Substance Abuse Counselors Research Articles

Impact of Brief Intervention Workshops on Addiction Provider Knowledge, Skills, Negative Attitudes, and Interest in Implementing Evidence-Based Practices.

This study evaluated the impact of Motivational Interviewing (MI) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) workshops on posttraining knowledge, skills, negative attitudes, and interest in implementing evidence-based practices (EBPs). Participants ( N = 70) were primarily mental health counselor (41.4%), social workers (20.0%), substance abuse counselors (15.7%), school counselors (5.7%), and nursing professionals (4.3%) who selected the 1- or 2-day workshop for continuing education credit. Participants attended either a Basic MI training workshop (1 day) or a Basic MI training plus an advanced MI/SBIRT training workshop (2 days) to assess if exposure to two EBPs would improve training outcomes. Participants in both the 1-day and 2-day workshops reported posttraining increased perceived knowledge and skills, decreased negative attitudes toward EBPs, and increased interest in implementing EBPs from pretraining to posttraining. There were no differences between participants in the Basic MI or MI plus advanced MI/SBIRT training conditions. Implications for reducing the research-practice gap in EBPs are discussed.

Solution Focused Counseling with a Substance Abusing Client

Substance abuse counseling is typically offered from a cognitive-behavioral or 12-step based approach. Solutionfocused theory can offer counselors with an alternative perspective for working with clients with drug abuse issues. In this article, a case report is presented in which the author utilized a solution-focused approach with a client experiencing co-occurring anxiety and severe alcohol use. Solution-focused theory is briefly described and techniques for use with the model are detailed. The effective use of exception and coping questions are described in the case report and outcomes of these interventions are presented. The article concludes with a discussion on the need for further research and suggests specific areas for additional investigation.

Every Reader Her Book: Creation of a Therapeutic Library at a Women’s Residential Treatment Facility

In July 2015, an interdisciplinary team of librarians, information professionals, and education specialists began development of a therapeutic library for the women residents of the Drug Abuse Comprehensive Coordinating Office, Inc. (DACCO) in Tampa, Florida. This 88-bed alcohol and other drug (AOD) addiction treatment center’s mission is to provide counseling for substance abuse and co-occurring mental health conditions. Treatment lasts from 6 to 8 months. The residential population is racially, ethnically, and socio-economically diverse, with many residents referred through the criminal justice system with the stipulation that they cannot leave the treatment center without prior court approval. Prior to the establishment of this library, residents did not have access to the Internet or reading materials. With funding from a grant from the Library Services and Technology Act (LSTA), the team began to design a therapeutic library for the women residents. The DACCO library now offers services to the center and its residents that focus on providing therapeutic outcomes consistent with their treatment goals. Service promises include circulation, reference services, and health literacy instruction. This article discusses the creation of a model therapeutic library and the future of providing services to special populations who reside in a restricted environment with little or no access to Web-based resources.

Factors Associated with HIV Testing Among Participants from Substance Use Disorder Treatment Programs in the US: A Machine Learning Approach.

HIV testing is the foundation for consolidated HIV treatment and prevention. In this study, we aim to discover the most relevant variables for predicting HIV testing uptake among substance users in substance use disorder treatment programs by applying random forest (RF), a robust multivariate statistical learning method. We also provide a descriptive introduction to this method for those who are unfamiliar with it. We used data from the National Institute on Drug Abuse Clinical Trials Network HIV testing and counseling study (CTN-0032). A total of 1281 HIV-negative or status unknown participants from 12 US community-based substance use disorder treatment programs were included and were randomized into three HIV testing and counseling treatment groups. The a priori primary outcome was self-reported receipt of HIV test results. Classification accuracy of RF was compared to logistic regression, a standard statistical approach for binary outcomes. Variable importance measures for the RF model were used to select the most relevant variables. RF based models produced much higher classification accuracy than those based on logistic regression. Treatment group is the most important predictor among all covariates, with a variable importance index of 12.9%. RF variable importance revealed that several types of condomless sex behaviors, condom use self-efficacy and attitudes towards condom use, and level of depression are the most important predictors of receipt of HIV testing results. There is a non-linear negative relationship between count of condomless sex acts and the receipt of HIV testing. In conclusion, RF seems promising in discovering important factors related to HIV testing uptake among large numbers of predictors and should be encouraged in future HIV prevention and treatment research and intervention program evaluations.

