Transcript Open poster - CTN Dissemination Library

Counselor Attitudes toward Buprenorphine
in the Clinical Trials Network*
Hannah K. Knudsen,
1
Ph.D.,
& Paul M. Roman,
2
Ph.D.
1Department
of Behavioral Science & Center on Drug and Alcohol Research, University of Kentucky
2Institute for Behavioral Research and Department of Sociology, University of Georgia
*Supported by the National Institute on Drug Abuse (2R01DA14482)
METHODS
BACKGROUND
Early research on counselor attitudes toward
buprenorphine indicated knowledge gaps
about its effectiveness and low acceptability. A
survey from 2002-2004 found that two-thirds of
counselors did not know whether
buprenorphine was effective.1 Lack of
buprenorphine-specific training and greater
endorsement of a 12-step treatment orientation
were identified as barriers to perceiving
buprenorphine as an acceptable treatment
technology. A comparison of counselors
working in treatment programs affiliated with
the National Drug Abuse Treatment Clinical
Trials Network (CTN) and counselors outside
the CTN found that differences in perceived
acceptability were largely a function of greater
access to training and greater implementation
of buprenorphine within the CTN.2 In this
research, we examine more recent data on CTN
counselors’ attitudes toward buprenorphine
and identify counselor characteristics
associated with perceived effectiveness and
acceptability.
RESEARCH QUESTIONS
1.In 2008-2009, to what extent did CTN
counselors view buprenorphine as effective and
acceptable?
2.What characteristics differentiate counselors
who view buprenorphine as effective from
those who perceive buprenorphine as a)
ineffective, b) don’t know if it is effective, or c)
neither effective nor ineffective?
3.What characteristics differentiate counselors
who view buprenorphine as acceptable from
those who perceive buprenorphine as a)
unacceptable, b) don’t know if it is acceptable,
or c) neither acceptable nor unacceptable?
1Knudsen,
Ducharme, Roman, & Link. (2005). Journal of Substance Abuse Treatment, 29, 95-106.
2Knudsen,
Ducharme, & Roman. (2007). The American Journal on Addictions, 16, 365-371.
RESULTS
Data Collection
•198 community-based treatment program (CTP)
administrators participated in face-to-face interviews
in 2008-2009 (84.7%) and were asked to provide lists
of counselors
•Surveys were mailed to each identified counselor
•934 counselors working in 175 CTPs participated in
the survey (62% response rate; $40 honorarium)
Measures
•Perceived effectiveness categorizes counselors into
those rating buprenorphine as effective, ineffective,
don’t know, or neither effective nor ineffective
•Perceived acceptability categorizes counselors into
those rating buprenorphine as acceptable,
unacceptable, don’t know, or neither acceptable nor
unacceptable
•See “Sample Characteristics” (below) for
independent variables
Data Analysis
•Multiple imputation by chained equations (“ice” in
Stata 11) used to address missing data on the
independent variables; cases missing on either
dependent variable were excluded from the analysis
(final N = 918)
•Two multinomial logistic regressions with
effective/acceptable as the reference group, using
robust standard errors to adjust for clustering of
counselors within CTPs
Few CTN counselors had negative attitudes toward
buprenorphine. The majority rated buprenorphine as effective
(Figure 1). Two-thirds of the counselors indicated that
buprenorphine was acceptable (Figure 2). Fewer than 20% of
counselors chose the “don’t know” option for these measures
of perceived effectiveness and acceptability.
Multinomial logistic regressions were conducted to identify
significant correlates of perceived effectiveness and
acceptability among CTN counselors. Both models include all
variables presented in “Sample Characteristics,” but only
significant variables appear in Figures 3 and 4.
Figure 3: Multinomial Logistic Regression of Perceived Effectiveness of Buprenorphine
Buprenorphine is Effective
(Reference Category)
Odds of Being in the
“Not Effective” Category
Negatively Associated with:
Training (RRR = .72***)
Program-level adoption
(RRR = .56, p = .06)
Odds of Being in the
“Not Effective” Category
Positively Associated with:
12-step orientation
(RRR = 1.16, p = .07)
Odds of Being in the
“Don’t Know” Category
Negatively Associated with:
Training (RRR = .41***)
Having a master’s-level degree
(RRR = .54*)
Odds of Being in the
“Don’t Know” Category
Positively Associated with:
Being Hispanic (RRR = 2.15*)
Being in the other race
category (vs. white;
RRR = 2.66, p = .07)
*p<.05, **p<.01, ***p<.001 (two-tailed)
Odds of Being in the
“Neither” Category
Negatively Associated with:
Training (RRR = .82***)
Belief in the utility of
scientifically-supported
treatments (RRR = .85, p =
.06)
Being certified/licensed
(RRR = .62, p = .07)
Odds of Being in the
“Neither” Category
Positively Associated with:
12-step treatment orientation
(RRR = 1.15, p = .05)
Figure 4: Multinomial Logistic Regression of Perceived Acceptability of Buprenorphine
Buprenorphine is Acceptable
(Reference Category)
SAMPLE CHARACTERISTICS
% or
Mean (SD)
% or
Mean (SD)
Female
66.7%
Personally in recovery
Hispanic ethnicity
9.9%
Twelve-step treatment orientation (1=strongly
disagree, 7 = strongly agree)
Race
41.2%
3.89 (1.56)
Certified or licensed addictions counselor
71.9%
White
73.7%
Master’s level degree
51.7%
African American
21.8%
Works in a CTP that uses buprenorphine
41.9%
Other
4.4%
Extent of buprenorphine training (1=no extent, 7 =
very great extent)
3.78 (2.15)
Believes scientifically supported treatments are
useful (1=strongly disagree, 7 = strongly agree)
5.89 (1.26)
Years working at CTP
5.33 (5.65)
Odds of Being in the
“Not Acceptable” Category
Negatively Associated with:
Training (RRR = .65***)
Being certified/licensed
(RRR = .50*)
Odds of Being in the
“Not Acceptable” Category
Positively Associated with:
Twelve-step orientation
(RRR = 1.25*)
*p<.05, **p<.01, ***p<.001 (two-tailed)
Odds of Being in the
“Don’t Know” Category
Negatively Associated with:
Training (RRR = .39***)
Having a master’s-level degree
(RRR = .56*)
Odds of Being in the
“Don’t Know” Category
Positively Associated with:
Being Hispanic (RRR = 2.07,
p = .07)
Being in the other race
category (vs. white;
RRR = 3.99*)
Odds of Being in the
“Neither” Category
Negatively Associated with:
Training (RRR = .75***)
Belief in the utility of
scientifically-supported
treatments (RRR=.83, p = .05)
Being certified/licensed
(RRR = .55*)
Odds of Being in the
“Neither” Category
Positively Associated with:
Being African American (vs.
white; RRR=1.95, p = .06)
CONCLUSIONS
•Compared to earlier studies, these data
from CTN counselors show improved
attitudes regarding the effectiveness and
acceptability of buprenorphine.
•The percentages choosing the “don’t
know” options were much lower than our
prior surveys, suggesting greater diffusion
of buprenorphine-related information.
•Strong associations between training and
the two attitudes suggest that additional
investments in training may yield benefits
in counselors’ receptivity to
buprenorphine.
•Counselors who more strongly endorse a
12-step treatment philosophy were more
likely to rate buprenorphine as
unacceptable and ineffective. Future
research should consider what steps are
needed to address the concerns of these
counselors.