Acceptance and relationship context: a model of substance use disorder treatment outcome

ABSTRACT Aims This study presented and tested a model of behavior change in long‐term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance‐based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the development of these factors. Design This study used a prospective longitudinal naturalistic design and controlled for baseline levels of study variables. Setting and participants The model was tested on a sample of 2549 patients in 15 residential substance use disorder treatment programs. Measurements Acceptance‐based responding (ABR), social relationship quality (SRQ), treatment program alliance (TPA) and substance use‐related impairment were assessed using interviews and self‐report questionnaires. Findings TPA predicted ABR and SRQ and, in turn, ABR predicted better 2‐year and 5‐year treatment outcomes. The baseline‐controlled model accounted for 41% of the variance in outcome at 2‐year follow‐up and 28% of the variance in outcome at 5‐year follow‐up. Conclusions Patients from treatment programs with an affiliative relationship network are more likely to respond adaptively to internal states associated previously with substance use, develop constructive social relationships and achieve long‐term treatment benefits.