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CORK Bibliography: Clinicians

83 citations. January 2010 to present

Prepared: December 2013

Acier D; Kern L. Problematic Internet use: Perceptions of addiction counsellors. Computers & Education 56(4): 983-989, 2011. (43 refs.)

Despite a growing number of publications on problematic Internet use (PIU), there is no consensus on the nature of the phenomenon, its constituent criteria, and its clinical threshold. This qualitative study examines the perceptions of addiction counsellors who have managed individuals with PIU in Quebec (Canada). Four focus groups were conducted with 21 addictions counsellors working in public addiction rehabilitation centres. Discussion groups were digitally recorded, transcribed using a word processor, and analyzed using N'vivo 8.0 software. The results present the perceptions of counsellors regarding case management issues, including problematic applications, clinical picture, number of hours of Internet use for assessment, and for treatment.

Acri MC; Gogel LP; Pollock M; Wisdom JP. What adolescents need to prevent relapse after treatment for substance abuse: A comparison of youth, parent, and staff perspectives. Journal of Child & Adolescent Substance Abuse 21(2): 117-129, 2012. (42 refs.)

Objective: Little is known about what factors and supports youths identify as important for their sustained recovery after substance abuse treatment, and if their caregivers and treatment staff identify similar needs. The purpose of this study was to explore what youths, caregivers, and staff perceive as important to remain substance free after completing a residential treatment program. Methods: Semi-structured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at 3 treatment agencies. Data were coded thematically and themes were organized by respondent type. Results: There was high frequency and concordance across respondents regarding the need for aftercare services, supportive relationships, and activities. Only one item, outpatient treatment, demonstrated significant differences across groups. Conclusions: External supports and activities are important to recovery of adolescents from substances following treatment completion. Implications and potential areas of inquiry are discussed.

Ager R; Roahen-Harrison S; Toriello PJ; Kissinger P; Morse P; Morse E et al. Predictors of adopting motivational enhancement therapy. Research on Social Work Practice 21(1): 65-76, 2011. (58 refs.)

Substance abuse counselors have shown limited success in adopting evidence-based practices (EBPs). The purpose of this paper is to identify the barriers and facilitators of adopting an EBP called motivational enhancement therapy (MET). One hundred thirty-six predominantly female (60%) African American (68%) addiction counselors representing over 40 agencies completed surveys before and after participating in a 2-day MET training. Based on stepwise regressions, 10 variables predicted gains in MET knowledge, attitudes, and/or skills: high consistency of MET with organization's philosophy, being Caucasian, being younger, low self-efficacy, high practitioner self-perceived cultural competency, low adherence to the 12-step treatment philosophy, viewing MET as challenging to learn, high workload, fewer colleagues in same MET training, and working in a smaller organization. Implications for social work practice are discussed.

Albert ER. People who use drugs as agents of change: Peer-to-peer education as a force for positive change. (editorial). Substance Use & Misuse 47(5): 566-567, 2012. (0 refs.)

Allamani A. Views: Active drug users as social change agents a straw for the pilgrim/beyond specialization. Substance Use & Misuse 47(5): 588-590, 2012. (3 refs.)

Allan J; Kemp M. Aboriginal and non aboriginal women in New South Wales non governmental oganisation (NGO) drug and alcohol treatment and the implications for social work: Who starts, who finishes, and where do they come from? Australian Social Work 64(1): 68-83, 2011. (47 refs.)

Limited access to care is frequently identified as a reason for poor health in Indigenous communities. This study aimed to identify the proportion of Aboriginal women accessing mainstream non government organisation (NGO) drug treatment in New South Wales (NSW) compared to non Indigenous women. Statistical analysis of two NGO subsets of the Australian Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS-NMDS) for years 2005 to 2007 was conducted. A statistically significant relationship was found between gender and Indigenous status ( 2=4.582, df=1, p=.001) in the two stages of analysis. Among NSW Aboriginal people who have accessed episodes of drug and alcohol treatment in the NGO sector, there is a significantly greater proportion of females versus males (37%F vs 63%M, n=3,080 episodes) compared to the non Indigenous service users (29%F vs 71%M, n=21,791 episodes). Aboriginal women are more likely to be referred from criminal justice settings. However, both groups of women complete treatment at the same rate. Treatment providers' perceptions of their inability to successfully intervene with Aboriginal women may be a barrier to treatment. Agency client data should be examined for both race and gender details before treatment providers decide if what they supply is accessible to Aboriginal and Torres Strait Islander populations. This study demonstrates the importance of using evidence rather than assumptions about access to and effectiveness of service provision to Aboriginal women. Analysis of agency, State, and national datasets can inform policy and practice evaluations. Social workers can then support a more hopeful future for Aboriginal women, families, and communities.

Ashcraft RGP; Foster SL; Lowery AE; Henggeler SW; Chapman JE; Rowland MD. Measuring practitioner attitudes toward evidence-based treatments: A validation study. Journal of Child & Adolescent Substance Abuse 20(2): 166-183, 2011. (23 refs.)

A better understanding of clinicians' attitudes toward evidence-based treatments (EBT) will presumably enhance the transfer of EBTs for substance-abusing adolescents from research to clinical application. The reliability and validity of two measures of therapist attitudes toward EBT were examined: the Evidence-Based Practice Attitude Scale (Aarons, 2004), and Attitudes Toward Psychotherapy Treatment Manuals Scale (Addis Krasnow, 2000). Participants included 543 public sector, master's-level mental health and substance abuse therapists who treat adolescents. Factor analyses generally corroborated factor structures of the instruments found previously. Beliefs that EBTs negatively affect treatment process were associated with relatively low openness to new treatments and with beliefs that EBTs do not produce positive outcomes.

Bamatter W; Carroll KM; Anez LM; Paris M; Ball SA; Nich C et al. Informal discussions in substance abuse treatment sessions with Spanish-speaking clients. Journal of Substance Abuse Treatment 39(4): 353-363, 2010. (51 refs.)

This study investigated the extent to which bilingual counselors initiated informal discussions about topics that were unrelated to the treatment of their monolingual Spanish-speaking Hispanic clients in a National Institute on Drug Abuse Clinical Trial Network protocol examining the effectiveness of motivational enhancement therapy (MET). Session audiotapes were independently rated to assess counselor treatment fidelity and the incidence of informal discussions. Eighty-three percent of the 23 counselors participating in the trial initiated informal discussions at least once in one or more of their sessions. Counselors delivering MET in the trial initiated informal discussion significantly less often than the counselors delivering standard treatment. Counselors delivering standard treatment were likely to talk informally the most when they were ethnically non-Latin In addition informal discussion was found to have significant inverse correlations with client motivation to reduce substance use and client retention in treatment. These results suggest that informal discussion may have adverse consequences on Hispanic clients motivation for change and substance abuse treatment outcomes and that maintaining a more formal relationship in early treatment sessions may work best with Hispanic clients. Careful counselor training and supervision in MET may suppress the tendency of counselors to talk informally in sessions

Barrick C; Homish GG. Readiness to change and training expectations prior to a training workshop for substance abuse clinicians. Substance Use & Misuse 46(8): 1032-1036, 2011. (17 refs.)

Understanding clinicians' readiness to change their clinical practice, as well as their training expectations prior to a clinical workshop, may be helpful for improving technology transfer in the substance user treatment field. This study aimed to explore both these areas prior to a workshop designed to offer a new clinical intervention for their practice. Fifty-four clinicians volunteered to participate in a Behavioral Couples Therapy (BCT) workshop. Using negative binomial regression models, significant associations were found between clinicians' readiness to change and training expectations. Participants were found to be highly motivated to learn new technologies and highly endorsed notions of adopting elements of BCT into their practice. There was greater caution with regard to committing to adopt the full protocol. Exploring some of the obstacles in adopting new treatment approaches by even the most motivated of clinicians could be a fruitful area for future research.

