Effect of shared decision-making on therapeutic alliance in addiction health care

EAG Joosten^1,2, GH de Weert³, T Sensky⁴, CPF van der Staak⁵, CAJ de Jong^1,2

¹Novadic-Kentron, Network for Addiction Treatment Services, Vught, the Netherlands; ²Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands; ³Julius Center for Health Sciences and Primary Health Care, UMC Utrecht, Utrecht, the Netherlands; ⁴Department of Psychological Medicine, Imperial College London, London, United Kingdom; ⁵Academic Centre for Social Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands

Background: In recent decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to examine the effect of a shared decision-making intervention (SDMI) for substance-dependent patients on patients’ and clinicians’ perceptions of therapeutic alliance.

Methods: Clinicians were randomly assigned to SDMI or usual procedures to reach a treatment agreement. SDMI is a structured, manualized, 5-session procedure to facilitate treatment agreement and consists of five standardized sessions.

Results: Patients’ perceptions of the therapeutic alliance were very favorable at start of treatment, and no differences were found between intervention groups. Clinicians’ scores on perceived helpfulness and on the overall therapeutic alliance were higher in the SDMI group than in the controls, after 8 weeks of treatment and at the end of treatment.

Conclusion: The present study has shown that a specific intervention to enhance shared decision-making results in favorable changes in clinicians’ perceptions of the therapeutic alliance.

Keywords: therapeutic alliance, helping alliance, shared decision-making, addiction, substance-dependence