Substance Abuse Treatment Counselors Research Articles

Death and Work: Utilizing Diverse Methods to Integrate Mortality into Management Research

Many occupations involve mortality cues, or external stimuli that remind employees of death. Yet we know relatively little about: (1) how employees experience mortality cues in workplaces and (2) the effect of mortality cues on employees and organizations. On one hand, mortality cues can trigger employee stress, trauma, and uncertainty. On the other hand, employees can bond and find humor and purpose in these experiences. Our symposium reports qualitative and quantitative research that extends the understanding of mortality in the management literature, and, in so doing, strongly contributes to the Academy of Management’s conference theme “20/20: Broadening our Sight”. The symposium includes four papers showcasing the influence of mortality cues on employees’ emotions, work orientations, well-being, and performance. We address dichotomies in this symposium – that mortality cue exposure has both positive (e.g., work engagement, meaning) and negative (e.g., emotional exhaustion) employee outcomes – and clarify mechanisms and boundary conditions contributing to these dichotomies. Taken together, our papers and discussion, led by Dr. Peter Bamberger, endeavors to provide insight into the consequences of mortality cues for employees and organizations, deliver actionable recommendations for managers, and generate future academic research. Called to Cure: Patient Deaths, Death Fear, and Calling of Substance Abuse Treatment Counselors Presenter: Zhenyu Yuan; U. of Illinois at Chicago Presenter: Lisa E. Baranik; U. at Albany, State U. of New York Presenter: Lillian Eby; U. of Georgia Presenter: Robert R Sinclair; Clemson U. Another Day, Another Death? The Impact of Mortality Cues on Employees Exposed to Death at Work Presenter: Pascale Fricke; U. of British Columbia Presenter: Danielle Van Jaarsveld; U. of British Columbia Presenter: David Douglas Walker; U. of British Columbia Mortality Cue Threats, Death Anxiety, and Employee Well-Being: A Moderated-Mediation Model Presenter: Alexandra Jacobsen; Central Michigan U. Presenter: Terry A Beehr; Central Michigan U. Song of Sorrow: A Longitudinal Study of Work-Related Grief and Organizational Change Presenter: Elizabeth E. Stillwell; U. of Minnesota Presenter: Angelica Leigh; U. of North Carolina, Chapel Hill Presenter: Olivia Amanda O'Neill; George Mason U.

"Keeping It Real": The Relational Effects of Trauma Among African American Women and Their Substance Abuse Treatment Counselors.

African American women experience disproportionately high rates of trauma. Interpersonal forms of trauma often make it much more difficult for trauma survivors to initiate and maintain positive, healthy relationships with others. This study examined the kinds of relationships women with extensive histories of trauma and substance had with their substance abuse treatment counselors and the characteristics that they believe contributed to connected and disconnected client-counselor relationships. Using the case study method, 26 in-depth interviews were conducted with African American women. Data analysis revealed three primary kinds of relationships women had with their substance abuse treatment counselors: reparative, damaging, and transactional. Eighteen (69%) of the 26 women had reparative relationships with their counselors. Reparative relationships had two primary characteristics: empowering and mattering. Two (8%) of the 26 women had damaging relationships with their substance abuse treatment counselors. Damaging relationships had two primary characteristics: unimportant and untrustworthy. Six of the women (23%) had transactional relationships with their substance abuse treatment counselors. Transactional relationships were task-focused and superficial. Healing from interpersonal experiences of trauma is possible only within the context of trusting relationships. Substance abuse treatment counselors have an opportunity to help African American women with histories of trauma heal and recover. Creating positive, therapeutic relationships between clients and professionals is essential.

Lagged Versus Difference Score Regression: An Example From a Community-Based Educational Seminar Evaluation

Objectives. To demonstrate the use of evaluation data in determining the effectiveness of a series of community-based educational seminars designed to educate substance abuse treatment counselors on the latest science regarding the effects of alcohol abuse on diseases of the liver and pancreas; in the process, to highlight the use of difference scores versus lagged regression as alternative approaches to conducting such evaluations. Methods. Data were collected from 338 seminar participants during 4 half-day seminars in 2007, 2009, 2010, and 2014. Pre- and post-seminar data were collected immediately before and after the seminar, approximately 3 hours apart. Survey questions included demographics and a series of multiple-choice knowledge questions that were identical at pre- and posttest. Results. Analyses showed that, on average, participants improved their knowledge by 19.7 percentage points from 0.44 to 0.63, or 44.7%. Factors associated with learning using difference scores revealed that only survey wave (time) was associated with learning. In contrast, lagged regression results showed that in addition to wave, participants who reported attending the seminar because they were required to for their job learned less, whereas those attending because they wanted to learn the material learned more. Education was also significantly associated with knowledge change. Conclusions. This study illustrates that relying on difference score analyses to estimate programmatic effects and changes in knowledge for educational programs can lead to faulty conclusions whereas lagged regression is a better approach to assess program impact.