Bonar EE; Rosenberg H. Substance abuse professionals' attitudes regarding harm reduction versus traditional interventions for injecting drug users. Addiction Research & Theory 18(6): 692-707, 2010. (22 refs.)

Investigations of attitudes regarding harm reduction have usually assessed the acceptance of specific interventions, but investigators have rarely compared the ratings of harm reduction interventions to the ratings of traditional interventions or tested whether the perceived value of harm reduction interventions varies as a function of client characteristics. Therefore, using a vignette describing an injecting drug user, we tested whether clinical administrators of substance abuse treatment agencies and licensed chemical dependency counselors rated the beneficence (on a 7-point scale from "Extremely Harmful" to "Extremely Beneficial") of injection-related harm reduction interventions (e. g., cleaning needles with bleach, muscling, non-injecting routes of administration) differently from the beneficence of traditional treatment interventions (e. g., self-help group, individual and group counseling), and whether client gender and human immunodeficiency virus (HIV) status impacted such ratings. In Study One, a set of traditional interventions was rated as more beneficial than a set of harm reduction interventions. Study Two showed that a subset of harm reduction interventions designed to prevent transmission of blood-borne diseases was seen as more beneficial than a subset designed to prevent overdose fatalities. Clinical administrators rated harm reduction as more beneficial for HIV-negative clients than for those whose HIV status was described as unknown (Study One), but there was no impact of HIV status on perceived beneficence of harm reduction among licensed chemical dependency counselors (Study Two). Gender of the vignette client did not influence the beneficence ratings in either sample.

Breuer E; Stoloff K; Myer L; Seedat S; Stein DJ; Joska J. Reliability of the lay adherence counsellor administered Substance Abuse and Mental Illness Symptoms Screener (SAMISS) and the International HIV Dementia Scale (IHDS) in a primary care HIV clinic in Cape Town, South Africa. AIDS & Behavior 16(6): 1464-1471, 2012. (28 refs.)

HIV infection is associated with an increased prevalence of common mental disorders and with the development of HIV associated neurological disorders (HAND). The aim of this research was to determine the reliability of lay adherence counsellors in the administration of the Substance Abuse and Mental Illness Symptom Screener (SAMISS) for common mental disorders and International HIV Dementia Scale (IHDS) for HAND in a South African sample of 269 people living with HIV/AIDS and on HAART in a primary healthcare setting. We used a cross-sectional design with each patient assessed by a mental health nurse and counsellor, 1 week apart. Reliability was fair for the SAMISS overall (k = 0.39, CI95 0.29-0.49, P < 0.01), but was higher for the substance abuse component compared to the mental illness component. Reliability for the IHDS between counsellors and nurses was slight (k = 0.11, CI95 0.00-0.27, P < 0.02). Counsellors tended not to miss symptoms, and detected symptoms more often than nurses for the both the SAMISS and IHDS. Strategies to improve the ability of primary healthcare providers to screen for neurocognitive disorders as well as avoiding over-detection of mental illness and substance abuse symptoms need to be developed and implemented for the primary healthcare setting.

Brissenden V; Gleeson M. Professional development ... Beyond a classroom. Drug and Alcohol Review 29(Supplement 1): 9, 2010. (0 refs.)

Industry based e-learning is a growing platform for professional development delivery, offering myriad advantages to organisations wishing to train their workforce. In recent years many industry based training organisations within the AOD sector have extended their training options to include online modalities. UnitingCare Moreland Hall commenced the development of both alcohol and other drugs and mental health online training in 2008. Despite the well documented advantages of online training, there remains a skepticism in many quarters regarding the rigor and credibility of e-learning courses in general. E-learning providers in the AOD sector are faced with the additional challenge of delivering training to an industry whose skills and knowledge are often grounded in human interaction. Moreland Hall's Education and Training Team has recognised the need to address these difficulties and has sought to overcome them through a combination of strategies that inform the unit's instructional design. Engaging writing styles were combined with the use of multimedia and instructional design principles that seek to simulate the rigour and accountability of a classroom environment. To date, Moreland Hall has received very positive feedback on the effectiveness of its online training. In this presentation we will address the key features of a training program that are crucial to the engagement of students in an e-learning environment including: The structural prerequisites that support effective e-learning development; The importance of writing style and structure; The use of multimedia to cater to different learning styles; Examples of simple tools for the development of e-learning multimedia; Instructional design considerations that address some of the barriers to human interaction; and Implications of technological advancement for e-learning in the AOD sector

Brooks AC; DiGuiseppi G; Laudet A; Rosenwasser B; Knoblach D; Carpenedo CM et al. Developing an evidence-based, multimedia group counseling curriculum toolkit. Journal of Substance Abuse Treatment 43(2): 178-189, 2012. (70 refs.)

Training community-based addiction counselors in empirically supported treatments (ESTs) far exceeds the ever-decreasing resources of publicly funded treatment agencies. This feasibility study describes the development and pilot testing of a group counseling toolkit (an approach adapted from the education field) focused on relapse prevention (RP). When counselors (N = 17) used the RP toolkit after 3 hours of training, their content adherence scores on "coping with craving" and "drug refusal skills" showed significant improvement, as indicated by very large effect sizes (Cohen's d = 1.49 and 1.34, respectively). Counselor skillfulness, in the "adequate-to-average" range at baseline, did not change. Although this feasibility study indicates some benefit to counselor EST acquisition, it is important to note that the impact of the curriculum on client outcomes is unknown. Because a majority of addiction treatment is delivered in group format, a multimedia curriculum approach may assist counselors in applying ESTs in the context of actual service delivery.

Brooks AC; Ryder D; Carise D; Kirby KC. Feasibility and effectiveness of computer-based therapy in community treatment. Journal of Substance Abuse Treatment 39(3): 227-235, 2010. (29 refs.)

Computerized therapy approaches may expand the reach of evidence-based treatment; however, it is unclear how to integrate these therapies into community-based treatment. We conducted a two-phase pilot study to explore (a) whether clients' use of the Therapeutic Education System (TES), a Web-based community reinforcement approach (CRA) learning program, would benefit them in the absence of counselor support and (b) whether counselors and clients would use the TES in the absence of tangible research-based reinforcement. In Phase 1, clients in the TES condition (n = 14) demonstrated large improvements in knowledge, F(1, 20) = 8.90, p = .007, d = 1.05, and were significantly more likely to select CRA style coping responses, F(1, 20) = 11.95, p = .002, d = 1.16, relative to the treatment-as-usual group (n = 14). We also detected small, nonsignificant, between-group effects indicating TES decreased cocaine use during treatment. In Phase 2, counselors referred only around 10% of their caseload to the TES, and the modal number of completed modules in the absence of tangible reinforcement was three. Computer-based therapy approaches are viable in community-based treatment but must be integrated with incentive systems to ensure engagement.

Butler S. Addiction counsellors in the Republic of Ireland: Exploring the emergence of a new profession. Drugs: Education, Prevention and Policy 18(4): 295-302, 2011. (31 refs.)

