A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment

Rieckmann, Traci; Kovas, Anne E.; McFarland, Bentson H.; Abraham, Amanda J.

doi:10.1016/j.jsat.2011.05.005

Cited by 36 publications

(47 citation statements)

References 70 publications

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“…Likewise, perceived effectiveness was re-coded into a second binary dependent variable, where 0=scale responses of 1–4 (“not effective”; 49% of valid responses), and 1=scale responses of 5–7 (“effective”). The coding of these variables is consistent with prior research (Abraham et al, 2009; Abraham et al 2011; Rieckmann et al, 2011). …”

Section: Methodssupporting

confidence: 63%

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Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

Rieckmann

Abraham

Kovas

et al. 2014

Addictive Behaviors

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There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (n=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (n=198). Models included 922 counselors in 172 CTN programs and 1,203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors’ acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.

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Section: Methodssupporting

confidence: 63%

“…Counselor- and program-level independent variables were identified from previous research (Abraham et al, 2011; Rieckmann et al, 2011; Knudsen et al, 2005; 2007a). In preparation for hierarchical modeling, SPSS version 18 was used for descriptive, bivariate, and preliminary multivariate analysis of the dependent variables.…”

Section: Methodsmentioning

confidence: 99%

Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

Rieckmann

Abraham

Kovas

et al. 2014

Addictive Behaviors

Self Cite

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“…Among the many topics to be covered should be discussions of OUD as a chronic disorder that requires extended and ongoing treatment (51) and reducing SUD and treatment related stigma (52, 53). In order to facilitate dissemination, adoption, and implementation of MAT, providers and counselors also need to be better informed about and have a more favorable attitude toward MAT (54–56), suggesting the need for initial and ongoing training and continuing medical education.…”

Section: Discussionmentioning

confidence: 99%

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Venner

Donovan

Campbell

et al. 2018

Addictive Behaviors

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The U.S. is experiencing an alarming opioid epidemic, and although American Indians and Alaska Natives (AI/AN) are especially hard hit, there is a paucity of opioid-related treatment research with these communities. AI/ANs are second only to Whites in the U.S. for overdose mortality. Thus, the National Institute on Drug Abuse convened a meeting of key stakeholders to elicit feedback on the acceptability and uptake of medication assisted treatment (MAT) for opioid use disorders (OUDs) among AI/ANs. Five themes from this one-day meeting emerged: (1) the mismatch between Western secular and reductionistic medicine and the AI/AN holistic healing tradition; (2) the need to integrate MAT into AI/AN traditional healing; (3) the conflict between standardized MAT delivery and the traditional AI/AN desire for healing to include being medicine free; (4) systemic barriers; and (5) the need to improve research with AI/ANs using culturally relevant methods. Discussion is organized around key implementation strategies informed by these themes and necessary for the successful adoption of MAT in AI/AN communities: (1) type of medication; (2) educational interventions; (3) coordination of care; and (4) adjunctive psychosocial counseling. Using a community-based participatory research approach is consistent with a “two eyed seeing” approach that integrates Western and Indigenous worldviews. Such an approach is needed to develop impactful research in collaboration with AI/AN communities to address OUD health disparities.

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“…Counselors employed in programs already using buprenorphine 25,26 are more likely to be aware of buprenorphine and rank it favorably. Similarly, counselors employed in centers offering methadone are more likely to be accepting of its use.…”

Section: Introductionmentioning

confidence: 99%

Counselor Training and Attitudes toward Pharmacotherapies for Opioid use Disorder

et al. 2016

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Background Methadone and buprenorphine have been demonstrated to be effective in the treatment of opioid use disorder (OUD), especially when combined with psychosocial treatment. Despite buprenorphine’s association with fewer withdrawal symptoms and lessened risk of abuse, compared to methadone, its adoption remains limited. Given the vital role that counselors may play in its successful implementation, their knowledge and perceptions of opioid agonist therapy may be facilitators or barriers to its acceptance. Methods Informed by diffusion theory, the current study examined perceptions of buprenorphine and methadone acceptability among 725 counselors employed in a nationally representative sample of substance use disorder treatment centers. First, we provided descriptive statistics about medication diffusion, extent of training received about the medications, and perceptions of acceptability of each medication. Then, we compared acceptability of opioid agonists with other treatment approaches for OUD. Finally, we conducted two ordinary least squares regressions to examine counselor acceptability of buprenorphine and of methadone. Results Descriptive statistics suggested that diffusion of information about buprenorphine and methadone was not complete, and training was not extensive for either medication. Counselors reported greater acceptability and training of buprenorphine compared to methadone. Methadone was rated as the least acceptable among all other treatment approaches. Multivariate analyses indicated regional differences, and that medication-specific training, adaptability, and educational attainment were positively related with perceptions of acceptability of either medication, even after controlling for organizational characteristics. Adherence to a 12-step orientation was negatively associated with acceptability. Conclusions Dissemination of information about opioid agonist therapy is occurring. Nevertheless, the fact that 20% of counselors admitted not knowing enough about either buprenorphine’s or methadone’s effectiveness is surprising in light of the extensive literature documenting their effectiveness. Future research should focus upon different types of training that can inform physicians, counselors and patients about the use of opioid agonist therapy.

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A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment

Cited by 36 publications

References 70 publications

Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Counselor Training and Attitudes toward Pharmacotherapies for Opioid use Disorder

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