Substance Use Disorder Counselors Research Articles

Experiential suicide prevention training for substance use treatment intensive outpatient program counselors: Stepped wedge cluster-randomized training study

IntroductionThe goal of this study was to evaluate changes in knowledge, attitudes, and other key suicide prevention issues for substance use disorder (SUD) counselors trained to administer the Preventing Addiction Related Suicide (PARS) module as part of a large-scale clinical trial. The PARS is a 3-hour, PowerPoint based intervention designed with and for community SUD agencies for their Intensive Outpatient (IOP) group therapy programs. A previous randomized study of 906 patients from 15 community SUD sites showed positive changes in patients' suicide prevention knowledge, attitudes, and help seeking. MethodsCounselor participants completed measures of knowledge and attitudes about suicide and their confidence treating suicidal patients at each step of a large, stepped wedge cluster randomized trial of PARS, including after the final step. Data analysis compared scores in steps prior to counselors' training in PARS with scores in the steps following counselors' PARS training. ResultsA total of 126 counselors participated in the study (89 % of those approached; 89–92 % retention across follow-up). Evaluation of both PARS efficacy and the PARS training by SUD counselors was highly rated. Counselor scores after receiving PARS training (vs. scores prior to PARS training) showed greater suicide knowledge, less maladaptive attitudes about suicide, and greater confidence in working with suicidal patients. ConclusionsBased on this rigorous test of PARS training for SUD counselors working in community SUD intensive outpatient programs, PARS training, as well as doing the PARS intervention, was rated as highly effective and acceptable. PARS offers an integrated, brief, engaging, and effective training method to improve suicide care for both SUD counselors and SUD clients.

Closing the gap in substance use disorder treatment through paraprofessional counselor training

ABSTRACT There is currently an insufficient supply of licensed substance use disorder counselors (SUDCs) to meet demand for services and the gap between supply and demand is projected to grow. Paraprofessional SUDCs offer one path to helping close this gap. The current study presents outcomes from a paraprofessional SUDC certificate program for Bachelor of Social Work (BSW) students. Student data (N = 66) were used to examine pre- to post-program changes in generalized SUDC knowledge and pre- to posttest changes in knowledge and self-efficacy from evidence-based workshops. Paired sample t-tests indicated that program participation significantly increased generalized SUDC knowledge. Participation in workshops significantly increased knowledge of motivational interviewing, integrative medicine, harm reduction, and grief and loss and self-efficacy for integrative medicine and harm reduction. BSW students gained generalized and treatment-specific knowledge via participation in a SUDC certificate program. The deployment of paraprofessionals SUDCs may provide one strategy to reduce treatment gaps.

Closing the gap in substance use disorder treatment through paraprofessional counselor training

ABSTRACT There is currently an insufficient supply of licensed substance use disorder counselors (SUDCs) to meet demand for services and the gap between supply and demand is projected to grow. Paraprofessional SUDCs offer one path to helping close this gap. The current study presents outcomes from a paraprofessional SUDC certificate program for Bachelor of Social Work (BSW) students. Student data (N = 66) were used to examine pre- to post-program changes in generalized SUDC knowledge and pre- to posttest changes in knowledge and self-efficacy from evidence-based workshops. Paired sample t-tests indicated that program participation significantly increased generalized SUDC knowledge. Participation in workshops significantly increased knowledge of motivational interviewing, integrative medicine, harm reduction, and grief and loss and self-efficacy related to integrative medicine and harm reduction. BSW students gain generalized and treatment-specific knowledge via participation in a SUDC certificate program. The deployment of paraprofessional SUDCs may provide one strategy to reduce treatment gaps

Effectiveness of Brief In-person and Virtual Substance Use Disorder Counselor Trainings, 2019-2021.

Paraprofessional substance use disorder counselors (SUDCs) are an important component of expanding access to substance use disorder treatment, but little research on SUDC training currently exists. We evaluated knowledge and self-efficacy gain from brief in-person and virtual workshops for paraprofessional SUDC student-trainees. Student-trainees (N = 100) enrolled in an undergraduate SUDC training program completed 6 brief workshops from April 2019 to April 2021. Three in-person workshops during 2019 covered clinical assessment, suicide risk and evaluation, and motivational interviewing, and 3 virtual workshops during 2020-2021 covered family engagement and mindfulness-oriented recovery enhancement, as well as screening, brief intervention, and referral to treatment for expectant mothers. Pretest and posttest online surveys measured student-trainee knowledge gain related to all 6 SUDC modalities. Results of paired sample t tests evaluated changes in knowledge and self-efficacy from pretest to posttest. All 6 workshops showed a significant gain in knowledge from pretest to posttest. Four workshops showed a significant gain in self-efficacy from pretest to posttest. Hedges g ranged from 0.70 to 1.95 for knowledge gain and from 0.61 to 1.73 for self-efficacy gain across workshops. Common language effect sizes indicating the probability that a participant increased one's score from pretest to posttest ranged from 76% to 93% for knowledge gain and from 73% to 97% for self-efficacy gain across workshops. Results of this study add to the limited research base on training for paraprofessional SUDCs and suggest that in-person learning and virtual learning are both viable brief training tools for students.

