Substance Abuse Counselors Research Articles

Psychiatrist Ready for Challenges of Heading Huge MH System

Psychiatrist Ready for Challenges of Heading Huge MH System

Barriers to Substance Abuse Treatment in Rural and Urban Communities: Counselor Perspectives

The purpose of this study is to compare rural and urban substance abuse counselors’ perceptions of barriers to providing effective treatment services. Data were collected from 28 substance abuse counselors in Kentucky during four focus group sessions in 2008. Line-by-line coding and memoing were used by two raters on the transcribed data to isolate findings. The results of this study suggest that, though rural and urban counselors encounter similar constraints that hamper successful treatment outcomes, rural counselors are subject to special circumstances within their communities that present unique challenges to treatment efficacy. Novel contributions, implications, and limitations are also discussed.

A randomized trial of Web-based videoconferencing for substance abuse counseling

Web-based videoconferencing can improve access to substance abuse treatment by allowing patients to receive counseling services in their homes. This randomized clinical trial evaluates the feasibility and acceptability of Web-based videoconferencing in community opioid treatment program (OTP) participants. Participants that reported computer and Internet access (n=85) were randomly assigned to receive 12weeks of weekly individual counseling in-person or via eGetgoing, a Web-based videoconferencing platform. Fifty-nine of these participants completed the study (eGetgoing=24; in-person=35), with most study withdrawal occurring among eGetgoing participants. Participants exposed to the study conditions had similar rates of counseling attendance and drug-positive urinalysis results, and reported similar and strong ratings of treatment satisfaction and therapeutic alliance. These results support the feasibility and acceptability of Web-based counseling as a good method to extend access to individual substance abuse counseling when compared to in-person counseling for patients that are able to maintain a computer and Internet connection for reliable communication.

Incorporating Spirituality Into Substance Abuse Counseling: Examining the Perspectives of Service Recipients and Providers

ABSTRACT Spirituality represents an important internal and external strength that can support clients when facing a variety of problems including substance misuse and addiction. Spirituality is commonly included in peer-run mutual aid support groups for addiction, while incorporating a client's spiritual preference is less common in professional substance abuse counseling. Considering the potential benefits of this practice, this research study conducted focus groups with both service recipients and providers to understand how to best integrate spiritual preferences into counseling for alcohol and substance abuse. The findings offer a set of suggestions that emerged from these group discussions regarding the importance of respecting client autonomy while also encouraging and challenging clients to consider new coping strategies. Recipients and providers felt this tension between respecting and challenging can be managed through increased training and education regarding how to remain culturally responsive to one's spiritual beliefs. Implications for practice are discussed.

The Use of Self-Disclosure: Lived Experiences of Recovering Substance Abuse Counselors

This phenomenological investigation explored the lived experiences of recovering substance abuse counselors regarding their use of self-disclosure of their personal histories of addiction with clients in counseling for substance abuse–related issues. A total of 10 recovering counselors were interviewed and asked to describe in detail their uses of self-disclosure, changes in frequencies, amount, and rationale for use or nonuse of self-disclosure. The interviews were analyzed for patterns in recovering counselors' lived experiences related to self-disclosure, and themes related to rationale for and against the use of self-disclosure, benefits, and drawbacks of self-disclosure were identified.

P2.158 One-Stop Shop Service Delivery Model: Integrating Prevention Interventions with HIV Care/Treatment Services in a Community-Based Medical Home Setting

BackgroundNeighborhood Health Services Corporation (NHSC), an urban community-based not-for-profit ambulatory health centre in Plainfield, New Jersey, USA, provides services to over 350 persons living with HIV/AIDS. Presently 75% of NHSC...

Professional Confidence and Job Satisfaction

Understanding substance abuse counselors' professional confidence and job satisfaction is important since such confidence and satisfaction can affect the way counselors go about their jobs. Analyzing data derived from a random sample of 110 counselors from faith-based and non-faith-based treatment programs, this study examines counselors' professional confidence and job satisfaction in both faith-based and non-faith-based programs. The multivariate analyses indicate years of experience and being a certified counselor were the only significant predictors of professional confidence. There was no significant difference in perceived job satisfaction and confidence between counselors in faith-based and non-faith-based programs. A majority of counselors in both groups expressed a high level of satisfaction with their job. Job experience in drug counseling and prior experience as an abuser were perceived by counselors as important components to facilitate counseling skills. Policy implications are discussed.

Job Frustration in Substance Abuse Counselors Working With Offenders in Prisons Versus Community Settings

Substance abuse counselors who work with offenders are facing increasing caseloads, which puts them at higher risk of job frustration. The purpose of this study was to explore differences between substance abuse counselors employed in prison versus community settings in terms of level of organizational support and job frustration. This study also investigated whether organizational support was associated with job frustration after controlling for counselor characteristics and workplace setting. This was accomplished utilizing data that were collected from 267 counselors as part of the Criminal Justice Drug Abuse Treatment Studies research cooperative. Results indicated that counselors employed in community settings, as compared with those employed in prisons, are more likely to report higher levels of perceived organizational support. In addition, ordinal logistic regression results reveal that counselors who are non-White and have greater levels of organizational support have less job frustration, after controlling for counselor characteristics and workplace setting. The researches to practice implications are discussed.