Examining College Counselors' Integration of Religion and Spirituality Into Substance Abuse Counseling

The authors explored college counselors' (N = 77) integration of religion and spirituality into substance abuse counseling. Results indicated a discrepancy between the importance ratings of religion and spirituality and the frequency of using such elements in counseling practice.

Medical System Rant and Response: Perspective of a Substance Abuse Counselor

This commentary features a brief description of a frustrating medical experience by a U.S. health-care provider, with responses offered by several experts from various perspectives of the health-care system. Health-care providers are on the front lines of care and their ability to influence outcomes is importantly shaped by policy. This rant by a substance abuse counselor expresses the point of view that Medicare reimbursement actually contributes to our opiate crisis and wastes vast sums of money. This forum allows for the venting of such a viewpoint, with responses offered by several academic researchers whose work is expressly intended to contribute to the crafting of public policy solutions to crises such as the heroin epidemic. Any such solutions ought to take into account the experiences of those most intimately acquainted with the experience of implementation.

Development of the Older Adult Prescription Drug Assessment Questionnaire for Case Workers.

Instruments assessing geriatric case managers' perceptions of prescription abuse are limited. Based on a review of current literature and pilot testing feedback, 22 items were initially assembled to form an older adult Prescription Drug Assessment Questionnaire (PDAQ). Case managers ( N = 161) at an older adult agency located in a Midwestern state were surveyed using the instrument. Data were subjected to exploratory factor analysis using principal axis factoring (PAF) and Promax rotation, and Horn's parallel analysis determined the number of extracted factors. PAF generated a final 11-item three-factor model accounting for 51% of total variance explained: Standard Assessment (Factor 1; four items; ∞ = .83), Assessment Belief (Factor 2; three items; ∞ = .74), and Problem Scope (Factor 3; four items; ∞ = .62). The older adult PDAQ is a brief, data-driven instrument with acceptable psychometric properties for assessing perceptions of prescription drug abuse and misuse assessment and counseling.

Opioid Use Disorder, Attachment, and Parenting: Key Concerns for Practitioners

In the United States, the current epidemic of opioid use disorders impacts many parents and their children. Historically, interventions for parents with substance use disorders have focused on two separate areas, achieving and maintaining abstinence and learning parenting skills. These interventions do not address the parent/child relationship, and the impact of parental opioid use disorder on attachment. Insecure attachment, particularly disorganized attachment, negatively affects the child’s development and safety. Attachment should always be considered when doing a safety assessment or planning an intervention for parents with opioid use disorders. This conceptual paper describes the impact of parental opioid use on attachment across the developmental span of childhood, highlighting research about opioid use disorder, parenting, and attachment which is relevant for practitioners working with parents with opioid use disorders, as child protection workers, substance abuse counselors, or therapists. Identification, attachment assessment tools, and empirical research on attachment-based interventions are discussed.