This article reviews the emergence and expansion of addiction counselling as a specialist form of professional practice with problem drinkers and drug users in Ireland, over the past 30 years. It sees addiction counselling as having its roots in a widely shared disenchantment with the ''medical model'' of addiction treatment, and identifies the main factors which have shaped the growth of this new profession over this period. It is argued that statutory health authorities have largely allowed addiction counselling to evolve in an ad hoc style: ceding maximum discretion to individual counsellors and teams of counsellors, while making minimal efforts to standardize counsellor training or to integrate the counsellors'' work into a broader, coherent health service response. Reference is made to attempts currently under way to establish statutory registration systems for addiction counsellors in this country, which, if successful, should raise standards of practice and provide greater protection for members of the public availing themselves of such services. It is also argued, however, that both statutory registration and implementation of Tiered Care models of service delivery are likely to reduce the level of autonomy which addiction counsellors have traditionally enjoyed vis-a-vis service managers.

Chien AT. Can pay for performance improve the quality of adolescent substance abuse treatment? (editorial). Archives of Pediatrics & Adolescent Medicine 166(10): 964-965, 2012. (14 refs.)

Cunningham CE; Henderson J; Niccols A; Dobbins M; Sword W; Chen Y et al. Preferences for evidence-based practice dissemination in addiction agencies serving women: A discrete-choice conjoint experiment. Addiction 107(8): 1512-1524, 2012. (89 refs.)

Aim: To model variables influencing the dissemination of evidence-based practices to addiction service providers and administrators. Design: A discrete-choice conjoint experiment. We systematically varied combinations of 16 dissemination variables that might influence the adoption of evidence-based practices. Participants: chose between sets of variables. Setting Canadian agencies (n = 333) providing addiction services to women. Participants: Service providers and administrators (n = 1379). Measurements: We estimated the relative importance and optimal level of each dissemination variable. We used latent class analysis to identify subsets of participants with different preferences and simulated the conditions under which participants would use more demanding professional development options. Findings: Three subsets of participants were identified: outcome-sensitive (52%), process-sensitive (29.6%) and demand-sensitive (18.2%). Across all participants, the number of clients who were expected to benefit from an evidence-based practice exerted the most influence on dissemination choices. If a practice was seen as feasible, co-worker and administrative support influenced decisions. Client benefits were most important to outcome-sensitive participants; type of dissemination process (e.g. active versus passive learning) was more important to process-sensitive participants. Brief options with little follow-up were preferred by demand-sensitive participants. Simulations predicted that initiatives selected and endorsed by government funders would reduce participation. Conclusions: Clinicians and administrators are more likely to adopt evidence-based addiction practices if the practice is seen as helpful to clients, and if it is supported by co-workers and program administration.

Curtis SL; Eby LT. Recovery at work: The relationship between social identity and commitment among substance abuse counselors. Journal of Substance Abuse Treatment 39(3): 248-254, 2010. (43 refs.)

The complex makeup of the substance abuse treatment workforce poses unique challenges to the field. One interesting dynamic is the high rate of counselors who are personally recovering from addictions. Based on social identity theory, it was expected that counselors working in the field of substance abuse treatment who are in recovery themselves will identify more with their profession and report higher professional and organizational commitment. Data from a study of substance abuse counselors from across the United States support the proposed relationship between personal recovery status and professional commitment but not organizational commitment.

Doukas N; Cullen J. Recovered addicts working in the addiction field: Pitfalls to substance abuse relapse. Drugs: Education, Prevention and Policy 17(3): 216-231, 2010. (71 refs.)

In the 1940s, due to a shortage of professional counselors, combined with the hope of rehabilitation for the addict, there grew a belief that the recovered alcoholic could be trained to enter the field of addiction treatment as a paraprofessional. These early stages of addiction treatment and the emergence of the recovered substance abuser as a counselor fostered a discussion in the role played by the paraprofessional. This discussion subsequently encouraged an accumulation of literature during the early stages of substance abuse treatment in North America, which later began to diminish as the field moved forward towards the twenty-first century. This paper reviews the literature to examine the perceived potential risks for relapse associated with recovered addicts working in the addictions field. Potential risks for relapse discussed are the ex-addict's motivation for entering the addiction field, personal help from self-help groups may be lost once in the field, over involvement with clients, over involvement with work, over identification with clients and the repercussions of relapse. The paper also addresses the limitations of the studies conducted to date, provides recommendations for further research and proposes that this topic be explored using a qualitative approach, so that recovered counselors can construct their own narratives.

Ducharme LJ; Knudsen HK; Abraham AJ; Roman PM. Counselor attitudes toward the use of motivational incentives in addiction treatment. American Journal on Addictions 19(6): 496-503, 2010. (39 refs.)

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.

Eby LT; Burk H; Maher CP. How serious of a problem is staff turnover in substance abuse treatment? A longitudinal study of actual turnover. Journal of Substance Abuse Treatment 39(3): 264-271, 2010. (33 refs.)

In the substance abuse treatment field, the annual turnover rate is cited as being anywhere between 19% and 50% (J.A. Johnson & P. M. Roman, 2002; S.L. Gallon, R.M. Gabriel, J.R.W. Knudsen, 2003; H.K. Knudsen, J.A. Johnson, & P.M. Roman, 2003; A.T. McLellan, D. Carise, & H.D. Kleber, 2003). However, no research to date has evaluated these claims by tracking turnover longitudinally using organizational turnover data from substance abuse treatment centers. This research presents the results of a longitudinal study designed to systematically examine actual turnover among counselors and clinical supervisors. Twenty-seven geographically dispersed treatment organizations, serving a wide range of clients in the public and private sector, provided data for the study over a 2-year time span (2008-2009). The annual turnover rate was 33.2% for counselors and 23.4% for clinical supervisors. For both groups, the majority of turnover was voluntary (employee-initiated). Specific reasons for turnover were largely consistent across the two groups, with the most common reason being a new job or new opportunity. The findings are discussed in terms of the unique employment context of substance abuse treatment. Practical recommendations are also discussed to help stem the tide of turnover in the field of substance abuse treatment.

Eby LT; Rothrauff-Laschober TC. The relationship between perceptions of organizational functioning and voluntary counselor turnover: A four-wave longitudinal study. Journal of Substance Abuse Treatment 42(2, special issue): 151, 2012. (41 refs.)

Using data from a nationwide study, we annually track a cohort of 598 substance use disorder counselors over a four-wave period to (a) document the cumulative rates of voluntary turnover and (b) examine how counselor perceptions of the organizational environment (procedural justice, distributive justice, perceived organizational support, and job satisfaction) and clinical supervisor leadership effectiveness (relationship quality, in-role performance, extra-role performance) predict voluntary turnover over time. Survey data were collected from counselors in Year 1, and actual turnover data were collected from organizational records in Years 2, 3, and 4. Findings reveal that 25% of the original counselors turned over by Year 2, 39% by Year 3, and 47% by Year 4. Counselors with more favorable perceptions of the organizational environment are between 13.8% and 22.8% less likely to turn over than those with less favorable perceptions. None of the leadership effectiveness variables are significant.

Eversman M. Harm reduction practices in outpatient drug-free substance abuse settings. Journal of Substance Use 17(2): 150-162, 2012. (34 refs.)

Objective: In the United States, drug-free (non-drug substitution) substance abuse treatment practices are informed by an abstinence-only model that has been criticized as hindering service retention and utilization. The public health paradigm of harm reduction offers alternative treatment practice ideas, yet little is known about how they are viewed by front-line practitioners in these settings. Methods: Using semi-structured interviewing, this qualitative study explored support for and use of harm reduction amongst a sample of 15 practitioners from 9 outpatient drug-free substance abuse agencies. Results: Respondents identified personal, professional, contextual and client factors as indicating or contraindicating harm reduction. Support for specific practices (tapering plans, non-abstinence treatment goals and substance use management) was limited, although harm reduction was supported as a guiding practice philosophy and in non-substance using areas of clients' lives. Specific concerns were articulated as personal objections to harm reduction, needing to send an abstinence-based message, and inter- and intra-agency dynamics and formal and informal policies. Conclusions: The generalizability of the study is unknown, but it provides a framework for understanding harm reduction practices in these settings. Practitioner support for harm reduction in these settings does exist but is highly qualified and nuanced.

