Smoking Cessation in Addiction Treatment

1
Counselor Attitudes toward Buprenorphine in the
Clinical Trials Network Hannah K. Knudsen,
Ph.D.,1 Paul M. Roman, Ph.D.2 1Department of
Behavioral Science Center on Drug and Alcohol
Research, University of Kentucky 2Institute for
Behavioral Research and Department of Sociology,
University of Georgia Supported by the National
Institute on Drug Abuse (2R01DA14482)

• METHODS
• Data Collection
• 198 community-based treatment program (CTP)
  administrators participated in face-to-face
  interviews in 2008-2009 (84.7) and were asked to
  provide lists of counselors
• Surveys were mailed to each identified counselor
• 934 counselors working in 175 CTPs participated
  in the survey (62 response rate 40 honorarium)
  
• Measures
• Perceived effectiveness categorizes counselors
  into those rating buprenorphine as effective,
  ineffective, dont know, or neither effective nor
  ineffective
• Perceived acceptability categorizes counselors
  into those rating buprenorphine as acceptable,
  unacceptable, dont know, or neither acceptable
  nor unacceptable
• See Sample Characteristics (below) for
  independent variables
• Data Analysis
• Multiple imputation by chained equations (ice
  in Stata 11) used to address missing data on the
  independent variables cases missing on either
  dependent variable were excluded from the
  analysis (final N 918)
• Two multinomial logistic regressions with
  effective/acceptable as the reference group,
  using robust standard errors to adjust for
  clustering of counselors within CTPs
• SAMPLE CHARACTERISTICS

• BACKGROUND
• Early research on counselor attitudes toward
  buprenorphine indicated knowledge gaps about its
  effectiveness and low acceptability. A survey
  from 2002-2004 found that two-thirds of
  counselors did not know whether buprenorphine was
  effective.1 Lack of buprenorphine-specific
  training and greater endorsement of a 12-step
  treatment orientation were identified as barriers
  to perceiving buprenorphine as an acceptable
  treatment technology. A comparison of counselors
  working in treatment programs affiliated with the
  National Drug Abuse Treatment Clinical Trials
  Network (CTN) and counselors outside the CTN
  found that differences in perceived acceptability
  were largely a function of greater access to
  training and greater implementation of
  buprenorphine within the CTN.2 In this research,
  we examine more recent data on CTN counselors
  attitudes toward buprenorphine and identify
  counselor characteristics associated with
  perceived effectiveness and acceptability.
• RESEARCH QUESTIONS
• In 2008-2009, to what extent did CTN counselors
  view buprenorphine as effective and acceptable?
• What characteristics differentiate counselors who
  view buprenorphine as effective from those who
  perceive buprenorphine as a) ineffective, b)
  dont know if it is effective, or c) neither
  effective nor ineffective?
• What characteristics differentiate counselors who
  view buprenorphine as acceptable from those who
  perceive buprenorphine as a) unacceptable, b)
  dont know if it is acceptable, or c) neither
  acceptable nor unacceptable?
• 1Knudsen, Ducharme, Roman, Link. (2005).
  Journal of Substance Abuse Treatment, 29, 95-106.
• 2Knudsen, Ducharme, Roman. (2007). The American
  Journal on Addictions, 16, 365-371.

RESULTS Few CTN counselors had negative
attitudes toward buprenorphine. The majority
rated buprenorphine as effective (Figure 1).
Two-thirds of the counselors indicated that
buprenorphine was acceptable (Figure 2). Fewer
than 20 of counselors chose the dont know
option for these measures of perceived
effectiveness and acceptability. Multinomial
logistic regressions were conducted to identify
significant correlates of perceived effectiveness
and acceptability among CTN counselors. Both
models include all variables presented in Sample
Characteristics, but only significant variables
appear in Figures 3 and 4.

Figure 3 Multinomial Logistic Regression of
Perceived Effectiveness of Buprenorphine

• CONCLUSIONS
• Compared to earlier studies, these data from CTN
  counselors show improved attitudes regarding the
  effectiveness and acceptability of buprenorphine.
  
• The percentages choosing the dont know options
  were much lower than our prior surveys,
  suggesting greater diffusion of
  buprenorphine-related information.
• Strong associations between training and the two
  attitudes suggest that additional investments in
  training may yield benefits in counselors
  receptivity to buprenorphine.
• Counselors who more strongly endorse a 12-step
  treatment philosophy were more likely to rate
  buprenorphine as unacceptable and ineffective.
  Future research should consider what steps are
  needed to address the concerns of these
  counselors.

plt.05, plt.01, plt.001 (two-tailed)
Figure 4 Multinomial Logistic Regression of
Perceived Acceptability of Buprenorphine
or Mean (SD) or Mean (SD)
Female 66.7 Personally in recovery 41.2
Hispanic ethnicity 9.9 Twelve-step treatment orientation (1strongly disagree, 7 strongly agree) 3.89 (1.56)
Race Certified or licensed addictions counselor 71.9
White 73.7 Masters level degree 51.7
African American 21.8 Works in a CTP that uses buprenorphine 41.9
Other 4.4 Extent of buprenorphine training (1no extent, 7 very great extent) 3.78 (2.15)
Years working at CTP 5.33 (5.65) Believes scientifically supported treatments are useful (1strongly disagree, 7 strongly agree) 5.89 (1.26)
plt.05, plt.01, plt.001 (two-tailed)