A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment.

Despite evidence that buprenorphine is effective, safe, and easier for patients to access than methadone, implementation of this medication for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This analysis of National Treatment Center Study (NCTS) data, which includes data collected from substance abuse treatment centers affiliated with the National Drug Abuse Treatment Clinical Trials Network (CTN), used hierarchical linear modeling to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine.

Conclusions: Overall, these findings suggest that (a) specific training about buprenorphine is useful, (b) counselors’ attitudes toward buprenorphine are improving over time, and (c) having a program-wide treatment philosophy that does not emphasize a 12-step model facilitates implementation. These findings are important in terms of translational research as they confirm the need to address knowledge and attitudes of frontline providers, but they also emphasize the importance of organizational culture and support for the adoption of new practices. As a critical link to the diffusion of medications, the important role of counselors and associated efforts to improve their willingness to suggest buprenorphine to their clients cannot be ignored.