Client and counselor attitudes toward the use of medications for treatment of opioid dependence

Abstract

Attitudes, perceived social norms and intentions were assessed for 376 counselors and 1083 clients from outpatient, methadone and residential drug treatment programs regarding four medications used to treat opiate dependence: methadone, buprenorphine, clonidine, and ibogaine. Attitudes, social norms and intentions to use varied by treatment modality. Methadone clients and counselors had more positive attitudes toward the use of methadone, while their counterparts in residential and outpatient settings had neutral or negative assessments. Across modalities, attitudes, perceived social norms, and intentions toward the use of buprenorphine were relatively neutral. Assessments of clonidine and ibogaine were negative for clients and counselors in all settings. Social normative influences were dominant across settings and medications in determining counselor and client intentions to use medications, suggesting that perceptions about beliefs of peers may play a critical role in use of medications to treat opiate dependence. INTRODUCTIONInvestments in the development of pharmacotherapies for the treatment of alcohol and drug dependence have begun to yield medications that enhance treatment effectiveness (Garbutt, West, Carey, Lohr, & Crews, 1999; Litten,1999;O'Brien, 1997;Swift, 1999). Underutilization of these innovative phamacotherapies, however, is a concern and points to the need for advancements in adoption and implementation strategies (Institute of Medicine, 1998). Speculation about resistance to the use of medications suggests that some patients and therapists believe that the use of medication to treat addiction is inconsistent with the experience of recovery (Institute of Medicine, 1995;Institute of Medicine, 1997). Unfortunately, there is Corresponding Author: Traci Rieckmann, Ph.D., OHSU Dept. PHPM, 3181 SW Sam Jackson Park Rd. CB 669, Portland, OR 97239, rieckman@ohsu.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. little empirical data on the attitudes and beliefs of clients and counselors toward using medication as part of a therapeutic plan for the treatment of drug dependence. NIH Public Access Attitudes Toward the Use of Medications for Opiate DependenceInvestigations conducted in the early 1970's found ambivalent attitudes and beliefs about the use of methadone in treating opiate dependence (Brown, 1975). More contemporary investigations used a measure of "abstinence orientation" (beliefs that methadone use should be time-limited) and assessed the opinions of staff in methadone programs in Australia (Caplehorn, Irwig, Saunders, 1996a;Caplehorn, Irw...

Barriers to implementation of evidence-based addiction treatment: A national study

“…Finally, it should be noted that our study shows relatively low levels of variation in staff and director levels of education, which possibly could have contributed to the lack of significance identified between education and level of barriers in implementing an EBP. However, published results from one of our studies (Lundgren, Krull, et al, 2011), focusing not on barriers but on attitudes about EBPs, identified through multivariate modeling that educational levels of staff and directors were significantly associated with more positive attitudes about EBPs, which is consistent with prior research efforts (Ducharme, Knudsen, Roman, & Johnson, 2007;Rieckmann et al, 2007;Roman et al, 2006). In addition, as in our study, the samples of addiction treatment staff in these studies all showed a similar range in education levels.…”

“…The treatment unit and staff characteristic factors selected as control factors have been identified in a number of research efforts as associated with attitudes about EBPs and EBP implementation. For example, several studies have identified that addiction treatment staff (both directors and clinical staff) with higher levels of education and with more professional knowledge have more positive attitudes about evidence-based addiction treatment practices, science-based staff training, and usefulness of EBPs (Lundgren, Amodeo, et al, 2011;Lundgren, Krull, et al, 2011;McCarty et al, 2007;Rieckmann, Daley, Fuller, Thomas, & McCarty, 2007).…”

“…McCarty et al (2007) and Fuller et al (2007) did not find treatment unit to be associated with differences in staff attitudes regarding EBPs. However, in a study of 376 counselors and 1,083 clients involved in methadone, residential and outpatient substance abuse programs in Oregon and Massachusetts, Rieckmann et al (2007) reported that the most consistent support for pharmacological therapies was from staff in outpatient settings. Furthermore, in a comparison of over 750 public and private substance abuse treatment organizations, Roman, Ducharme, & Knudsen (2006) found that pharmacotherapy was more likely to be adopted in private centers compared with public centers.…”

Medication-Assisted Treatment: Overcoming Individual Resistance Among Members in Groups Whose Membership Consists of Both Users and Nonusers of MAT: A Clinical Review

“…A number of researchers have investigated counselor attitude toward the use of MAT (Abraham, Rieckmann, McNulty, Kovas, & Roman, 2011;Knudsen, Ducharme, Roman, & Link, 2005;Rieckmann, Daley, Fuller, Thomas, & McCarty, 2007). All three studies demonstrated that counselor attitude and acceptance of MAT significantly affected patients' perception and acceptance of MAT as a therapeutic option.…”

Factors associated with the prescribing of buprenorphine or methadone for treatment of opiate dependence

“…A study in the United States on client and counselor attitudes toward medications used in the treatment of opioid dependence found that attitudes toward methadone were generally positive, whereas those toward buprenorphine were largely neutral (Rieckmann, Daley, Fuller, Thomas, & McCarty, 2007). However, there has been little research on patient choice and patient expectations with regard to buprenorphine pharmacotherapy.…”