Proactive criminal thinking, cold heartedness, and counselor rapport in correctional clients participating in substance abuse treatment

The purpose of this study was two-fold. The first purpose was to determine whether a self-report measure of cold heartedness (CH) correlated significantly better with proactive criminal thinking (PCT) than with reactive criminal thinking (RCT). The second purpose was to investigate whether cold heartedness was partially responsible for the negative relationship proposed to exist between PCT and counselor rapport. These two hypotheses were tested in a sample of 4638 male and female correctional clients enrolled in substance abuse counseling for an average of 121 to 141days. In support of the first hypothesis the zero-order CH–PCT correlation was significantly higher than the zero-order CH–RCT correlation and PCT but not RCT correlated with CH when age, sex, and race were controlled. The second hypothesis, that CH would partially explain the correlation between PCT and counselor rapport, also found support in the form of a positive interaction between cold heartedness and PCT in predicting counselor rapport. These results suggest that cold heartedness or callous/unemotional traits are both antecedents of proactive criminal thinking and features of personality partially responsible for the putative rapport-inhibiting effects of proactive criminal thinking.

Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems?

ObjectiveTo assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems. MethodsAnalyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed. ResultsThirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker. ConclusionsOn-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.

Tolerating Transphobia in Substance Abuse Counseling: Perceptions of Trainees

ABSTRACTOrganizational tolerance for discrimination against people who identify as transgender is a significant social justice issue affecting all organizations, including substance abuse counseling and human services organizations. Substance abuse counseling and human services organizations promote inclusive practices with people of various gender identities and expressions, yet there may be organizational climate factors that challenge inclusive practice. This exploratory study sought to address that gap by examining perceived organizational tolerance for transphobia within a cross-sectional sample of substance abuse counselor trainees completing an internship in the state of Texas. Overall, counselor trainees reported low tolerance of transphobia within their organizations. Yet, the sample offered insights concerning how people with nonbinary gender identity and expression may be otherwise ostracized within their substance abuse counseling and human services organizations. Discussion about how these experiences can influence practice, policy, education, and research in the substance abuse counseling and human services fields is presented for further consideration.

Clinical Supervision in the Addictions Field: A Case Example of Effective Gatekeeping

ABSTRACTClinical supervision is essential to the development of competent, ethical, and professional practice among substance abuse counselors. A vital role of supervisors is to act as gatekeepers responsible for protecting clients and the profession. Many supervisors in the addictions field lack formal education and training in supervision and, hence, could benefit from information and guidance in performing challenging supervisory tasks such as gatekeeping. This article focuses on the key elements of effective supervision, particularly with regard to supervisee assessment, remediation, and dismissal, all while considering the common pitfalls experience and encountered by those receiving supervision. These processes are presented and illustrated through a case example as a means of providing practical guidance to those who supervise current and aspiring substance abuse counselors.

Substance Abuse Counselors' Recovery Status and Self-Schemas: Preliminary Implications for Empirically Supported Treatment Implementation.

PurposeThe purpose of this paper is to better understand the relationship between substance abuse counselors’ personal recovery status, self-schemas, and willingness to use empirically supported treatments for substance use disorders.MethodsA phenomenological qualitative study enrolled 12 practicing substance abuse counselors.ResultsWithin this sample, recovering counselors tended to see those who suffer from addiction as qualitatively different from those who do not and hence themselves as similar to their patients, while nonrecovering counselors tended to see patients as experiencing a specific variety of the same basic human struggles everyone experiences, and hence also felt able to relate to their patients’ struggles.DiscussionSince empirically supported treatments may fit more or less neatly within one or the other of these viewpoints, this finding suggests that counselors’ recovery status and corresponding self-schemas may be related to counselor willingness to learn and practice specific treatments.

Commentary

Commentary

Understanding Substance Abuse Counselor Turnover Due to Burnout: A Theoretical Perspective

Clinical staff turnover resulting from burnout is one of the most challenging issues facing the substance abuse treatment field. This article provides a succinct description of the impact of clinical staff turnover on organizational performance and client treatment, along with a comprehensive literature review of individual and organizational characteristics that often lead to burnout. The Job Demand-Control Model and six areas of work life are explicated to identify leverage points for organizational leaders to make the largest impact on improving work conditions and mitigate the consequences of burnout.

