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This secondary analysis of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0008, “Assessment of the CTN: A Baseline for Investigating Diffusion of Innovation,” examined the relative contribution of providers’ professional affiliation (medical vs. non-medical), involvement in research, and training needs for associations with endorsement of the following evidence-based practices (EBPs): (1) pharmacological — buprenorphine treatment and (2) psychosocial – Cognitive Behavioral Therapy (CBT). As part of CTN-0008, 571 substance abuse treatment providers (medical, social workers, psychologists, and counselors) were surveyed. After multivariate linear regression models were used to analyze the cross-sectional survey data, results found that medical providers and providers with previous research involvement more strongly endorsed the effectiveness of buprenorphine over CBT. Compared to medical providers, psychosocial providers more strongly endorsed CBT. There was a positive association between needing training in rapport with patients and endorsement of buprenorphine and a negative association with CBT. There was also a positive association between needing training in behavioral management and needs assessment and endorsement of CBT.
Conclusions: The current findings revealed that providers’ specializations, as well as their involvement in research, are critical to their perceptions about various practices. Therefore, provider training should explicitly address issues of evidence regardless of providers’ education, job title, and knowledge level. Greater emphasis ought to be place on training all providers how to practice in transdisciplinary teams so that knowledge about pharmacological and psychosocial practices is elevated among all professionals.
Related protocols: CTN-0008
Adoption of contingency management (CM) by the addiction treatment community is limited to date despite much evidence for its efficacy. This investigation examined systemic and idiographic staff predictors of CM adoption attitudes via archival data collected from treatment organizations affiliated with the National Drug Abuse Treatment Clinical Trials Network (CTN) (part of protocol CTN-0008). Multilevel modeling analyses evaluated potential predictors from organizational, treatment unit, and workforce surveys. Among these were individual and shared perceptions of staff concerning aspects of their clinic culture and climate. Modeling analyses identified three systemic predictors (clinic provision of opiate agonist services, national accreditation, and lesser shared perception of workplace stress) and five idiographic predictors (staff with a graduate degree, longer service tenure, managerial position, e-communication facility, and openness to change in clinical procedures).
Findings are discussed as they relate to extant literature on CM attitudes, established implementation science constructs, and practical implications. It is hoped these findings may spur further research into how effectively CM (and other empirically supported practices) transition from academic innovators to the treatment community.
Related protocols: CTN-0008
Access to evidence-based practices across the substance use disorder treatment continuum is critical to improving client outcomes and improving the quality of care overall. In order to improve quality of care and champion adoption of evidence-based practices, a comprehensive understanding of the workforce is critical. The National Drug Abuse Treatment Clinical Trials Network (CTN) is an alliance of drug abuse treatment programs and research centers testing new interventions and implementation factors for treating alcohol and drug use disorders. This paper reports on a workforce survey distributed to those providing direct services in 295 treatment units in the CTN, which obtained responses from 1750 individuals with a job title of “counselor” (n=1395) or “counselor supervisor” (n=355). A secondary analysis compared and described both groups.
Conclusions: Supervisors were more likely to be licensed or certified. Master’s degrees were more common among counselors in outpatient and methadone programs. Counselors in residential settings tended to be on the job fewer years. Finally, higher education was associated with greater familiarity with and acceptance of evidence-based practices. In a climate of diminishing public resources with an emphasis on scientifically based treatment practices, the present study’s results create a platform from which training, supervision, development of new practices, and implementation of interventions may be built.
Related protocols: CTN-0008
This newsletter article summarizes the research reported in a recent Journal of Substance Abuse Treatment article (see CTN Library record 514) by researcher Rogerio M. Pinto and colleagues about a CTN ancillary investigation of data from protocol CTN-0008 that that examined the contribution of several factors (demographics, attitudes, and involvement in research) influencing substance abuse treatment providers’ willingness to use research findings in practice. The study found that providers involved as clinical staff or research assistants were more willing to use research findings in practice. Compared to providers who were not involved in research, involved providers had, on average, a 0.15 unit higher willingness to apply research findings to their work. Future research should seek to uncover the specific factors that inspire providers to become involved in research and, ultimately, to use research findings in practice consistently.
Related protocols: CTN-0008
Using publicly-available data sets from the National Drug Abuse Treatment Clinical Trials Network baseline protocol (CTN-0008), this project examined the contribution of several factors (demographics, attitudes, and involvement in research) influencing substance abuse treatment providers’ willingness to use research findings in practice. This study is unique in that it used the same measures with four categories of providers unified by the primary function of providing counseling in community settings: medical staff, social workers, psychologists, and counselors.
Using a multiple linear regression model, the researchers examined the impact of involvement in research and willingness to use research findings in practice. Providers involved in research were more willing to use findings in practice; Latinos/Latinas were less willing. Providers with favorable attitudes toward evidence-based practices and whose agencies supported professional growth were also more willing to use findings. Involvement in research may enhance providers’ willingness to use findings in practice and increase quality of services. Results underscore the need to provide opportunities for all providers to engage in substance abuse treatment research, particularly racial/ethnic minority providers.