Latent practice profiles of substance abuse treatment counselors: Do evidence-based techniques displace traditional techniques?

As more substance abuse treatment counselors begin to use evidence-based treatment techniques, questions arise regarding the continued use of traditional techniques. This study aims to (1) assess whether there are meaningful practice profiles among practitioners reflecting distinct combinations of cognitive–behavioral and traditional treatment techniques; and (2) if so, identify practitioner characteristics associated with the distinct practice profiles. Survey data from 278 frontline counselors working in community substance abuse treatment organizations were used to conduct latent profile analysis. The emergent practice profiles illustrate that practitioners vary most in the use of traditional techniques. Multinomial regression models suggest that practitioners with less experience, more education, and less traditional beliefs about treatment and substance abuse are least likely to mix traditional techniques with cognitive–behavioral techniques. Findings add to the understanding of how evidence-based practices are implemented in routine settings and have implications for training and support of substance abuse treatment counselors.

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.

Treating depression and substance use: A randomized controlled trial

Few integrated substance use and depression treatments have been developed for delivery in outpatient substance abuse treatment settings. To meet the call for more “transportable” interventions, we conducted a pilot study to test a group cognitive–behavioral therapy (CBT) for depression and substance use that was designed for delivery by outpatient substance abuse treatment counselors. Seventy-three outpatient clients were randomized to usual care enhanced with group CBT or usual care alone and assessed at three time points (baseline and 3 and 6 months postbaseline). Our results demonstrated that the treatment was acceptable and feasible for delivery by substance abuse treatment staff despite challenges with recruiting clients. Both depressive symptoms and substance use were reduced by the intervention but were not significantly different from the control group. These results suggest that further research is warranted to enhance the effectiveness of treatment for co-occurring disorders in these settings.

The Influence of Rural and Urban Substance Abuse Treatment Counselor Characteristics on Client Outcomes

ABSTRACT Focus group data were collected from 28 substance abuse treatment counselors employed in rural and urban areas to examine their perceptions of factors influencing treatment outcomes. The influence of the counselor characteristics (i.e., education, experience, and recovery status) on client outcomes and geographic differences is explored. Focus group data were analyzed by three raters using line-by-line coding, focused coding, and memoing. This analytic approach revealed geographic differences in the counselors’ perceptions of the effect of counselor education, experience, and recovery status on client outcomes. Recommendations for treatment planning and future research are provided.

An Effectiveness Trial of Group Cognitive Behavioral Therapy for Patients With Persistent Depressive Symptoms in Substance Abuse Treatment

Although depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment. The Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors. We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care. A nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years. Four treatment programs in Los Angeles County. We screened 1262 clients for persistent depressive symptoms (Beck Depression Inventory-II score >17). We assigned 299 clients to receive either usual care (n = 159) or usual care plus the intervention (n = 140). Follow-up rates at 3 and 6 months after the baseline interview were 88.1% and 86.2%, respectively, for usual care and 85.7% and 85.0%, respectively, for the intervention group. Sixteen 2-hour group sessions of cognitive behavioral therapy for depression. Change in depression symptoms, mental health functioning, and days of alcohol and problem substance use. Intervention clients reported significantly fewer depressive symptoms (P < .001 at 3 and 6 months) and had improved mental health functioning (P < .001 at 3 months and P < .01 at 6 months). At 6 months, intervention clients reported fewer drinking days (P < .05) and fewer days of problem substance use (P < .05) on days available. Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care. clinicaltrials.gov Identifier: NCT01191788.

Counselor Attitudes toward the Use of Motivational Incentives in Addiction Treatment

Counselor attitudes toward evidence-based practices, such as motivational incentives/contingency management (MI/CM), are important in bridging the gap between research and practice. Mailed surveys from 1,959 substance abuse treatment counselors showed ambivalence toward MI/CM and strong disagreement with using monetary rewards for achievement of treatment goals. Attitudes were associated with counselors' educational attainment, a 12-step treatment ideology, affiliation with NIDA's Clinical Trials Network, and working in opioid treatment programs. Exposure to MI/CM via training was more strongly associated with attitudes when counselors worked in programs that had adopted MI/CM. While there is substantial resistance to MI/CM, dissemination and training about the essential elements of MI/CM may enhance counselors' receptivity toward this intervention.