A Qualitative Study Assessing the Effectiveness of the Key Components of a Drug Court

Drug courts are guided by 10 key components that help ensure fidelity to the treatment model and guide practitioners in effectively treating substance use disorders in criminal justice settings. This qualitative study assessed the effectiveness of certain key components, such as the quality of substance abuse treatment and the importance of frequent contact with the judge, by interviewing drug court participants (N = 41). Participants felt that the substance abuse counseling they received could have been improved by offering more individual counseling and by developing a trustworthy therapeutic relationship among the drug court team, participants, and substance abuse counselors. Having frequent contact with the judge and the random drug testing system were viewed as effective interventions in assisting participants with being successful in the program, with the ultimate goal of graduating drug court. Implications for drug court practice and future research are discussed.

Psychological distress and substance abuse counselors: an exploratory pilot study of multiple dimensions of burnout

Those working in human services have a high susceptibility to burnout due to the counselor or clinician’s feelings of responsibility for the well-being of clients. Substance abuse counselors are at a higher risk for experiencing burnout because substance abusers have the potential to be more demanding than other client groups. The current exploratory pilot study seeks to examine the multiple constructs of burnout in substance abuse counselors. Fifty substance abuse counselors completed a survey to assess their levels of emotional exhaustion, depersonalization, confidence in therapeutic success and negative attitudes towards their substance abusing clients. Results showed that counselors exhibit high levels of depersonalization after continued interpersonal interactions. Results also showed that emotional exhaustion is a significant predictor of whether or not a person will choose to remain a counselor in the area of substance abuse treatment. Depersonalization, confidence in therapeutic success and negative attitudes towards clients predicted levels of emotional exhaustion. The results of this study demonstrate a need to further explore the occupationally specific dimensions of burnout for substance abuse counselors in order to protect their own mental health and well-being, and their relationships with clients.

Assessing the relationship between medical residents' perceived barriers to SBIRT implementation and their documentation of SBIRT in clinical practice

Of the 17.9 million adult Americans who have an alcohol use disorder, most (89%) are unaware of their condition.1 The Centers for Disease Control and Prevention (CDC) lists more than 30 specific immediate and long-term health risks associated with excessive alcohol use,2 suggesting that identifying and addressing alcohol use is an important component of primary medical care. Screening, brief intervention, and referral to treatment (SBIRT) is an integrated and validated approach to identifying risky or problematic alcohol use and providing services to those who need them.3 In 2009, Indiana University School of Medicine (IUSM) reached a cooperative agreement with the Substance Abuse and Mental Health Services Administration (SAMHSA) to begin training its medical residents in SBIRT. The training curriculum focuses on delivery of SBIRT services using motivational interviewing techniques (MI). In addition to developing this curriculum and integrating it into the first year of medical residency at IUSM, we developed a protocol for implementing SBIRT services at an internal medicine continuity clinic. This clinic is part of a larger safety-net health system in Indianapolis at which some residents are assigned a small panel of patients during their internal medicine residency. At the time of the study, the continuity clinic was classified as a community health centre, though it since has received federally qualified health center (FQHC) designation. Medical conditions presenting in the clinic vary, with a predominance of adult chronic diseases such as hypertension, heart failure, diabetes, and chronic obstructive lung disease. At each visit, all adult patients were screened for alcohol, drug, and tobacco use by a medical assistant (MA) using the AUDIT-C tool and single drug and tobacco screening questions. These data were given to care providers, both medical residents and staff physicians, to enable delivery of targeted SBIRT services. At the conclusion of each clinical encounter, providers were then asked to document the components of SBIRT that they completed by responding to four yes/no statements, such as ‘I referred the patient to a substance abuse counselor.’ However, across 9954 initial physician visits with unique patients that occurred between 1/31/2011 and 6/29/2012 (hereafter ‘the study period’), we observed a high frequency of incomplete SBIRT encounter forms (83.8%), meaning that the physicians generally were not documenting whether they completed SBIRT. While this was seen as a cause for concern, logically, we could not conflate incomplete forms with a failure to provide SBIRT services. We therefore were moved conceptually to separate two distinct behaviours: actually performing SBIRT, and documenting that SBIRT was completed. In order for SBIRT to be an integrated part of primary medical care, all associated processes and results need to be recorded. Since we have access to evaluative data collected during their SBIRT training that assesses residents’ anticipated barriers to utilizing SBIRT and MI in their medical practice, we examined whether medical residents’ self-reported barriers to performing SBIRT or using MI in their clinical practice predicted appropriate SBIRT documentation in their clinical practice.

