Effect of Therapeutic Alliance of Clients on Methadone Maintenance Treatment Outcomes

138 Pages·2017·0.76 MB·English

Walden University
ScholarWorks
Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2017
Effect of Therapeutic Alliance of Clients on
Methadone Maintenance Treatment Outcomes
Teresa Lyn Fresquez
Walden University
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Walden University

College of Social and Behavioral Sciences

This is to certify that the doctoral dissertation by

Teresa Fresquez

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Tracy Marsh, Committee Chairperson, Psychology Faculty
Dr. Carolyn Davis, Committee Member, Psychology Faculty
Dr. Elisha Galaif, University Reviewer, Psychology Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2016
Abstract
Effect of Therapeutic Alliance of Clients on Methadone Maintenance Treatment
Outcomes
by
Teresa Lyn Fresquez

MCC, University of Phoenix, 2006
BS, Elizabeth City State University, 2003

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Clinical Psychology

Walden University
January 2017
Abstract
Opioid abuse costs affect the majority of the adult population in our society directly or
indirectly. The current prevailing medical treatment for opioid addiction is methadone
maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use,
criminal activity, and overdose potential. MMT is only as effective as the length of time a
client remains active and compliant with the program. In previous studies, therapeutic
alliance (TA) has been shown to positively influence the effectiveness of substance abuse
treatment. However, a gap exists in research in regards to the impact of TA on the
effectiveness of MMT outcomes. The theoretical framework of this study is based on
therapeutic alliance, which guided an examination on whether therapeutic alliance (as
measured by the Session Rating Scale) influenced MMT retention and compliance (drug
screens and session attendance). Archival data from 264 clients receiving MMT for
opioid dependence were reviewed from a nonprofit community-based agency in Arizona.
Logistic regression results revealed that TA did not significantly affect retention or
compliance. However, issues were noted such as how the SRS was administered, a lack
of understanding by clients regarding scoring the SRS, and unique social desirability
demands when clients are in MMT. The finding that TA alone did not significantly affect
retention and compliance does not decrease the need to find effective means to improve
MMT outcomes. Rather, the findings suggest a critical need to identify and utilize
measures more appropriate for clients receiving MMT. In doing so, positive social
change may be achieved by assisting clinical staff in developing a strong therapeutic
alliance with MMT clients as they focus on problem solving as a joint venture when
challenges in the recovery process arise.
Effect of Therapeutic Alliance of Clients on Methadone Maintenance Treatment
Outcomes
by
Teresa Lyn Fresquez

MCC, University of Phoenix, 2006
BS, Elizabeth City State University, 2003

Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Clinical Psychology

Walden University
January 2017
Dedication
I dedicate this to the most amazing husband on earth, Tomas Fresquez who stood
by me through-out this process, even with the cross country and cross state moves to find
practicum, internship and supervision. I love you for being funny, supportive, tolerant
and for the most part patient, but also for allowing me to be me and pursue my dream
through to reality. To my father, George Osborne recently deceased, whose constant
staying on top of me was annoying, but also kept the push on for me to not give up. To
my daughter, Taya and grandsons, whose lives were ended way before their time. So
many times, when I would be feeling like crying, I would remember her humor and
infectious laughter and find the strength to continue on. And most importantly to my
Lord God who gave me all that I have and am.
Acknowledgements
I would like to thank my past committee members, Dr. Stephen Geibel (chair) and
Dr. Mary Devitt (methods committee member), for their support, and dedication through
to my first URR review by Dr. Bonnie Nastasi. I then would like to thank Dr. Carolyn
Davis, who was assigned to replace Dr. Mary Devitt and Dr. Tracy Marsh, for her
guidance, patience, and support during the final dissertation process, both of whom
volunteered to step in as my committee so I would not lose a time trying to find a
replacement for my committee who left. I am thankful that even when I was a crazy
maniac Dr. Marsh did not give up on me. Thanks to Dr. Linda Whinghter my final URR,
who stepped in for Dr. Bonnie Nastasi for my final review before my oral defense.
To my many friends (especially Carol, Sherry and Lavonne) who understood
when I would say “I’m sorry I can’t do anything this weekend.” or “I call you later.” and
later never came. The warmth of the love, support and patience of my friends even in the
face of their own tribulations has been overwhelming. I am so looking forward to having
time and energy to spend together with all of you, and becoming the friend that I haven’t
been able to be through this process.
I want to make a special thanks to Southwest Behavioral Health Services for
giving me the opportunity. Dr. Bob Bohanske, who made it possible for me to access the
data that made this study possible. Dr. Deborah Partington who bent over backwards to
help make internship work. Dr. Ron Wilcoxon who was an amazing support and was
always available to talk and share knowledge. Dr. Ahmad Reza Djangi for hiring me and
heading me in the right direction.
I want to thank my mother, brothers and sisters, nieces and nephews who have
understood my inability to come home for holidays and other times because of another
revision or lack of money. I wasn’t able to be present but they sent me pictures as they
grew up, graduated, married and started their own families. Thank you to advances in
technology like Facebook, I could hear their news and see their pictures so I still felt a
part of the family I love dearly.
I also want to thank my children, grandchildren and great-grandchildren for
understanding when I couldn’t spend the time with them that I wanted to. I love all of you
with all my heart and look forward to the future.
And once again I acknowledge all that my amazing husband has sacrificed in
order to support me.
Table of Contents
List of Tables .......................................................................................................................v
Chapter 1: Introduction to the Study ....................................................................................1
Background ....................................................................................................................1
Studies Addressing the Problem ....................................................................................3
Problem Statement .........................................................................................................6
Nature of the Study ......................................................................................................10
Hypothesis 1: ....................................................................................................... .11
Hypothesis 2: ....................................................................................................... 11
Hypothesis 3: ....................................................................................................... 12
Purpose Statement ........................................................................................................12
Theoretical Framework ................................................................................................14
Definition of Key Terms ..............................................................................................16
Assumptions:.............................................................................................................. .19
Scope and Delimitations: ........................................................................................... 20
Limitations: ................................................................................................................. 20
Significance of Study ...................................................................................................22
Social Change Implications .........................................................................................22
Summary of Chapters ..................................................................................................22
Chapter 2: Literature Review .............................................................................................24
Organization of the Chapter .........................................................................................24
Literature Search Strategy...........................................................................................25
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A Historical Perspective of Methadone Treatment for Opioid Dependence ..............26
What Is Opioid Dependence or Abuse.........................................................................28
Diagnostic Criteria in Relation to Opioids ..................................................................29
Prevalence of Opioid Abuse in the United States ........................................................29
Effects of Opioid Abuse on Society.............................................................................30
Medication-Assisted Treatment Approaches for Opioid and
Abuse/Dependence Effectiveness ............................................................................... 33
Anesthesia-Assisted Rapid Opiate Detoxification ...........................................33
Levomethadyl Acetate .....................................................................................34
Naltrexone ........................................................................................................35
Buprenorphine..................................................................................................35
Methadone Maintenance Treatment ................................................................36
Opioid Dependence Treatment Goals .........................................................................37
Importance of and Factors for Retention in Methadone Treatment .............................37
The Theory: Therapeutic Alliance ...............................................................................39
Factors Influencing Perception of Therapeutic Alliance .............................................40
The Influence of Therapeutic Alliance on Treatment ..................................................42
Effect of Therapeutic Alliance on Treatment Retention ..............................................43
Teaching Clinical Staff Therapeutic Alliance Skills ...................................................44
Summary ......................................................................................................................46
Chapter 3: Research Method .............................................................................................47
Research Design and Approach ...................................................................................48
ii