Ethical Dilemmas Facing Substance Use Counselors During the COVID-19 Pandemic.

During the COVID-19 pandemic, substance use disorder (SUD) treatment settings experienced several abrupt changes, including decreased admissions, reduction in services, and modified requirements for medication for substance use disorder. While these changes were implemented to facilitate the maintenance of important treatment options, the ethical consequences of such changes remained unknown. The current study aimed to explore ethical issues related to COVID-19-related changes reported by counselors in SUD treatment facilities. From May to August 2020, we conducted 60 to 90 minutes in-depth interviews with 18 front-line staff in 1 residential and 1 outpatient treatment program, exploring issues drawn from the ethical principles of the national organization representing SUD counselors. Counselors volunteered to participate via phone or email, and participation was confidential. Interviews were conducted via videoconferencing. Topics included day-to-day experiences of ethical dilemmas in the workplace, particularly during the COVID-19 era. Interviews were recorded, transcribed, and checked for accuracy and a trained team of analysts then coded transcripts using thematic analysis. As a result of the COVID-19 pandemic, SUD treatment programs quickly modified procedures to adhere to public health mandates while also continuing to offer care to clients. SUD counselors reported several ways their programs adapted new and creative procedures to reduce the risk of COVID-19 transmission. SUD counselors also identified several novel ethical dilemmas that occurred during the COVID-19 pandemic, often resulting from the counselor balancing the needs for responding to public health mandates with providing services to clients. There were several ways that COVID-19 related changes resulted in therapeutic challenges for some clients, and the SUD counselors highlighted ways that changes resulted in more flexible services for other clients. This study highlights the quick response to COVID-19 that occurred within SUD treatment. While these changes resulted in novel ethical dilemmas, they also offered more flexible and client-centered approaches to treatment.

Effectiveness of a Suicide Prevention Module for Adults in Substance Use Disorder Treatment

Individuals with substance use disorders (SUDs) are at high risk for suicide. The Preventing Addiction Related Suicide (PARS) module is the first suicide prevention module developed in and for community substance use intensive outpatient programs (IOPs). To evaluate the effectiveness of PARS on suicide-related outcomes (ie, knowledge, attitudes, and help-seeking behavior) compared with usual care. This stepped-wedge cluster-randomized clinical trial was conducted from 2017 to 2020, with follow-up assessments conducted after treatment and at 1, 3, and 6 months. Participants included adult outpatients in SUD treatment at community IOPs across western Washington state. Data were analyzed from July 1, 2020, to January 20, 2022. The intervention, PARS, was a 1-session secondary prevention module administered by trained SUD counselors consisting of didactic presentations and group discussions about suicide risk factors, warning signs, and actions to take if suicide risk is observed in self or others. The control group received usual care. Primary outcomes were suicide knowledge, attitudes about suicide, and help-seeking behavior among patients enrolled in an IOP. A total of 906 participants (mean [SD] age, 37.5 [12.0] years; 540 [59.6%] men) were included, with 478 participants receiving usual care and 428 participants receiving PARS. In intent-to-treat analysis from baseline to after treatment, there was a greater improvement in suicide knowledge (d = 0.15; 95% CI, 0.08 to 0.23; P < .001) and a greater reduction in maladaptive attitudes (d = 0.18; 95% CI, 0.14 to 0.25; P < .001) for PARS participants compared with those receiving usual care. Improvements were maintained at follow-up for suicide knowledge (1 month: d = 0.16; 95% CI, 0.07 to 0.22; P < .001; 3 months: d = 0.12; 95% CI, 0.05 to 0.19; P = .001; 6 months: d = 0.13; 95% CI, 0.06 to 0.20; P < .001) and reductions in maladaptive attitudes (1 month: d = 0.20; 95% CI, 0.12 to 0.23; P < .001; 3 months: d = 0.10; 95% CI, 0.05 to 0.16; P < .001; 6 months: d = 0.14; 95% CI, 0.09 to 0.19; P < .001), with 788 participants (87.0%) of the sample responding across time points. From baseline to 6 months, there was a greater improvement in help-seeking in the PARS group vs usual care (d = 0.16; 95% CI, 0.01 to 0.32; P = .04). This stepped-wedge cluster-randomized clinical trial found that PARS was superior to usual care in improving suicide knowledge, maladaptive attitudes, and help-seeking in adults undergoing community addiction treatment. As a 1-session IOP module developed in partnership with community addiction agencies, PARS has the potential for wide impact in the national suicide prevention strategy. ClinicalTrials.gov Identifier: NCT03166709.

