Methods: The study uses data collected for the National Treatment Improvement Evaluation Study (NTIES), a prospective, cohort study of U.S. substance abuse treatment programs and their clients with an analytic sample of 59 service delivery units and 3,027 clients. Structural equation modeling (SEM) was used to assess the structural relations and causal connections of the comprehensive service model that included access services, substance abuse counseling services, matched services, client-provider relationship and service outcome variables of treatment duration and post-treatment substance use. Organizational factors, and client characteristics were used as control variables. OLS regression analysis was used to evaluate the variance accounted for in outcome for each of the service factors. The analytic sample consists of 3027 clients from 59 service delivery units.
Results: Standardized path coefficients from the SEM indicate that client-provider relationship directly predicts remaining longer in treatment (B=.12, p<.05) and reduced post-treatment substance use (B=-.05, p<.05) and indirectly predicts reduced post-treatment substance use through the provision of more matched services (B=-.09, P<.05). Client provider relationship mediates the relationship between substance abuse counseling and post-treatment substance abuse. OLS regression indicated client-provider relationship accounted for an R-squared of 2% for reduced post-treatment substance use compared with a 14% for substance abuse counseling.
Conclusions and implications: The findings point to the role of a positive client-provider relationship in insuring receipt of targeted substance abuse services, increased treatment duration and ultimately reduced post-treatment substance use. Findings are relevant to the development of effective models of substance abuse service delivery.