Garner BR; Godley SH; Dennis ML; Hunter BD; Bair CML; Godley MD. Using pay for performance to improve treatment implementation for adolescent substance use disorders. Archives of Pediatrics & Adolescent Medicine 166(10): 938-944, 2012. (43 refs.)

Objective: To test whether pay for performance (P4P) is an effective method to improve adolescent substance use disorder treatment implementation and efficacy. Design: Cluster randomized trial. Setting: Community-based treatment organizations. Participants: Twenty-nine community-based treatment organizations, 105 therapists, and 986 adolescent patients (953 with complete data). Intervention: Community-based treatment organizations were assigned to 1 of the following conditions: the implementation-as-usual (IAU) control condition or the P4P experimental condition. In addition to delivering the same evidence-based treatment (i.e., using the Adolescent Community Reinforcement Approach [A-CRA]), each organization received standardized levels of funding, training, and coaching from the treatment developers. Therapists in the P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (i.e., A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions (i.e., target A-CRA) that has been found to be associated with significantly improved patient outcomes. Main Outcome Measures: Outcomes included ACRA competence (i.e., a therapist-level implementation measure), target A-CRA (i.e., a patient-level implementation measure), and remission status (i.e., a patient-level treatment effectiveness measure). Results: Relative to therapists in the IAU control condition, therapists in the P4P condition were significantly more likely to demonstrate A-CRA competence (24.0% vs. 8.9%; event rate ratio, 2.24; 95% CI, 1.12-4.48; P = .02). Relative to patients in the IAU control condition, patients in the P4P condition were significantly more likely to receive target A-CRA (17.3% vs. 2.5%; odds ratio, 5.19; 95% CI, 1.53-17.62; P = .01). However, no significant differences were found between conditions with regard to patients' end-of-treatment remission status. Conclusion: Pay for performance can be an effective method of improving treatment implementation.

Garner BR; Hunter BD; Godley SH; Godley MD. Training and retaining staff to competently deliver an evidence-based practice: The role of staff attributes and perceptions of organizational functioning. Journal of Substance Abuse Treatment 42(2. special issue): 191, 2012. (54 refs.)

Within the context of an initiative to implement evidence-based practices (EBPs) for adolescents with substance use disorders, this study examined the extent to which staff factors measured at an initial EBP training workshop were predictive of EBP competence and turnover status of staff (N = 121) measured 6, 9, and 12 months posttraining. By the final assessment point, 52.3% of staff transitioned to the employed/EBP-competent category, 26.6% transitioned to the not employed/not EBP-competent category, 4.6% transitioned to the not employed/EBP-competent category, and 16.5% had not transitioned out of the initial category. Multilevel multinomial regression analysis identified several measures that were significant predictors of staff transitions to the not employed/not EBP-competent category (e.g., program needs, job satisfaction, burnout) and transitions to the employed/EBP-competent category (e.g., months in position, pressures for change, influence). Findings have implications for the development and testing of strategies to train and retain staff to deliver EBPs in practice settings.

Garner BR; Hunter BD; Modisette KC; Ihnes PC; Godley SH. Treatment staff turnover in organizations implementing evidence-based practices: Turnover rates and their association with client outcomes. Journal of Substance Abuse Treatment 42(2, special issue): 134, 2012. (40 refs.)

High staff turnover has been described as a problem for the substance use disorder treatment field. This assertion is based primarily on the assumption that staff turnover adversely impacts treatment delivery and effectiveness. This assumption, however, has not been empirically tested. In this study, we computed annualized rates of turnover for treatment staff (N = 249) participating in an evidence-based practice implementation initiative and examined the association between organizational-level rates of staff turnover and client-level outcomes. Annualized rates of staff turnover were 31% for clinicians and 19% for clinical supervisors. In addition, multilevel analyses did not reveal the expected relationship between staff turnover and poorer client-level outcomes. Rather, organizational-level rates of staff turnover were found to have a significant positive association with two measures of treatment effectiveness: less involvement in illegal activity and lower social risk. Possible explanations for these findings are discussed.

Gogel LP; Cavaleri MA; Gardin JG; Wisdom JP. Retention and ongoing participation in residential substance abuse treatment: Perspectives from adolescents, parents and staff on the treatment process. Journal of Behavioral Health Services & Research 38(4): 488-496, 2011. (39 refs.)

Many adolescents entering substance abuse treatment do not stay for the full course of prescribed treatment. There have been few explorations into what facilitates the ongoing participation of adolescents while in treatment. This paper describes adolescent, parent, and treatment staff perceptions of the barriers and facilitators to retention and participation. Interviews were conducted with 87 adolescents, parents, and staff from three residential substance abuse treatment agencies in two states. Data were coded thematically and organized into themes by respondent type. Respondents reported barriers related to treatment population, program design, and communication and relationships, and reported facilitators related only to communication and relationships. Staff reported far more barriers than facilitators in comparison to either adolescents or parents. Findings suggest that parents and staff underestimate their contributions to the treatment process and practitioners might benefit from rethinking how to communicate the value of these stakeholders.

Guerrero EG. Managerial capacity and adoption of culturally competent practices in outpatient substance abuse treatment organizations. Journal of Substance Abuse Treatment 39(4): 329-339, 2010. (51 refs.)

The field of cultural competence is shifting its primary emphasis from enhancement of counselors skills to management organizational policy and processes of care This study examined managers' characteristics associated with adoption of culturally competent practices in the nation's outpatient substance abuse treatment field Findings indicate that in 1995, supervisors cultural sensitivity played the most significant role in adopting practices, such as matching counselors and clients based on race and offering bilingual services Staff's exposure to cross-cultural training increased from 1995 to 2005. In this period positive associations were found between managers cultural sensitivity and connection with the community and staff receiving cross-cultural training and the number of training hours completed. However, exposure to and investment in this training were negatively correlated with managers' formal education. Health administration policy should consider the extent to which the decision makers education, community involvement and cultural sensitivity contribute to building culturally responsive systems of care.

Hartzler B; Donovan DM; Tillotson CJ; Mongoue-Tchokote S; Doyle SR; McCarty D. A multilevel approach to predicting community addiction treatment attitudes about contingency management. Journal of Substance Abuse Treatment 42(2. special issue): 213, 2012. (58 refs.)

Adoption of contingency management (CM) by the addiction treatment community is limited to date despite much evidence for its efficacy. This study 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. 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 and established implementation science constructs, and their practical implications are discussed.

Harvey R; Jason LA. Contrasting social climates of small peer-run versus a larger staff-run substance abuse recovery setting. American Journal of Community Psychology 48(3-4): 365-372, 2011. (37 refs.)

This study compared the social climate of peer-run homes for recovering substance abusers called Oxford House (OH) to that of a staffed residential therapeutic community (TC). Residents of OHs (N = 70) and the TC (N = 62) completed the Community Oriented Programs Environment Scales. OHs structurally differ on two primary dimensions from TCs in that they tend to be smaller and are self-run rather than professionally run. Findings indicated significantly higher Involvement, Support, Practical Orientation, Spontaneity, Autonomy, Order and Organization, and Program Clarity scores among the OH compared to TC residents. Additional analyses found the OH condition was higher Support, Personal Problem Orientation, and Order and Organization scores among women compared to men residents. These results suggested that these smaller OH self-run environments created a more involving and supportive social milieu than a larger staff-run TC. These findings are interpreted within Moos' (2007) four theoretical ingredients (i.e., social control, social learning, behavioral economics, and stress and coping), which help account for effective substance abuse treatment environments.

