More is better: counseling participation and the effectiveness of outpatient drug treatment.

Counseling is a cornerstone of virtually all drug treatment modalities, yet there is relatively little research examining counseling effectiveness. This article addresses a simple question concerning counseling: Is more frequent participation in counseling associated with better treatment outcomes? Findings from an evaluation of the Los Angeles Target Cities Project indicate that monthly counseling frequency varied substantially for participants of outpatient programs, and more frequent counseling was associated with lower levels of relapse to drug use, even for individuals who successfully completed the treatment program. The association between counseling frequency and relapse did not attend to all types of counseling, however, but mainly to group and individual counseling. More frequent attendance of family counseling and 12-step meetings during the outpatient treatment phase did not significantly lower the probability of relapse. Frequent participants of group and individual counseling who continued to be frequent participants of 12-step meetings during the posttreatment period had the lowest probability of relapse. The policy implications of the findings and directions for further research are discussed.