Interpersonal Pathoplasticity and Trajectories of Change in Routine Adolescent and Young Adult Residential Substance Abuse Treatment

• Published in: Journal of consulting and clinical psychology 2017-07, Vol.85 (7), p.676-688
• Main Authors: Boswell, James F., Cain, Nicole M., Oswald, Jennifer M., McAleavey, Andrew A., Adelman, Robert
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adult; Alliances; Change agents; Child; Clinical outcomes; Clinical research; Correlation analysis; Female; Hospitalization; Human; Humans; Interpersonal factors; Interpersonal problems; Male; Medical treatment; Mental disorders; Mental health care; Mental health services; Partnerships; Patients; Professional-Patient Relations; Quality management; Rehabilitation Centers; Residential Care Institutions; Residential Treatment; Self Report; Stakeholders; Substance abuse treatment; Substance Use Disorder; Substance Use Treatment; Substance-Related Disorders - therapy; Subtypes; Symptoms; Teenagers; Therapeutic Alliance; Therapeutic alliances; Treatment Outcome; Treatment Outcomes; Young Adult; Young adults
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000219

Background: Partnerships between mental health care stakeholders provide a context for generalizable clinical research with implications for quality improvement. In the context of a partnership between an adolescent residential substance abuse disorder (SUD) treatment center and clinical researchers, stakeholders identified knowledge gaps (internal and the field broadly) with regard to patient interpersonal factors that influence working alliance and acute SUD residential treatment outcome trajectories. Objective: To (a) examine interpersonal pathoplasticity and identify interpersonal subtypes in a naturalistic sample of adolescent and young-adult patients presenting for routine residential SUD treatment and (b) investigate the association between identified interpersonal subtypes and working alliance and acute treatment outcome trajectories. Method: N = 100 patients (Mage = 17.39 years, 68% male, 84% White) completed self-reports of symptom and functioning outcomes, interpersonal problems, and the working alliance on multiple occasions between admission and discharge. Multiple methods were used to identify interpersonal subtypes and test pathoplasticity. Interpersonal subtype was entered as a predictor in respective multilevel models of working alliance and symptom outcome. Results: Interpersonal subtypes of vindictive and exploitable patients demonstrated pathoplasticity. Subtype did not predict working alliance trajectories; however, a significant interaction between interpersonal subtype and a quadratic effect for time demonstrated that exploitable patients with longer than average treatment lengths experienced attenuated symptom change over the course of treatment whereas vindictive patients appeared to demonstrate steady progress. Conclusions: Interpersonal assessments should be integrated into residential SUD treatment to identify patients with an exploitable interpersonal style who might require additional attention or alternative interventions. What is the public health significance of this article? This study highlights 2 interpersonal subtypes of adolescent substance users: vindictive and exploitable. Interpersonally exploitable substance users may experience attenuated benefits over the course of longer-term residential substance use treatment compared with individuals who are interpersonally vindictive.