Integrating buprenorphine maintenance therapy into federally qualified health centers: Real-world substance abuse treatment outcomes

BackgroundFew studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs). MethodsOpioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months. ResultsParticipants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35–3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20–0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days. ConclusionsIntegrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.

Adaptation of a general primary care package for HIV‐infected adults to an HIV centre setting in Gaborone, Botswana

As life expectancy of HIV-infected patients improves due to antiretroviral treatment (ART) and the importance of associated co-morbidities and chronic diseases increases, preventive care will become increasingly important. Adaptation of existing preventive guidelines to local environments will become a priority for HIV treatment programmes. Guidance from the World Health Organization, a focused evidenced-based literature review, Botswana national guidelines, Botswana-specific morbidity and mortality data and centre-specific data were used to adapt a published general primary care package for limited-resource areas to our centre's specific setting. The preventive care package contains recommendations on tuberculosis prevention, malnutrition, depression, cervical and breast cancer, hepatitis B coinfection, cardiovascular risk factors, external injury prevention, domestic violence screening, tobacco and substance-abuse counselling, contraception and screening and treatment of sexually transmitted infections. This preventive care package addresses the comprehensive health needs of HIV-infected adults in the FMC in an evidence-based manner. The process of combining clinic-specific prevalence data, national guidelines, regional literature and assessment of public-sector resources to adapt an existing general package could be utilised to develop similar guidelines in other resource-limited locales.

Aripiprazole for the treatment of methamphetamine dependence: a randomized, double‐blind, placebo‐controlled trial

To test aripiprazole for efficacy in decreasing use in methamphetamine-dependent adults, compared to placebo. Participants were randomized to receive 12 weeks of aripiprazole or placebo, with a 3-month follow-up and a platform of weekly 30-minute substance abuse counseling. The trial was conducted from January 2009 to March 2012 at the San Francisco Department of Public Health. Ninety actively using, methamphetamine-dependent, sexually active adults were recruited from community venues. The primary outcome was regression estimated reductions in weekly methamphetamine-positive urines. Secondary outcomes were study medication adherence [by self-report and medication event monitoring systems (MEMS)], sexual risk behavior and abstinence from methamphetamine. Participant mean age was 38.7 years, 87.8% were male, 50.0% white, 18.9% African American, and 16.7% Latino. Eighty-three per cent of follow-up visits and final visits were completed. By intent-to-treat, participants assigned to aripiprazole had similar reductions in methamphetamine-positive urines as participants assigned to placebo [risk ratio (RR) 0.88, 95% confidence interval (CI): 0.66-1.19, P = 0.41]. Urine positivity declined from 73% (33 of 45 participants) to 45% (18 of 40) in the placebo arm and from 77% (34 of 44) to 44% (20 of 35) in the aripiprazole arm. Adherence by MEMS and self-report was 42 and 74%, respectively, with no significant difference between arms (MEMS P = 0.31; self-report P = 0.17). Most sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug, although participants randomized to aripiprazole reported more akathisia, fatigue and drowsiness (P < 0.05). Compared with placebo, aripiprazole did not reduce methamphetamine use significantly among actively using, dependent adults.

Enhancing Supervision in the Addictions Field: Introducing the Supervisor Evaluation of the Professional and Ethical Competence of Substance Abuse Counselors

Supervision is essential for promoting the professional and ethical competence of substance abuse counselors (SACs). However, supervisors in the addictions field often lack the preparation and resources to provide effective supervision, which may be contributing factors to the continued occurrence of ethical infractions by SACs. To assist those who supervise aspiring SACs and improve the supervision they provide, this article presents the Supervisor Evaluation of the Professional and Ethical Competence of Substance Abuse Counselors (SPEC-SAC). Ultimately, the SPEC-SAC is intended to assist supervisors in addressing the promoting the professional and ethical competence of those they supervise.

Causes, Consequences, and Prevention of Burnout Among Substance Abuse Treatment Counselors: A Rural Versus Urban Comparison

Substance abuse counselors are vulnerable to burnout, which has negative repercussions for the counselor, employing organization, and clients. However, little is known about differences in counselor burnout from the counselors' perspective in rural versus urban treatment centers. In 2008, focus group data from 28 rural and urban counselors in a southern state were analyzed, revealing three burnout themes across all counselors: causes, consequences, and prevention. However, there were various differences between rural and urban counselors in subthemes, with only rural counselors citing office politics and low occupational prestige as causes of burnout. Only urban counselors reported responses endorsing the subthemes of role reversal, clients trying to choose their counselors, and changing jobs as consequences of burnout. All counselors cited coworker support, clinical supervision, and self-care as important strategies for managing burnout. In sum, context clearly matters as rural counselors cited more causes of burnout; yet, the implications of burnout are universal in that they often lead to poor quality clinical care. There is a continued need for greater understanding of addiction as a disease, which would reduce stigma, especially in rural areas, as well as increase the prestige and earning potential of the substance abuse counseling occupation.