Substance Abuse Treatment Counselors and Tobacco Use: A Comparison of Comprehensive and Indoor-Only Workplace Smoking Bans

While indoor smoking bans reduce employee tobacco use, less is known about whether comprehensive bans, which prohibit smoking in both indoor and outdoor areas, are associated with lower rates of tobacco use than indoor-only bans. This study integrated data collected via mailed surveys from 1,910 substance abuse treatment counselors and telephone interviews with 417 administrators of substance abuse treatment organizations. Multinomial logistic regression was used to estimate the associations between counselors' self-reported tobacco use and administrators' reports about organizational smoking bans while controlling for counselors' professional and demographic characteristics. In this sample, 20.3% of counselors were current tobacco users, 47.7% identified as former users, and 32.0% reported never using tobacco products. Only 19.5% of counselors worked in a treatment organization that had a comprehensive smoking ban. The likelihood of being a current tobacco user, compared with being a former user or nonuser, was significantly lower for counselors in organizations with comprehensive bans even after controlling for professional and demographic characteristics. Although relatively few substance abuse counselors worked in treatment organizations with comprehensive bans, such bans may represent a promising direction for tobacco control. Given recent research documenting how tobacco use is negatively associated with the delivery of smoking cessation services by health care workers, additional research on the impact of comprehensive environmental tobacco policies is needed.

The Substance Abuse Treatment Workforce of South Africa

The purpose of this paper is to describe characteristics of substance abuse treatment counselors in the Republic of South Africa, including demographics, education, training, and job duties. Counselors recruited from 24 treatment centers completed a survey after signing informed consent. Counselors were primarily female (75%), racially diverse (36.4% White, 30.8% Black, 18.9% Coloured, 12.6% Indian or Asian, and 1.4% Cape Malay), and were 38 years old on average. The majority (62.3%) held at least an equivalent of a bachelor’s degree, and just under half (49%) were registered social workers. Counselors had a mean of 5.3 years’ experience in substance abuse treatment. The substance abuse treatment workforce of South Africa appears to be young and educated, yet only one third of the counselors had any formal training in Cognitive Behavioral Therapy. South African counselors could benefit from more training in evidence-based techniques.

Clinical supervision, emotional exhaustion, and turnover intention: A study of substance abuse treatment counselors in the Clinical Trials Network of the National Institute on Drug Abuse

An intriguing hypothesis is that clinical supervision may protect against counselor turnover. This idea has been mentioned in recent discussions of the substance abuse treatment workforce. To test this hypothesis, we extend our previous research on emotional exhaustion and turnover intention among counselors by estimating the associations between clinical supervision and these variables in a large sample ( N = 823). An exploratory analysis reveals that clinical supervision was negatively associated with emotional exhaustion and turnover intention. Given our previous findings that emotional exhaustion and turnover intention were associated with job autonomy, procedural justice, and distributive justice, we estimate a structural equation model to examine whether these variables mediated clinical supervision's associations with emotional exhaustion and turnover intention. These data support the fully mediated model. We found that the perceived quality of clinical supervision is strongly associated with counselors' perceptions of job autonomy, procedural justice, and distributive justice, which are, in turn, associated with emotional exhaustion and turnover intention. These data offer support for the protective role of clinical supervision in substance abuse treatment counselors' turnover and occupational well-being.

Substance Abuse Treatment Providers' Explicit and Implicit Attitudes Regarding Sexual Minorities

Lesbian, gay, bisexual, and transgender (LGBT) individuals have been found to have elevated rates of substance use disorders when compared with heterosexuals. However, little is known about the challenges a sexual minority might face in presenting for substance use treatment. In this study, treatment providers' attitudes toward LGBT individuals were assessed among a sample of 46 substance abuse treatment counselors who provide publicly funded treatment. Participants completed both explicit measures of heterosexist bias and an implicit measure designed to assess for biases that exist at an automatic, uncontrolled level. Results indicate that treatment counselors' negative biases regarding LGBT individuals were stronger for heterosexual counselors and for those with few LGBT friends. However, biases among this sample were significantly less than in comparison samples. Findings were also related to a newly developed measure of cultural competence in working with LGBT substance users. Implications for provision of appropriate services and recommendations to treatment agencies are discussed.