Hepner KA; Hunter SB; Paddock SM; Zhou AJ; Watkins KE. Training addiction counselors to implement CBT for depression. Administration and Policy in Mental Health and Mental Health Services Research 38(4, special issue): 313-323, 2011. (48 refs.)

Many clients in publicly funded substance abuse treatment programs suffer from depression yet lack access to effective mental health treatment. This study sought to examine whether addiction counselors could be effectively trained to deliver group CBT for depression and to ascertain client perceptions of the treatment. Five counselors were trained in the therapy and treated 113 clients with depression symptoms. Counselors demonstrated high fidelity to the therapy and client perceptions of the therapy were positive. Our results suggest that training addiction counselors to deliver group CBT for depression is a promising integrated treatment approach for co-occurring depression and substance disorders.

Hunt JJ; Cupertino AP; Garrett S; Friedmann PD; Richter KP. How is tobacco treatment provided during drug treatment? Journal of Substance Abuse Treatment 42(1): 4-15, 2012. (41 refs.)

The purpose of this study was to obtain descriptions of tobacco treatment services across different substance abuse treatment settings. We conducted mixed-method assessments in eight facilities among eight directors, 25 staff, 29 clients, and 82 client charts. Measures included systems assessment, chart reviews, and semistructured interviews. Although many programs reported they offer key components of evidence-based treatment, few actually provided any treatment and none did so systematically. Many addressed tobacco as part of drug education or part of a health promotion session. Chart reviews suggested that provision of tobacco treatment is rare. By many reports, clients had to specifically request treatment and few staff reported encouraging unmotivated smokers to quit. Systems to facilitate consistent, evidence-based tobacco treatment and to implement quality improvement were nonexistent. The findings imply that drug treatment facilities may need to build capacity in several domains to deliver care that is consistent with national guidelines.

Institute of Medicine. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press, 2012. (Chapter refs.)

Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade--in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD). To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs), including issues of confidentiality, staff development, the need for more outpatient treatment services, and evidence-based care. This report reviews the IOM's task of assessing access to SUD care for service members, and their dependents, as well as the education and credentialing of SUD care providers. It then sets forth specific recommendations to DoD on where and how improvements in these areas could be made.

Ives R. Meeting professionals' needs in the United Kingdom for effective VSM intervention. Substance Use & Misuse 46(Supplement 1): 134-139, 2011. (17 refs.)

An exploratory study examined what professionals needed to support their responses to volatile substance misuse (VSM). Many respondents saw VSM as a problem of unknown dimensions and were uncertain about how to tackle it. Resources for treatment and prevention were seen as outdated. Workers were concerned that VSM was becoming more common among adults, supporting an indication found in a study of VSM-related deaths. Evidence-informed treatment protocols, information on working with clients, assessments of local needs, and the evaluation of existing approaches to VSM would improve the response. A further phase of the research will be reported in 2012.

Johnson KA; Ford JH; McCluskey M. Promoting new practices to increase access to and retention in addiction treatment: An analysis of five communication channels. Addictive Behaviors 37(11): 1193-1197, 2012. (15 refs.)

Addiction treatment programs adopt evidence-based practices slowly, in part because adopting a new practice is a process, not an event. Using different communication channels may have a different effect at different points in the process. This paper reports the effectiveness of five communication channels in getting substance abuse treatment programs to adopt new business practices. In this study, national trade media coverage produced the greatest interest among programs and the greatest number of decisions to adopt. Conference presentations produced fewer decisions to adopt than national media, but were the most effective channel when compared to the number of programs they reached. Peers were the greatest influence in moving clinic staff from the decision to adopt to implementation. These findings give preliminary evidence for using different communication channels at different times during an effort to promote the adoption of best practices.

Johnson ME; Robinson RV; Corey S; Dewane SL; Brems C; Casto LD. Knowledge, attitudes, and behaviors of health, education, and service professionals as related to fetal alcohol spectrum disorders. International Journal of Public Health 55(6): 627-635, 2010. (27 refs.)

We explored differences in fetal alcohol spectrum disorders (FASD) knowledge, attitudes, and behaviors across six groups of professionals in key position to provide primary and secondary prevention efforts (physicians, educators, correctional staff, social workers, public health nurses, and substance abuse counselors). Achieving a 60.1% response rate, 2,292 professionals returned surveys, providing data on basic knowledge of FAS, FASD-associated risks and cognitive deficits, and willingness to confront and recommend treatment to alcohol-consuming pregnant women. Across groups, findings revealed ample FASD knowledge and willingness to confront and recommend treatment to alcohol-consuming pregnant women that increases as consumption becomes more frequent and severe. However, results revealed significant between-group differences data that provide valuable guidance for targeted future FASD education efforts. Public health initiatives regarding FASD have been effective in increasing knowledge among a broad range of professionals. However, between-group differences indicate the need for targeted, discipline-specific interventions. These differences highlight the need for all professional groups to provide a consistent public health message regarding maternal alcohol consumption.

Kelly PJ; Deane FP; Lovett MJ. Using the theory of planned behavior to examine residential substance abuse workers intention to use evidence-based practices. Psychology of Addictive Behaviors 26(3): 661-664, 2012. (13 refs.)

There is considerable discrepancy between what is considered evidence-based practice (EBP) and what is actually delivered in substance abuse treatment settings. The Theory of Planned Behavior (TpB) is a well-established model that may assist in better understanding clinician's intentions to use EBPs. A total of 106 residential substance abuse workers employed by The Salvation Army participated in the current study. The workers completed an anonymous survey that assessed attitudes toward EBP and examined the constructs within the TpB. A linear regression analysis was used to predict clinicians' intentions to use EBPs. Overall, the model accounted for 41% of the variance in intentions, with attitudes, subjective norms, and perceived behavioral control all significant predictors. The discussion highlights the potential for social reinforcement in the workplace to promote the implementation of EBPs.

Knight DK; Becan JE; Flynn PM. Organizational consequences of staff turnover in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment 42(2, special issue): 143, 2012. (47 refs.)

The purpose of this study was to examine the impact of staff turnover on perceptions of organizational demands and support among staff who remained employed in substance abuse treatment programs. The sample consisted of 353 clinical staff from 63 outpatient agencies. Two scales from the Survey of Organizational Functioning measured work environment demands (stress and inadequate staffing), and 3 measured supportive work relationships (communication, cohesion, and peer collaboration). Results from a series of multilevel models documented that counselors working in programs that had previously experienced high staff turnover perceived higher demands and lower support within their organization, even after controlling for other potentially burdensome factors such as budget, census, and individual measures of workload. Two individual-level variables, caseload and tenure, were important determinants of work environment demands but were not related to supportive work relationships. Findings suggest that staff turnover increases workplace demands, decreases perceptions of support, and underscores the need to reduce stress and minimize subsequent turnover among clinical staff.

Knight DK; Landrum B; Becan JE; Flynn PM. Program needs and change orientation: Implications for counselor turnover. Journal of Substance Abuse Treatment 42(2. special issue): 159, 2012. (41 refs.)

Although evidence suggests that turnover rates are higher in high-stress/high-needs work environments, it is unclear whether agencies' attempts at improving practices influence individuals' decisions to stay at or leave a job. The purpose of this study was to examine whether program needs and change orientation influence individual decisions to quit. A sample of 206 counselors from 25 outpatient substance abuse treatment programs completed the Survey of Organizational Functioning, rating the organization on program needs, leadership, and change. They also rated themselves on stress, burnout, and job satisfaction. Multilevel modeling indicated a significant interaction between program needs and change orientation, even after controlling for stress, burnout, job satisfaction, tenure, and selected program characteristics. When perceptions of program needs were high, counselors were more likely to stay if they felt that the organization was making progress toward change. These findings suggest that an orientation toward change can counteract negative effects of perceived need within the workplace.

