The therapeutic alliance is well-recognized as an integral part of psychotherapy; however, there is little understanding of how it is best utilized in the treatment of substance use disorders (SUDs), particularly in young adults. In this study, researchers identified baseline predictors of the therapeutic alliance mid-treatment, and evaluated whether the therapeutic alliance had an impact on changes observed during treatment. Researchers specifically focused on changes in participants' psychological distress, motivation, self-efficacy, coping skills, and commitment to AA and/or NA, regardless of baseline influences. Subjects were evaluated at intake, mid-treatment, and discharge. The study found that higher age and higher baseline levels of motivation, self-efficacy, coping skills, and commitment to NA/AA served as predictors of a stronger therapeutic alliance. Overall, subjects who developed stronger therapeutic alliances during treatment experienced reduced stress independent of the aforementioned influences. The researchers' findings provide a better understanding of the role of the therapeutic alliance as a stress reduction tool in substance use disorder treatment.