Related protocols: CTN-0008
Individual and organizational variables influence attitudes towards use of naltrexone, methadone, and buprenorphine for the treatment of alcohol and drug disorders. Prior research has not considered both sets of influences simultaneously. Hierarchical linear modeling tested the contribution of individual and organizational variables using data the National Drug Abuse Treatment Clinical Trials Network treatment unit and workforce surveys (n = 2,269 staff nested within 247 treatment units), done as part of protocol CTN-0008, “Assessment of the National Drug Abuse Clinical Trials Network: A Baseline for Investigating Diffusion of Innovation.”
Individual-level variables consistently had more influence on attitudes, but a unique blend of variables existed for each medication. One predictor, support for psychiatric medications, influenced attitudes across all medications. Staff attitudes towards addiction medications varied significantly between treatment units. Implications for increasing the appropriate use of addiction medications are discussed.
Related protocols: CTN-0008
Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes. Substance abuse treatment programs too often ignore tobacco use. Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment.
This article, the concept for which originated from a National Drug Abuse Treatment Clinical Trials Network (CTN) workshop, provides a review of tobacco cessation literature and successful methods of intervention. Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success. The authors discuss how to incorporate smoking cessation, and mention briefly the results of a survey of nicotine dependence services offered at community treatment programs in the CTN (as part of CTN-0008, “Assessment of the National Drug Abuse Clinical Trials Network: A Baseline for Investigating Diffusion of Innovation”).
Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed Organizational Surveys (n=106 of 112; 95% response rate) and Treatment Unit Surveys (n=348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in the treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to the National Survey of Substance Abuse Treatment Services (N-SSATS), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented.
Outpatient, methadone, long-term residential and inpatient treatment units differ on patients served and services provided. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.
Related protocols: CTN-0008
The NIDA Clinical Trials Network (CTN) is a national network of drug abuse treatment programs and research centers partnering to implement and test emerging behavioral and pharmacological therapies. High staff turnover rates, a lack of professional development pathways and increasing use of evidence-based practices highlight the need to understand the characteristics of substance abuse treatment counselors.
As part of CTN-0008, a baseline survey of direct care staff in 344 treatment units participating in the CTN, the education, certification, and licensure of counselors and managers/supervisors was examined. Managers/supervisors were more likely to have a master’s degree or higher (61% managers vs. 43% counselors). Counselors and managers with master’s degrees were more common in outpatient (67%) and methadone (51%) programs than those in residential (40%) and detoxification (44%) programs. The majority of providers had state or national certification 849 (51%). Of the 700 (46%) managers and counselors who had professional licensure, the majority (68%; n = 337) were licensed as an alcohol and drug abuse counselor, 16% were licensed professional counselors, 6% were psychologists. Supervisors were significantly more likely to be credentialed and/or licensed (state: 53%, national 26%; professional licensure: 58%) than counselors (state: 46%, national 18%; professional licensure: 41%). Individuals without graduate degrees commonly provide substance abuse treatment services and remain an important component of the counseling workforce. Managers/supervisors have more education and experience and can provide guidance on implementation of evidence-based practices.
Related protocols: CTN-0008
For this study, individuals with direct care responsibilities in drug abuse treatment units were surveyed to obtain a description of the workforce and to assess support for evidence-based therapies. These surveys were distributed to 112 programs participating in the National Drug Abuse Clinical Trials Network (CTN).
Descriptive analyses characterized the workforce, and analyses of covariance tested the effects of job category on opinions about evidence-based practices and controlled for the effects of education, modality (outpatient or residential), race, and gender. The analyses determined that women make up two-thirds of the CTN workforce, one-third of the workforce had a master’s or doctoral degree, and one-third were from racial or ethnic minority groups, characteristics that seem to be consistent with data from previous assessments of the clinical workforce. In terms of support for evidence-based therapies, managers-supervisors were the most supportive, with support staff the least supportive.
Generally, individuals with graduate degrees also tended to have the more positive opinions about evidence-based therapies. Support for using medications and contingency management was modest across job categories. In conclusion, it appears that the relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices, thus, programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts. A commentary on this article, written by Henrick Harwood, is also available.
Related protocols: CTN-0008
Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol CTN-0008 (“Assessment of the National Drug Abuse Clinical Trials Network: A Baseline for Investigating Diffusion of Innovation”) completed surveys to characterize participating programs and practitioners.
A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC Scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress.
Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC’s utility in assessing agency strengths and needs during the implementation of evidence-based practices.
Related protocols: CTN-0008
This article examines the variables associated with the presence of smoking cessation interventions in drug abuse treatment units, as well as staff attitudes toward the integration of smoking cessation services as a component of care. Surveys were administered to 106 organizations, 348 treatment clinics, and 3,786 employees in agencies that participated in the National Drug Abuse Treatment Clinical Trials Network. Organizational factors, attributes of the treatment setting, and staff attitudes toward smoking cessation treatment were assessed. Use of smoking cessation interventions was associated with the number of additional services offered at clinics, residential detoxification services, and attitudes of the staff toward smoking cessation treatment. Staff attitudes toward integrating smoking cessation services in drug treatment were influenced by the number of pregnant women admitted, the number of ancillary services provided, the attitudes of staff toward evidence-based practices, and whether smoking cessation treatment was offered as a component of care.
Related protocols: CTN-0008