Therapist Drift from CBT is Associated with Substance Use Among IPV Offenders
AI Summary
Therapist drift occurred in 40.3% of sessions and was significantly associated with increased substance use among IPV offenders, especially within CBT-SADV.
At follow up, treatment condition predicted violence related outcomes, but therapist drift did not independently predict violence.
Maintaining fidelity to manualised therapies is crucial to reduce substance use; findings are associational and call for larger, more diverse research samples.
Subst Use Misuse. 2026 May 14:1-8. doi: 10.1080/10826084.2026.2670618. Online ahead of print.
ABSTRACT
BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
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