Engaging the Patient in Treatment

Patient engagement may be viewed in terms of intensity and duration of treatment participation. High levels of engagement are predictive of positive treatment outcomes but are contingent upon patient, clinician and clinic characteristics, namely: 

• • • Patient characteristics include pre-treatment motivation, severity of disorder, previous treatment experiences, strength of therapeutic relationship, and perception of helpfulness of the treatment services. 

    • Clinician characteristics include degree of empathy, therapeutic relationship, adequate time and interest, and counselling skills. Basic counselling ‘micro skills’ including warmth and optimism, and strong interpersonal skills are associated with better retention in treatment and indirectly with better treatment outcomes. 

    • Clinic characteristics include removal of practical access barriers such as transportation, fees, hours, physical surroundings, and perceptions about other patients of the service. 

Treatment adherence and completion are prominent issues in alcohol and other drug treatment and the factors that improve it are not yet well understood. A focus in early interactions with patients should be on maximising engagement with the professional and the service and fostering a sense of collaboration. Central to provision of any intervention is a strong bond and therapeutic alliance between patient and clinician. 

In addition to identifying clinical disorders and effective interventions, negotiation of treatment goals requires clarification of the patient’s insight, values and expectation. Evidence shows that providing the patient with a choice of treatment options improves treatment retention.