated that maladaptive coping, spirituality, the working alliance, and the bond subscale of the working alliance predicted treatment outcome. However, motivation did not predict treatment outcome. In addition, a test for indirect effects revealed that maladaptive coping was the only predictor variable that mediated the relationship between motivation to change and treatment outcome. The results of the study underscore the importance of the working alliance in treatment, the inclusion of spiritual interventions and continued training for clinicians in the area of spirituality, and the importance of helping clients to identify coping strategies that decrease the risk of relapse. Clinical and theoretical implications for substance abuse practice and research are discussed