Therapist Drift from CBT is Associated with Substance Use Among IPV Offenders

Alcohol and substance abuse are associated with increased rates of intimate partner violence (IPV). Manualized treatments that target both problems are associated with improved outcomes; however, therapist drift is an understudied factor that may influence outcomes.

This secondary, observational analysis, part of a National Institute of Health (NIH) funded randomized control study (RCT; NCT07140276), examined associations between therapist drift and treatment outcomes among court-mandated male IPV offenders with alcohol and substance use disorders. Therapist drift was not randomized; therefore, findings should be interpreted as associational rather than causal.

Sixty-two (N = 62) participants were assigned to one of two 12-session treatments: 1) Integrated Cognitive Behavioral Therapy targeting Substance Abuse and Domestic Violence (CBT-SADV) or 2) Drug Counseling (DC) focused on substance use only.

Outcomes included substance use (alcohol and cocaine) and self-reported violence. Analyses included descriptives, logistic regressions, t-tests, and ordinary least squares; due to small sample size and limited therapists, multilevel modeling was not feasible. Therapist drift was high (40.3%) across both treatment conditions and linked to poorer substance use outcomes. Within the SADV condition, higher drift was associated with increased substance use, t(15) = -3.40, p = .004. At follow-up, treatment condition was associated with violence related outcomes (b = -3.17, p = 0.04); but, drift was not uniquely associated with violence.

Findings highlight the importance of maintaining fidelity in manualized treatments to reduce substance use among IPV offenders. Future research should examine these associations in larger, non-court mandated and more diverse samples.