Counselor Attitudes in Methadone Maintenance

Kang, Sung–Yeon; Magura, Stephen; Nwakeze, Peter C.; Demsky, Sy

doi:10.1300/j126v01n02_04

Cited by 19 publications

(24 citation statements)

References 14 publications

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“…For example, although the concept of narcotic blockade has been repeatedly documented since Vincent Dole's work with methadone in the 1960s (Dole et al, 1966;Kleber, 2007;Tetrault and Fiellin, 2012), less than half of respondents agreed, and 45-56% were uncertain, that agonist medication reduces or blocks the effects of heroin. These responses are consistent with previous findings both in other criminal justice dispensations (Nunn et al, 2009;Friedmann et al, 2012) and among community treatment providers (Kang et al, 1997;Kayman et al, 2006) and serve as a disquieting reminder that the stigma and uncertainty with which the public regards MAT stubbornly prevails even among experienced drug court professionals.. Numerous reasons were cited for why agonist medication was either not available or had limited availability to opioid-dependent drug court participants.…”

Section: Discussionsupporting

confidence: 87%

“…The survey was designed with input from drug court professionals and was based in part on previous studies on MAT prescribing and referral practices in US prison systems (Nunn et al, 2009) as well as from scales that assessed counselor attitudes toward MAT (Caplehorn et al, 1997;Kang et al, 1997). Prior to launching the survey it was piloted with 10 drug courts.…”

Section: Survey Designmentioning

confidence: 99%

“…This stigma is pervasive in the community, among drug treatment professionals, and among drug users (Forman et al, 2001;Kang et al, 1997;Rosenblum et al, 1991). The stigma derives from concerns associated with diversion, negative beliefs that methadone generates an array of unwanted side effects, and opinions that its use prevents patients from achieving full recovery (e.g., keeps them addicted to an opioid).…”

Section: Introductionmentioning

confidence: 99%

“…Many of these beliefs are based on a misunderstanding of how methadone functions or a philosophical bias against maintenance medication in favor of interventions that do not use medications (Gerra et al, 2009;Kleber, 2007;White, 2009). Research has indicated that bias or misinformation about the benefits and risks associated with methadone results in poorer treatment outcomes (Kang et al, 1997), plays a role in limiting expansion of this treatment, and leads to counter-therapeutic rules on methadone treatment such as a imposing a ceiling dose or limiting duration of treatment (D'Aunno and Pollack, 2002;Magura and Rosenblum, 2001;Joseph et al, 2000). It is unclear to what extent negative attitudes toward methadone have extended to buprenorphine treatment.…”

Section: Introductionmentioning

confidence: 99%

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Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

Matusow

2012

Journal of Substance Abuse Treatment

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Drug treatment courts are an increasingly important tool in reducing the census of those incarcerated for non-violent drug offenses; medication assisted treatment (MAT) is proven to be an effective treatment for opioid addiction. However, little is known about the availability of and barriers to MAT provision for opioid-addicted people under drug court jurisdiction. Using an online survey, we assessed availability, barriers, and need for MAT (especially agonist medication) for opioid addiction in drug courts. Ninety-eight percent reported opioid-addicted participants, 47% offered agonist medication (56% for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among non-MAT providing courts. Political, judicial and administrative opposition appear to affect MAT's © 2012 Elsevier Inc. All rights reserved. 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. inconsistent use and availability in drug court settings. These data suggest that a substantial, targeted educational initiative is needed to increase awareness of the treatment and criminal justice benefits of MAT in the drug courts. NIH Public Access

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Section: Discussionsupporting

confidence: 87%

Section: Survey Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

Matusow

2012

Journal of Substance Abuse Treatment

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“…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, Irwig & Saunders, 1996b) and New York City (Caplehorn, Hartel, & Irwig, 1997;Kang, Magura, Nwakeze, & Demsky, 1997). These studies found variations among programs in support for abstinence-oriented treatment and that an abstinent orientation had a negative effect on retention in care.…”

Section: Attitudes Toward the Use Of Medications For Opiate Dependencementioning

confidence: 99%

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

Rieckmann

Daley

Fuller

et al. 2007

Journal of Substance Abuse Treatment

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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...

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Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge

Bromberg,

Machavariani,

Madden

et al. 2024

J Int AIDS Soc.

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IntroductionStigma has undermined the scale‐up of evidence‐based HIV prevention and treatment. Negative beliefs influence clinicians’ discriminatory behaviour and ultimately have wide‐ranging effects across the HIV prevention and treatment continuum. Stigma among clinicians can be mitigated in several ways, including through interpersonal contact. In this study, we test whether interactions with people who inject drugs (PWID) influence attitudes of both direct and indirect providers of opioid agonist therapies (OATs) within the same primary care clinics (PCCs) where OAT is newly introduced.MethodsIn a cluster randomized controlled trial integrating OAT and HIV care into PCCs in Ukraine, clinicians at 24 integrated care sites (two sites in 12 regions) from January 2018 to August 2022 completed a structured survey at baseline, 12 and 24 months. The survey included feeling thermometers and standardized scales related to clinician attitudes towards patients and evidence‐based care. Nested linear mixed‐effects models were used to examine changes in mean scores over three timepoints for both direct and indirect clinicians.ResultsThere were fewer significant changes in any of the scales for direct providers (n = 87) than for indirect providers (n = 155). Direct providers became less tough‐minded about substance use disorders (p = 0.002), had less negative opinions about PWID (p = 0.006) and improved their beliefs regarding OAT maintenance (p<0.001) and medical information (p = 0.004). Indirect providers reported improvements in most stigma constructs, including a significant decrease in prejudice (p<0.001), discrimination (p = 0.001), shame (p = 0.007) and fear (p = 0.001) towards PWID.ConclusionsIntegrating OAT services within primary settings was associated with significantly reduced stigma constructs and improved attitudes towards PWID, possibly through increased intergroup contact between PWID and general clinical staff. Unlike most stigma reduction interventions, re‐engineering clinical processes so that PWID receive their care in PCCs emerges as a multilevel stigma reduction intervention through the integration of specialized services in PCCs. Integration influences different types of stigma, and has positive effects not only on health outcomes, but also improves clinician attitudes and efficiently reduces clinician stigma.

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Counselor Attitudes in Methadone Maintenance

Cited by 19 publications

References 14 publications

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

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

Integrating methadone into primary care settings in Ukraine: effects on provider stigma and knowledge

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