Knudsen HK; Boyd SE; Studts JL. Substance abuse treatment counselors and tobacco use: A comparison of comprehensive and indoor-only workplace smoking bans. Nicotine & Tobacco Research 12(11): 1151-1155, 2010. (41 refs.)

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

Knudsen HK; Studts JL. The implementation of tobacco-related brief interventions in substance abuse treatment: A national study of counselors. Journal of Substance Abuse Treatment 38(3): 212-219, 2010. (48 refs.)

Most individuals receiving substance abuse treatment also use tobacco, which suggests that smoking cessation is an important clinical target for most clients. Few studies have measured the extent to which addiction treatment counselors address clients' tobacco use. In this study, we examined counselors' implementation of brief interventions that are consistent with the U.S. Public Health Service's (PHS) clinical practice guideline, Treating Tobacco Use and Dependence, when Counselors are engaging new clients in treatment. We hypothesized that counselors' implementation of tobacco-related brief interventions is associated with organizational and counselor-level factors. Data were collected from 2,067 counselors via mailed surveys. Implementation of recommended brief interventions during intake was significantly lower among counselors reporting greater barriers to smoking cessation services within their organizational context. Perceived managerial support for smoking cessation services was positively associated with implementation. Counselors with greater knowledge of the PHS guideline and who believed in the positive impact of smoking cessation interventions on sobriety reported greater implementation. Relative to counselors who have never been tobacco users, current tobacco users reported significantly lower implementation of these brief interventions. These findings suggest that attempts to increase the implementation of best practices in substance abuse treatment may require attention to organizational contexts and the individuals responsible for implementation.

Kotecha J; Savage C. Primary care and collaboration with addiction counselors. (commentary). Canadian Family Physician 56(6): 557-557, 2010. (2 refs.)

Landrum B; Knight DK; Flynn PM. The impact of organizational stress and burnout on client engagement. Journal of Substance Abuse Treatment 42(2. special issue): 222, 2012. (52 refs.)

This article explores the impact of organizational attributes on client engagement within substance abuse treatment. Previous research has identified organizational features, including small size, accreditation, and workplace practices, that impact client engagement (K. M. Broome, P. M. Flynn, D. K. Knight, & D. D. Simpson, 2007). This study sought to explore how aspects of the work environment impact client engagement. The sample included 89 programs located in 9 states across the United States. Work environment measures included counselor perceptions of stress, burnout, and work satisfaction at each program, whereas engagement measures included client ratings of participation, counseling rapport, and treatment satisfaction. Using multiple regression, tests of moderation and mediation revealed that staff stress negatively predicted client participation in treatment. Burnout was related to stress but was not related to participation. Two additional organizational measures-workload and influence-moderated the positive relationship between staff stress and burnout. Implications for drug treatment programs are discussed.

Lehman WEK; Becan JE; Joe GW; Knight DK; Flynn PM. Resources and training in outpatient substance abuse treatment facilities. Journal of Substance Abuse Treatment 42(2. special issue): 169, 2012. (35 refs.)

The exposure to new clinical interventions through formalized training and the utilization of strategies learned through training are two critical components of the program change process. This study considers the combined influence of actual program fiscal resources and counselors' perceptions of workplace resources on two mechanisms of training: exposure and utilization. Data were collected from 323 counselors nested within 59 programs located in nine states. Multilevel analysis revealed that training exposure and training utilization represent two distinct constructs that are important at different stages in the Program Change Model. Training exposure is associated primarily with physical and financial resources, whereas utilization is associated-with professional community and job burnout. These results suggest that financial resources are important in initial exposure to new interventions but that successful utilization of new techniques depends in part on the degree of burnout and collaboration experienced by counselors.

Leykin Y; Cucciare MA; Weingardt KR. Differential effects of online training on job-related burnout among substance abuse counsellors. Journal of Substance Use 16(2): 127-135, 2011. (15 refs.)

High voluntary turnover of substance abuse counsellors is a recognised and pervasive problem, likely due in large part to job-related burnout experienced by providers. This article explores the influence of the type of training on three facets of burnout (emotional exhaustion, depersonalisation and a reduced perception of personal accomplishments) among substance abuse counsellors participating in an online training protocol consisting of cognitive-behavioural therapy for substance use. Two training types were used: high fidelity (i.e. structured, didactic "classroom"-style training), and low fidelity (i.e. more flexible and customisable training). Participation in a more flexible training model predicted lower burnout scores for participants both immediately and 6 months after training. Participants with a history of personal recovery from substance abuse and those working in positions of leadership also reported lower burnout scores after training. We conclude that perception of support and flexibility in the workplace may be helpful to prevent burnout and decrease existing burnout.

Martin JA; Campbell A; Killip T; Kotz M; Krantz MJ; Kreek MJ et al. QT Interval screening in methadone maintenance treatment: Report of a SAMHSA expert panel. (editorial). Journal of Addictive Diseases 30(4): 283-306, 2011. (108 refs.)

In an effort to enhance patient safety in opioid treatment programs, the Substance Abuse and Mental Health Services Administration convened a multi-disciplinary Expert Panel on the Cardiac Effects of Methadone. Panel members (Appendix A) reviewed the literature, regulatory actions, professional guidances, and opioid treatment program experiences regarding adverse cardiac events associated with methadone. The Panel concluded that, to the extent possible, every opioid treatment program should have a universal Cardiac Risk Management Plan (incorporating clinical assessment, electrocardiogram assessment, risk stratification, and prevention of drug interactions) for all patients and should strongly consider patient-specific risk minimization strategies (such as careful patient monitoring, obtaining electrocardiograms as indicated by a particular patient's risk profile, and adjusting the methadone dose as needed) for patients with identified risk factors for adverse cardiac events. The Panel also suggested specific modifications to informed consent documents, patient education, staff education, and methadone protocols.

Martino S; Canning-Ball M; Carroll KM; Rounsaville BJ. A criterion-based stepwise approach for training counselors in motivational interviewing. Journal of Substance Abuse Treatment 40(4): 357- 365, 2011. (36 refs.)

This pilot study evaluated a criterion-based stepwise approach for training counselors in motivational interviewing (MI). Three sequential steps of training in MI were provided to 26 counselors who worked within the U.S. State of Connecticut Veterans Administration addiction treatment programs: a distance learning Web course (Step I), a skill-building workshop (Step 2), and a competency-based individual supervision (Step 3). Counselors first participated in the course and then only received the next step of training if they failed to meet an independently rated criterion level of adequate MI performance. The results showed that counselors who showed inadequate MI performance immediately after taking the Web course and who subsequently participated in a workshop or supervision improved their adherence to fundamental MI strategies over time, whereas those who performed MI adequately following the Web course continued to demonstrate similar levels of fundamental and advanced MI adherence and competence over a 24-week period without additional training. The pilot study's findings, although preliminary, suggest that different counselors likely require different types and amounts of training to perform a behavioral treatment well.

McDermott MS; West R; Brose LS; McEwen A. Self-reported practices, attitudes and levels of training of practitioners in the English NHS Stop Smoking Services. Addictive Behaviors 37(4): 498-506, 2012. (19 refs.)