Addiction counselors and suicide: Education and experience do not improve suicide knowledge, beliefs, or confidence in treating suicidal clients

Substance use disorders (SUDs) are strongly associated with suicide deaths. However, SUD treatment is associated with lower suicide risk. To this date, we know little about whether SUD counselors are sufficiently knowledgeable about suicide and feel prepared and comfortable with treating and assessing their suicidal clients. This study was designed to characterize SUD counselors' general knowledge and confidence in treating suicidal clients, which was measured by their self-report of general knowledge of suicide prevention and belief in common myths about suicide as well as their self-reported confidence in treating suicidal clients. We hypothesized that confidence would be greater for counselors with more years of education and experience, that degree of education would predict greater knowledge and fewer beliefs in suicide myths, and finally that those counselors with greater knowledge and fewer beliefs in myths would have more confidence when treating suicidal clients. A total of 118 SUD counselors from 15 sites in Western Washington State agreed to participate in the study and completed baseline assessments. They were consented in group setting, usually during a staff meeting, and they were administered surveys on tablet computers. On average, the SUD counselors answered more than half the knowledge questions correctly and disagreed or strongly disagreed with common suicide myths. Their confidence in treating suicidal clients scored across the entire range. Our hypotheses were not supported: Confidence was not greater for those with more education or with more years of experience; degree of education and experience did not predict fewer beliefs in suicide myths; degree of education and experience did not predict greater knowledge; and greater knowledge and fewer beliefs in myths did not predict more confidence. The surprising finding that neither general suicide knowledge nor confidence were associated with the years of their work experience as a SUD counselor nor the level of their education and neither was associated with the other suggests that SUD treatment leadership should not depend on experience, education, general suicide knowledge to assure counselors are confidently able to treat suicidal clients. New or more precise training methods should be considered and evaluated.

Increasing substance use disorder counselors’ self-efficacy and skills in talking to patients about sex and HIV risk: A randomized training trial

BackgroundPeople with substance use disorder (SUD) experience increased risk for HIV, Hepatitis C, and sexually transmitted illnesses via risky sex. This high-risk population would benefit from sexual risk reduction interventions integrated into SUD treatment. However, many SUD counselors report lack of skill or confidence in addressing sexual risk with patients. MethodsThis study was part of a larger nested 2 × 2 factorial repeated measures design, which compared two levels of counselor training (Basic-2 h versus Enhanced-10 h plus ongoing coaching). We determined whether counselors receiving Enhanced training addressing their motivation, confidence and skills (a) increased knowledge about sexual issues; (b) increased self-efficacy to discuss sex with patients; and (c) improved skills in discussing sex as part of SUD treatment, compared with those receiving shorter information-based training. Counselors providing individual therapy at two opioid treatment programs (OTP) and two psychosocial outpatient programs in the United States were eligible. Randomization occurred after Basic training. Measures included self-report (self-efficacy and knowledge) and blinded coding of standardized patient interviews (skill). ResultsCounselors receiving Enhanced training (n = 28) showed significant improvements compared to their Basic training counterparts (n = 32) in self-efficacy, use of reflections, and use of decision-making and communication strategies with standardized patients. These improvements were maintained from post-training to 3-month follow-up. No adverse effects of study participation were reported. ConclusionsResults suggest that counselors can improve their knowledge, self-efficacy and skill related to sexual risk conversations with patients based on modest skills-based training.

Substance Use Disorders (SUDs) in Transgender Communities: The Need for Trans‐Competent SUD Counselors and Facilities

Transgender individuals entering treatment for substance use disorders (SUDs) may have unique needs related to their gender identity. This article provides a lens for viewing transgender clients and demonstrates the need for trans‐competent SUD counseling through a case illustration.

Addiction counselors train CPS workforce on MAT in Conn.

Pregnant women who are in treatment for opioid use disorders with methadone or buprenorphine have a good chance of giving birth to a child with neonatal abstinence syndrome (NAS), a transient and easily treatable condition. However, in many states, these women are reported to child welfare authorities as soon as their babies are born, usually by hospital staff. In Connecticut, the Department of Children and Families (DCF) is working to educate the workers who go out on these and other calls relating to parental drug use about medication‐assisted treatment (MAT) and about substance use disorders (SUDs) in general. And the state has teamed with certified SUD counselors to help provide this training.

