Treatment outcomes of a combined cognitive behavior therapy and pharmacotherapy for a sample of women with and without substance abuse histories on an acute psychiatric unit: Do therapeutic alliance and motivation matter?

Background and Objectives Women with comorbid psychiatric and substance abuse problems (PwSA) experience more consequences from their use and typically have the poorest prognosis and outcome, compared to those with psychiatric problems but without substance abuse problems (PwoSA). The present study examined outcomes of a combined intensive inpatient cognitive behavior therapy (CBT) and pharmacotherapy program for women with PwSA and PwoSA. Methods Sample consisted of 117 women on a women-only acute inpatient unit (PwSA = 50, PwoSA = 67). Results Women in both groups made significant improvements in psychological functioning. High motivation at admission and therapeutic alliance at discharge were associated with improved psychological functioning at discharge for both groups. Scientific Significance Findings provide preliminary support for the efficacy of a combined CBT and pharmacotherapy program for women with psychiatric diagnoses on a women-only acute inpatient unit, and for pre-treatment motivation and therapeutic alliance as important correlates of better treatment outcomes. (Am J Addict 2013;22:556-573)