Patterns of internet discussion associated with the release of abuse-deterrent formulations of prescription opioids

Aims: Screening, briefmotivational counseling interventionand referral to treatment (SBIRT) has shown to be effective in reducing substance use and related harms among adolescents in clinical settings but it had not been adapted for use in schools. This translational research study aimed to (a) develop a proof of concept, (b) test the feasibility of conducting SBIRT in two urban New York schools, and (c) examine the economic sustainability. Methods: With the cooperation of the New York OSAS, licensed “health clinics” were createdwithin these schools, equippedwith a computer screening program and a trained substance abuse counselor. The computer presented a standard substance screening; provided tailored prevention information to the student and provided counselor guidance for an immediate, private Motivational Interviewing counseling session. Results: In Spring 2012, 248 students were randomly approached to participate; 100% accepted the screening; 42% of them (n=105) reported substance use (vs. 28% reported in schoolwide, anonymous survey). Importantly, 99% of positively screened students voluntarily accepted onemotivational counseling session and68% returned for additional counseling sessions. The SBIRTprocedure did not interfere with academic activities. Conclusions: The SBIRT was feasible to implement and attractive to students, teachers and administration. We believe the acceptance and participation was due the use of non-school personnel and the private, professional and confidential procedures employed. The data offer clear indication that further effectiveness testing is warranted and potentially valuable. SBIRT, as implemented, has been approved for Medicaid (and some private insurance) reimbursement without co-payment to the parents or students. Economicmodeling demonstrates the current national SBIRT reimbursement rates to be adequate to broadly implement and sustain school-based SBIRT in most mid to largesized schools. Financial support: Phoenix House and Treatment Research Institute.

Implementing screening and brief intervention in public schools: Feasibility and proof of concept

Aims: Screening, briefmotivational counseling interventionand referral to treatment (SBIRT) has shown to be effective in reducing substance use and related harms among adolescents in clinical settings but it had not been adapted for use in schools. This translational research study aimed to (a) develop a proof of concept, (b) test the feasibility of conducting SBIRT in two urban New York schools, and (c) examine the economic sustainability. Methods: With the cooperation of the New York OSAS, licensed “health clinics” were createdwithin these schools, equippedwith a computer screening program and a trained substance abuse counselor. The computer presented a standard substance screening; provided tailored prevention information to the student and provided counselor guidance for an immediate, private Motivational Interviewing counseling session. Results: In Spring 2012, 248 students were randomly approached to participate; 100% accepted the screening; 42% of them (n=105) reported substance use (vs. 28% reported in schoolwide, anonymous survey). Importantly, 99% of positively screened students voluntarily accepted onemotivational counseling session and68% returned for additional counseling sessions. The SBIRTprocedure did not interfere with academic activities. Conclusions: The SBIRT was feasible to implement and attractive to students, teachers and administration. We believe the acceptance and participation was due the use of non-school personnel and the private, professional and confidential procedures employed. The data offer clear indication that further effectiveness testing is warranted and potentially valuable. SBIRT, as implemented, has been approved for Medicaid (and some private insurance) reimbursement without co-payment to the parents or students. Economicmodeling demonstrates the current national SBIRT reimbursement rates to be adequate to broadly implement and sustain school-based SBIRT in most mid to largesized schools. Financial support: Phoenix House and Treatment Research Institute.