The primary aim of the current study is to investigate the self-reported practices, attitudes and levels of training of stop smoking practitioners (SSPs) working at the English National Health Service's (NHS) Stop Smoking Services (SSSs). A secondary aim was to investigate differences between 'Specialist' and 'Community' SSPs. An online survey was conducted with 484 SSPs. Most (94%) SSPs offered one-to-one appointments to smokers, only 43% always used the abrupt quit model and 30% reported ever recommending particular medication to clients. SSPs reported an average of 3.7 days training when starting work and 26% reported never observing an experienced practitioner before seeing clients of their own. Over half (56%) never received clinical supervision. SSPs reported having generally positive attitudes towards their jobs, but reported feeling less positive about their prospects for future employment within the field. 'Specialist' SSPs reported receiving more days training (4.1 vs. 3.0, p=0.002), more days observing an experienced practitioner when starting work (12.9 vs. 6.6, p<0.001) and were more likely to receive clinical supervision (48.9% vs. 34.9%, p<0.05) than 'Community' SSPs. Gaps between SSPs' current practices and evidence-based guidelines may be due to inadequate training. Similarly, differences in training between specialist and community SSPs may contribute to the observed difference in these practitioners' success rates. As recommended by the Department of Health for England, standardized training in evidence-based smoking cessation interventions should be implemented for both specialist and community SSPs.

Mills KL. National comorbidity guidelines for the AOD workforce: How useful are they? Drug and Alcohol Review 29(Supplement 1): 52, 2010. (0 refs.)

Background: Comorbid mental health conditions are common among people with alcohol and other drug (AOD) use disorders and present a significant challenge to AOD workers. To assist AOD workers in working with clients with comorbid AOD and mental health conditions, the Australian Government Department of Health and Ageing funded the National Drug and Alcohol Research Centre to develop guidelines on the management of co-occurring mental health conditions in AOD treatment settings. The Guidelines were released in December 2009. Hard copies were distributed to all AOD treatment services across Australia and electronic copies were available for free download from the internet (http: ndarc.med.unsw. edu.au/comorbidity). This paper examines the relevance and utility of the Guidelines to the AOD workforce. Methods: An online survey was made available for AOD workers to provide feedback on the usefulness of the Guidelines and their relevance for clinical practice. The survey comprised a mixture of open and closed questions. Results: In the first 3 months after the release of the Guidelines, 80 online-surveys were completed. Overall satisfaction with the Guidelines as a resource was high (94%). The majority of respondents thought that the Guidelines would be useful (94%) and would assist with clinical decision making (66%). In particular, respondents indicated that the Guidelines effectively illustrated links between the theory of responding to comorbidity and the practical aspects of responding (88%). Eighty-six percent reported that the Guidelines would enable them to respond to comorbidity related issues with greater confidence. The majority (92%) indicated that that would use some of the things they learnt from the Guidelines in their work. Conclusions: The feedback received was overwhelmingly positive, indicating that the resource is acceptable to the AOD field. Of primary importance, the vast majority AOD workers perceived that the Guidelines would be both useful and relevant in their clinical practice.

Newcombe D; Beatty S; Athanasos P; Roche A. What is the desirable model of addiction training in Australian and New Zealand? Drug and Alcohol Review 29(Supplement 1): 55-56, 2010. (0 refs.)

Background: In Australia and New Zealand addiction training is available at undergraduate and postgraduate levels in both the higher education and vocational education sector. Addiction workers can enter training at pre-degree level (e.g., Certificate IV) or at undergraduate level, while others can enter at post graduate level following completion of a generic educational programme (i.e., nursing, medicine, counselling etc.). While the emergence of such a (c) 2010 Australasian Professional Society on Alcohol and other Drugs 56 Abstract variety of training courses translates to increased availability and choice to the student it has largely occurred ad hoc, i.e. without adequate planning. As a result there has been little attempt to ensure uniformity in addiction training in the region. The implications of this include: a) Uncertainly for both students and employers; for the student in deciding what program is most relevant for their needs; for employers in fully comprehending the qualities graduates emerge with (in terms of knowledge and clinical competencies) and therefore whether they are suitable to employ in particular contexts. b) The lack of a systematic approach to avoid/address duplication across sectors and jurisdiction which has led to the development of similar programs within single jurisdictions/states. Analysis: With this context in mind this paper will critically explore a number of important questions/issues important to workforce development in the region. a) Given the cross disciplinary nature of the addiction workforce in the region, what extent does the current training model meet training needs of the workforce? [significant proportion of the addiction workforce, particularly the NGO workforce, do not have formal addiction qualifications] Should qualifications be viewed as mutually exclusive or should less advanced qualifications staircase to more advanced (i.e., undergraduate certificate through to post graduate qualifications)? b) At what stage in the training process is it appropriate to introduce specialist alcohol and drug content? i.e., need /desirability to have some generic training (human sciences) and maturity. Should there be a minimum qualification requirement for employment in the field?

Nguyen LM; Aylward P. Criminal conduct and substance abuse treatment, strategies for "self-improvement and change" model: A revision and adaptation of the SSC model to suit the Vietnamese cultural context. Drug and Alcohol Review 29(Supplement 1): 56, 2010. (0 refs.)

This project was collaborative, engaging a range of service providers including Drugs and Alcohol Services SA, Flinders Therapeutic Service, Adelaide University and SAPOL. It aims to build capacity of Vietnamese Community in Australia/SA, its staff and partnering agencies by applying 'action learning' principles to develop and deliver a Cognitive Behavioural Therapy, Strategies for Self Improvement and Change (SSC) treatment service to Vietnamese drug users in a therapeutic setting through: Cultural revision and adaptation of SSC model workbook: The two main areas of the SSC have been particularly revised are: - the model process - cultural appropriateness, and - model content; Provision of a four day CBT training for VCASA AOD Staff and partnering agencies, delivering by Dr. Harvey Milkman; Provision of an ATS information training session for all VCASA AOD staff; Delivery and trial of the CBT model through a 6 month program for Vietnamese Amphetamine users The project contracted Dr. Harvey Milkman as a partner in the reviewing and adaptation of his CBT model. Translation was externally contracted with substantial contributions from internal staff. Harm reduction was integrated into the model and the manual checked for clinical validity by both Dr. Milkman and DASSA. The model was condensed and structured with all materials and tasks translated and adapted for cultural congruence; suitability was further enhanced through client consultation. The model resources were confirmed as culturally appropriate by Vietnamese clients

Olmstead TA; Abraham AJ; Martino S; Roman PM. Counselor training in several evidence-based psychosocial addiction treatments in private US substance abuse treatment centers. Drug and Alcohol Dependence 120(1-3): 149-154, 2012. (24 refs.)

Background: Given that most addiction counselors enter the field unprepared to implement psychosocial evidence-based practices (EBPs), surprisingly little is known about the extent to which substance abuse treatment centers provide their counselors with formal training in these treatments. This study examines the extent of formal training that treatment centers provide their counselors in cognitive behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), and brief strategic family therapy (BSFT). Methods: Face-to-face interviews with 340 directors of a nationally representative sample of privately funded US substance abuse treatment centers. Results: Although a substantial number of treatment centers provide their counselors with formal training in EBPs that they use with their clients, coverage is far from complete. For example, of those centers that use CBT, 34% do not provide their counselors with any formal training in CBT (either initially or annually), and 61% do not provide training in CBT that includes supervised training cases. Sizable training gaps exist for MI, CM, and BSFT as well. Conclusions: The large training gaps found in this study give rise to concerns regarding the integrity with which CBT, MI, CM, and BSFT are being delivered by counselors in private US substance abuse treatment centers. Future research should examine the generalizability of our findings to other types of treatment centers (e.g., public) and to the implementation of other EBPs.

Oser CB; Biebel EP; Pullen EL; Harp KLH. The influence of rural and urban substance abuse treatment counselor characteristics on client outcomes. Journal of Social Service Research 37(4): 390-402, 2011. (44 refs.)