Predictors of Dropout from Psychosocial Treatment in Opioid‐Dependent Outpatients

Early dropout is common in substance abuse treatment settings and may lead to poorer outcomes relative to those completing a full course of treatment. Attempts to identify predictors of dropout have yielded mixed results, highlighting the need for additional research in this area to clarify risk and protective factors to guide intervention and retention efforts. This study evaluated predictors of dropout from psychosocial treatment among opioid-dependent patients on methadone maintenance therapy. Participants included 78 patients who had failed to respond to at least 4 months of methadone maintenance plus group counseling with clinic substance abuse counselors, and were enrolled in a study of randomized psychosocial treatment in addition to treatment-as-usual. Several factors that have been implicated in previous studies as well as two affective variables (distress intolerance and coping motives for drug use) were examined. Results indicated that when controlling for various risk factors, age was the only significant predictor of dropout, with younger patients more likely to discontinue treatment early. This study replicates previous findings in opioid-dependent samples that younger patients are at an increased risk of early treatment dropout. Targeted intervention may be needed to retain young patients in drug abuse treatment.

Results from the Pro-QOL-IV for Substance Abuse Counselors Working with Offenders

This study examines compassion fatigue, burnout and compassion satisfaction in two groups of counselors who specialize in substance dependency treatment in order to identify the unique features of substance abuse service delivery that may be related to professional quality of life. Qualitative interviews were conducted with 20 substance abuse counselors working with offenders both in prison and community facilities. In addition, interview subjects completed the ProQOL-IV to assist in exploring the unique challenges that may face the substance abuse treatment field with regards to professional self-care. Two key themes emerged from the examination of the group of interviewees that scored high on the Compassion Fatigue Subscale on the ProQOL-IV, revealing that working with women is more challenging, and substance abuse counselors who have family members with addiction problems or themselves are in recovery may make one more susceptible to compassion fatigue.

Transitioning to 10: Screening for Alcohol and Substance Abuse (Online Exclusive)

ICD-10-CM code distinction between Z13.89 for substance use and abuse counseling, and dependence on substances such as F10.920

Clinical Supervision in the Substance Abuse Profession: A Review of the Literature

Clinical supervision is a significant contributor to the development of substance abuse counselors and the efficacy of the services they render. This article represents a review of the literature on clinical supervision in the substance abuse field for the purposes of organizing existing data, providing focus for future research, and better informing those who use the literature as a means for professional development. Nine studies were identified, the results of which are discussed and compared, followed by recommendations for future research.

A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors.

Substance Abuse Counselor and Client Reports of Mental Health Screening and Enhanced Practices

The objective of this study was to examine mental health screening practices and attitudes from both counselor and client perspectives in the U.S. Marine Corps substance abuse program. This study examined mental health screening practices and attitudes of 23 substance abuse counselors and 442 clients from six Marine Corps substance abuse counseling centers. After receiving training on screening and enhanced counseling practices, 76% of counselors reported that they almost always screened their clients for post-traumatic stress symptoms. Seventy-three percent of clients agreed that substance abuse counselors should ask about their clients' stress concerns. Overall, implementing screening for common mental disorders was feasible in this setting. Counselors may need further support to increase collaboration with mental health professionals and adapt treatment plans to address co-occurring mental health conditions.

Postprison release HIV-risk behaviors in a randomized trial of methadone treatment for prisoners.

This secondary analysis examined the impact of methadone initiated in prison on postrelease HIV risk behaviors. The parent study was a three-group randomized clinical trial in which participants received drug abuse counseling in prison and were randomly assigned to: (1) passive referral to substance abuse treatment upon release; (2) guaranteed methadone treatment admission upon release; and (3) methadone in prison and guaranteed continuation of methadone upon release. Participants were 211 adult males with preincarceration histories of opiate dependence. The AIDS Risk Assessment was administered at baseline (in prison) and at 1-, 3-, 6-, and 12-month postrelease. Data were analyzed for the entire sample (N = 211) as well as the subsamples who reported injecting drugs in the 30 days prior to incarceration (n = 131) and who reported having unprotected sex in that time frame (n = 144) using generalized linear mixed model on an intent-to-treat basis. There were no significant changes in sex- or drug-risk by Condition over Time. There were significant Time and Condition main effects for the total sample as well as the injector subsample for drug-risk behaviors. There were no significant Condition main effects for HIV sex-risk behaviors, but there were significant Time main effects. Methadone initiated in prison or immediately postrelease is associated with reduced HIV drug-risk compared to counseling in prison without methadone and passive referral to treatment at release. Participation in several drug- and sex-risk behaviors also showed significant declines during the postrelease time periods.