Drug Treatment Counselor Practices and Effectiveness

Abstract

This article examines the literature on drug treatment counselor practices and effectiveness and discusses relevant issues in a multilevel framework by considering client outcomes in relation to varying characteristics of clients, counselors, and programs. Most drug treatment evaluation studies collect data from clients of the same treatment programs, and many of these clients share the same counselors. Across multiple programs, these data often form a multilevel (or hierar chical) structure, with clients nested within counselors and counselors within programs. Most analyses of treatment outcome are based on individual clients; this violates the assumption of independent observations underlying most statistical approaches. After reviewing relevant literature, the article presents a conceptual model for understanding counselor effects on client outcomes. Then follows a description of a hierarchical linear model that assesses counselor effectiveness on client outcomes while allowing considerations of potential interactions among the three levels of influence (i.e., client, counselor, and program).