Patient Violence Towards Counselors in Substance Use Disorder Treatment Programs: Prevalence, Predictors, and Responses

Abstract

Workplace violence disproportionately impacts healthcare and social service providers. Given that substance use and abuse are documented risk factors for the perpetration of violence, SUD treatment personnel are at risk for patient-initiated violence. However, little research has addressed SUD treatment settings. Using data nationally representative of the U. S., the present study explores SUD counselors’ experiences of violent behaviors perpetrated by patients. More than half (53%) of counselors personally experienced violence, 44% witnessed violence, and 61% had knowledge of violence directed at a colleague. Counselors reported that exposure to violence led to an increased concern for personal safety (29%), impacted their treatment of patients (15%), and impaired job performance (12%). In terms of organizational responses to patient violence, 70% of organizations increased training on de-escalation of violent situations and 58% increased security measures. Exposure to verbal assault was associated with age, minority, tenure, recovery status, 12-step philosophy, training in MI/MET, and higher caseloads of patients with co-occurring disorders. Exposure to physical threats was associated with age gender, minority, tenure, recovery status, and higher caseloads of patients with co-occurring disorders. Exposure to physical assault was associated with age, gender, and sample. Implications of these findings for organizations and individuals are discussed.

Client-Perpetrated Violence Among Frontline Child Welfare Workers

“…Larger studies of workers in social service professions, often including CPS workers, identify the importance of demographics (Robson et al, 2014). Studies indicate that younger social service workers were more susceptible to violence than their older counterparts (Bride, Choi, Olin, & Roman, 2015;Jayaratne et al, 2004;Jayaratne, Vinokur-Kaplan, Nagda, & Chess, 1996;Ringstad, 2009;Spencer & Munch, 2003). For example, among a national sample of NASW members (N = 1,129), workers younger than 45 years experienced higher incidence of physical threats, verbal abuse, and sexual violence than their older counterparts (Jayaratne et al, 2004).…”

“…In terms of years of experience, Jayaratne et al (1996) found that social workers with less experience received more threats in the past year, but not more verbal or physical assaults, compared to workers with more experience. In samples of nursing personnel and substance abuse counselors, however, those with more experience encountered higher rates of verbal assaults and physical threats in the prior year (Bride et al, 2015;Campbell et al, 2011). Others found that years of training were not related to client-perpetrated violence among social service workers (Newhill, 1996;Winstanley & Hales, 2008).…”

“…Most available studies of social services workers indicate that client-perpetrated violence does not vary by race (Jayaratne et al, 2004;Newhill, 1996;Ringstad, 2009); however, most studies are relatively racially homogeneous or have small sample sizes. In larger samples of nurses and substance abuse counselors, Campbell et al (2011) and Bride et al (2015), respectively, found that White workers were more likely to experience client-perpetrated violence than workers of color. For example, in a sample of substance abuse counselors (N = 1,890), workers of color had 41% and 24% lower odds of psychological assault and physical threat, respectively, compared to White workers (Bride et al, 2015).…”

“…In larger samples of nurses and substance abuse counselors, Campbell et al (2011) and Bride et al (2015), respectively, found that White workers were more likely to experience client-perpetrated violence than workers of color. For example, in a sample of substance abuse counselors (N = 1,890), workers of color had 41% and 24% lower odds of psychological assault and physical threat, respectively, compared to White workers (Bride et al, 2015).…”

Secondary traumatic stress in Norwegian SUD-therapists: Symptoms and related factors

“…The finding is in line with one study on the prevalence of patient threats towards SUD therapists in the USA, which reported that 84% of the participants had experienced directly some form of physical or psychological violence. The study also connected exposure to threats with work performance (Bride, Choi, Olin, & Roman, 2015), but did not report on the extent to which these experiences had occurred inside or outside clinical practice. Taken together, however, these numbers come across as high, and suggest SUD therapists may deal with threats as part of their everyday work lives.…”