Counselor assessments of training and adoption barriers

The prevailing emphasis on adopting evidence-based practices suggests that more focused training evaluations that capture factors in clinician decisions to use new techniques are needed. This includes relationships between postconference evaluations and subsequent adoption of training materials. We therefore collected training assessments at two time points from substance abuse treatment counselors who attended a training on dual diagnosis and another on therapeutic alliance as part of a state-sponsored conference. Customized evaluations were collected to assess counselor perceptions of training quality, relevance, and resources in relation to its use during the 6 months after the conference. Higher ratings for relevance of training concepts and materials to service the needs of clients, desire to have additional training, and level of program support were related to greater trial use during the follow-up period. Primary resource-related and procedural barriers cited by the counselors included lack of time and redundancy with existing practices.

Relating Substance Abuse Counselor Background to the Provision of Clinical Tasks

This study examines the diverse academic and professional background characteristics of substance abuse treatment counselors, relating these characteristics to the work counselors are doing. Results indicate that while academic and professional background characteristics differentiate whether counselors perform certain clinical tasks or not, they do not differentiate the amount of time they spend doing them. In fact, regression analyses indicate that academic and professional background characteristics currently account for less than 10% of the total variability associated with how counselors spend their time. While meager, the best predictors of individual work tasks appear to be more contextual in nature. The fact that academic and professional background characteristics do not differentiate counselors in terms of time spent on specific clinical responsibilities raises some questions regarding the quality of client care. Results also indicate that the knowledge and skill sets needed for counselors to be effective may vary according to the treatment setting

Secondary Traumatic Stress in Substance Abuse Treatment

Abstract The terms secondary traumatic stress (STS), vicarious traumatization (VT), and compassion fatigue (CF) have all been used, sometimes interchangeably, to refer to the observation that those who provide clinical services to trauma survivors may themselves experience considerable emotional disruption, becoming indirect victims of the trauma. Consequently, such reactions are becoming viewed as an occupational hazard of providing clinical services to traumatized populations. The purpose of this paper is to provide an overview of the conceptual and empirical literature on secondary traumatic stress, as well as recommendations for its prevention. It is hoped that this article will serve to increase the awareness of this potential occupational hazard of counseling traumatized substance abusers among substance abuse treatment counselors, administrators, and educators.

Buprenorphine diffusion: the attitudes of substance abuse treatment counselors

In October 2002, the Food and Drug Administration approved buprenorphine for use in the treatment of opioid dependence. Successful diffusion, adoption, and implementation of this medication within the treatment field depend in part on substance abuse counselors. Using questionnaire data obtained from 2,298 counselors in community-based treatment programs in the private and public sectors between June 2002 and July 2004, we explored the diffusion of this new treatment technique. Analyses indicate that a substantial proportion of the clinical workforce is unaware of the effectiveness of buprenorphine in the treatment of opiate addiction. Several variables predicted counselors' attitudes toward buprenorphine. Predictors included receipt of buprenorphine-specific training, educational attainment, years of experience, and 12-step orientation. Implications for the diffusion of this and other emerging treatment techniques are discussed.

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Retaining counseling staff at substance abuse treatment centers: effects of management practices

The turbulence created by the emergence of managed care has increased the importance of staff retention for substance abuse treatment centers. This study examines the relationships between management practices, organizational commitment, and turnover intention among substance abuse treatment counselors. Counselors from 345 randomly selected privately funded treatment centers were surveyed about management practices, organizational commitment, and turnover intention. Structural equation model estimates indicate significant associations between these variables. The effects of performance-based rewards and support for creativity, two measures of management practices, on turnover intention are mediated by organizational commitment. Job autonomy has a direct effect on turnover intention. Treatment center administrators may improve staff retention by systematic attention to these factors shown to enhance organizational commitment and reduce counselors' intentions to quit. Such steps may include increasing counselor autonomy, providing rewards for strong job performance, and establishing a work environment that supports creativity and innovation.

The Influence of Recovery Status and Education on Addiction Counselors' Approach to Treatment

The goal of this study is to examine the influence of education and recovery status on substance abuse treatment counselors' approach to patients. Three hundred forty-four drug abuse and alcoholism treatment counselors were questioned about treatment goals. A subgroup of 197 were also questioned about treatment practices. The influences of education and recovery status on the choice of treatment goals and treatment practices were examined through structural modeling procedures. Level of education influenced neither treatment goals nor techniques. Being in recovery, however, was associated with more varied treatment techniques and a broader range of treatment goals. The other variable related to treatment goals and practices was treatment modality. Working in resi dential programs was linked to a wider range of treatment goals and treatment practices. Implications of these findings for counselor training and the movement to professionalize substance abuse treatment are discussed.