Attitudes toward Substance Abuse Clients: An Empirical Study of Clinical Psychology Trainees

Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population are likely influenced by a lack of formal training in SUD treatment. Using a factorial survey-vignette design that included three clinical vignettes and a supplementary survey instrument, we investigated whether clinical psychology doctoral students differ in their level of negative emotional reactions toward clients with SUD versus major depressive disorder (MDD); whether they differ in their attributions for SUD versus MDD; and how their negative emotional reactions and attributions impact their interest in pursuing SUD clinical work. Participants were 155 clinical psychology graduate-level doctoral students (72% female). Participants endorsed more negative emotional reactions toward clients with SUD than toward clients with MDD. They were also more likely to identify poor willpower as the cause for SUD than for MDD. More than a third reported interest in working with SUD populations. Highest levels of interest were associated with prior professional and personal experience with SUD, four to six years of clinical experience, and postmodern theoretical orientation.

Counselors' Clinical Use of Definitive Drug Testing Results in Their Work with Substance-Use Clients: a Qualitative Study.

We conducted a psychotherapeutic examination of the use of definitive drug testing (liquid chromatography with tandem mass spectrometry) in the treatment of substance use disorders (SUD). Employing a generic qualitative method (Caelli et al. in International Journal of Qualitative Methods, 2(2), 2003; Merriam, 2009) we asked SUD counselors to provide narratives about cases where drug testing had revealed new or unexpected information about clients’ drug-taking behaviors. Semi-structured interviews with 12 SUD counselors were conducted by phone and analyzed for themes derived from the literature. These counselors reported many new positive drug tests in clients previously believed to be adherent with treatment. Key themes assessed in counselors’ narratives included initial client denial that was often followed by later acknowledgement of relapse and increased motivation, at times presenting new opportunities for clients to engage in treatment and enhance the therapeutic alliance. These results suggest that definitive drug testing can be used in a non-stigmatizing and therapeutic manner.

Traditional, Alternative, and Harm Reduction Approaches: What Do Social Work Students Think?

How social workers conceptualize substance use disorder (SUD) treatment will affect the types of interventions that they select, including the use of harm reduction strategies. An amended version of the Treatment Attitudes Scale–Revised was given to 280 social work students (graduate and undergraduate) along with 30 SUD counselors. The results indicated that all 3 groups in the sample scored similarly, with endorsing traditional methods as beneficial, blood-borne disease prevention and alternative methods as somewhat beneficial, and overdose fatality prevention methods as somewhat harmful. Implications for curriculum development and in-service training are discussed.

Effective Clinical Supervision in Substance Use Disorder Treatment Programs and Counselor Job Performance.

When mental health counselors have limited and/or inadequate training in substance use disorders (SUDs), effective clinical supervision (ECS) may advance their professional development. The purpose of the current study was to investigate whether ECS is related to the job performance of SUD counselors. Data were obtained in person via paper-and-pencil surveys from 392 matched SUD counselor-clinical supervisor dyads working in 27 SUD treatment organizations across the United States. ECS was rated by counselors and measured with five multi-item scales (i.e., sponsoring counselors' careers, providing challenging assignments, role modeling, accepting/confirming counselors' competence, overall supervisor task proficiency). Clinical supervisors rated counselors' job performance, which was measured with two multi-item scales (i.e., task performance, performance within supervisory relationship). Using mixed-effects models, we found that most aspects of ECS are related to SUD counselor job performance. Thus, ECS may indeed enhance counselors' task performance and performance within the supervisory relationship, and, as a consequence, offset limited formal SUD training.

Counselor Attitudes toward and Use of Evidence-based Practices in Private Substance Use Disorder Treatment Centers: A Comparison of Social Workers and Non-Social Workers

The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are nonsocial workers. A national sample of 1,140 counselors in private SUD treatment settings completed a mailed survey. Overall, counselors perceive both motivational interviewing (MI) and contingency management (CM) to be effective and acceptable interventions, with MI perceived to be both more effective and more acceptable than CM. The results of this study also shed light on the factors associated with perceptions of effectiveness and acceptability of MI and CM. The results of this study underscore the importance of exposure to EBPs in the development of positive attitudes toward and use of EBPs. In particular, professional networks are an important route to introduce social workers to EBPs, as is professional training on specific EBPs. Efforts to increase the uptake of evidence-based SUD interventions should not be limited to dissemination of information regarding effectiveness; rather, efforts should also be expended to expose social workers to EBPs.

Let's Clear the Air: The Difference Between Professional Enabling and Empathy

Abstract Within the substance use disorder (SUD) field, there is a continual state of confusion between what constitutes professional enabling and empathy. Such confusion has led many SUD counselors to resort to inappropriate therapeutic strategies when otherwise more understanding interventions are needed. This article defines the concepts of enabling and empathy, compares the key elements, and concludes that the concepts are utterly different ideas

"Either/Or" and "Both/Neither": Discursive Tensions in Transgender Politics -- TEST

"Either/Or" and "Both/Neither": Discursive Tensions in Transgender Politics -- TEST