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.

Peterson TA; Desmond JS; Cunningham R. Use of an administrative data set to determine optimal scheduling of an alcohol intervention worker. Journal of Emergency Medicine 42(6): 712-718, 2012. (16 refs.)

Background: Brief alcohol interventions are efficacious in reducing alcohol-related consequences among emergency department (ED) patients. Use of non-clinical staff may increase alcohol screening and intervention; however, optimal scheduling of an alcohol intervention worker (AIW) is unknown. Objectives: Determine optimal scheduling of an AIW based on peak discharge time of alcohol-related ED visits. Methods: Discharge times for consecutive patients with an alcohol-related diagnosis were abstracted from an urban ED's administrative data set from September 2005 through August 2007. Queuing theory was used to identify optimal scheduling. Data for weekends and weekdays were analyzed separately. Stationary independent period-by-period analysis was performed for hourly periods. An M/M/s queuing model, for Markovian inter-arrival time/Markovian service time/and potentially more than one server, was developed for each hour assuming: 1) a single unlimited queue; 2) 75% of patients waited no longer than 30 min for intervention; 3) AIW spent an average 20 min/patient. Estimated average utilization/hour was calculated; if utilization/hour exceeded 25%, AIW staff was considered necessary. Results: There were 2282 patient visits (mean age 38 years, range 11-84 years). Weekdays accounted for 45% of visits; weekends 55%. On weekdays, one AIW from 6:00 a.m.-9:00 a.m. (max utilization 42%/hour) would accommodate 28% of weekday alcohol-related patients. On weekends, 5:00 a.m.-11:00 a.m. (max utilization 50%), one AIW would cover 54% of all weekend alcohol-related visits. During other hours the utilization rate falls below 25%/hour. Conclusions: Evaluating 2 years of discharge data revealed that 30 h of dedicated AIW time-18 weekend hours (5:00 a.m.-11:00 a.m.), 12 weekday hours (6:00 a.m.-9:00 a.m.) would allow maximal patient alcohol screening and intervention with minimal additional burden to clinical staff.

Petry NM; Alessi SM; Ledgerwood DM. Contingency management delivered by community therapists in outpatient settings. Drug and Alcohol Dependence 122(1-2): 86-92, 2012. (31 refs.)

Background: Few community-based clinicians have been trained to deliver contingency management (CM) treatments, and little data exist regarding the efficacy of CM when administered by clinicians. Method: Fifteen clinicians from four intensive outpatient treatment programs received training in CM. Following a didactics seminar and a period in which clinicians delivered CM to pilot patients while receiving weekly supervision, clinicians treated 43 patients randomized to standard care or CM, without supervision. In both treatment conditions, urine and breath samples were collected up to twice weekly for 12 weeks, and CM patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting drug-free samples. Primary treatment outcomes were sessions attended, unexcused absences, longest continuous period of abstinence, and proportion of negative samples submitted. Results: All therapists completed the training and supervision phase, and 10 treated randomized patients. Patients randomized to CM achieved significantly greater durations of abstinence than patients randomized to standard care (5.0 +/-3.8 weeks versus 2.6 +/- 3.7 weeks) and had fewer unexcused absences (4.3 +/- 1.2 versus 8.1 +/- 5.4), but proportion of negative samples submitted and attendance did not differ significantly between groups. Therapist adherence and competence in CM delivery decreased when supervision was no longer provided, and competence in CM delivery was associated with duration of abstinence achieved and attendance. Conclusions: Community-based clinicians can effectively administer CM, and outcomes relate to competence in CM delivery. These data call for further training and supervision of community clinicians in this evidence-based treatment.

Polcin DL; Henderson DM; Korcha R; Evans K; Wittman F; Trocki K. Perceptions of sober living houses among addiction counselors and mental health therapists: Knowledge, views and perceived barriers. Journal of Psychoactive Drugs 44(3): 224-236, 2012. (21 refs.)

Affordable alcohol- and drug-free housing that supports recovery is limited in many areas. Sober living houses (SLHs) offer a unique living environment that supports abstinence and maintenance of a recovery lifestyle. Previous studies show that SLH residents make improvements on alcohol, drug and other problems that are maintained at 18-month follow-up (Polcin et al. 2010). However, for SLHs to maximize their impact they must recognize how they are viewed by community stakeholders and successfully address barriers. This pilot study recruited a convenience sample of two stakeholder groups, certified alcohol and drug counselors (N = 85) and licensed mental health therapists (N = 49), to explore knowledge and views about SLHs using an online survey. Therapists and counselors had similar views about SLHs, although counselors had more direct experience with them and were more knowledgeable. Both groups were highly supportive of increasing the role of SLHs to address addiction problems in their communities. Those who were most supportive had more knowledge about SLHs, agreed that alcohol and drug problems were caused by a physical disease, and agreed that successful recovery required an abstinent living environment. Both groups identified a variety of barriers, particularly social stigma. Recommendations are made for knowledge dissemination and decreasing barriers.

Proctor D; Connolly JM. Optimising treatment: Integrating web-based and face-to-face interventions. Drug and Alcohol Review 29(Supplement 1): 14, 2010. (0 refs.)

Background: The internet is increasingly being used to enhance the flexibility and accessibility of psychological interventions. Treatments are being modified and implemented for an internet audience. However, the process of integrating these treatments within existing service models has rarely been discussed in the literature. Similarly, minimal attention has been paid to the opportunity afforded by web-based models to build the capacity and skills of existing clinicians. This is a missed opportunity to use interactive web-based models to enhance and augment existing clinical practices. Aims: This workshop will outline possible ways in which existing OnTrack programs can be utilised to enhance face-to-face clinical contacts. The following areas will be covered during the session: Navigating the OnTrack practitioner site; Utilising the functionality of the site to optimise existing models of treatment; Using OnTrack for professional development; Tricks of the trade - using technology to make our life easier; Overcoming roadblocks in the application of technology; Ensuring a smooth integration.

Resko SM; Walton MA; Chermack ST; Blow FC; Cunningham RM. Therapist competence and treatment adherence for a brief intervention addressing alcohol and violence among adolescents. Journal of Substance Abuse Treatment 42(4): 429-437, 2012. (49 refs.)

This study examines therapist competency and treatment adherence for a brief intervention addressing alcohol misuse and violent behaviors among adolescents aged 14-18 years. Three observational measures of fidelity were used by independent raters to evaluate 60 therapist-delivered sessions (M = 32.5 minutes). Individual items from the Content Adherence scale, the Global Rating of Competence (Global Rating of Motivational Interviewing Therapist [GROMIT]), and the Self Exploration and Change Talk (SECT) demonstrated fair to excellent interrater reliability (intraclass correlations ranged from .40 to 1.0). Principal components analysis was used to identify the underlying factor structure of the Content Adherence and the GROMIT. Parallel analysis suggested the extraction of three components for the Content Adherence reflecting the three distinct goals for each segment of the intervention. Two components were identified for the GROMIT representing the general spirit of motivational interviewing and empowerment. Findings provide support for the fidelity instruments adapted for this study and offer direction for future training and clinical supervision.

Rieckmann T; Bergmann L; Rasplica C. Legislating clinical practice: Counselor responses to an evidence-based practice mandate. Journal of Psychoactive Drugs Supplement 7: 27-39, 2011. (66 refs.)

The demand to connect research findings with clinical practice for patients with substance use disorders has accelerated state and federal efforts focused on implementation of evidence-based practices (EBPs). One unique state driven strategy is Oregon's Evidence-Based Practice mandate, which ties state funds to specific treatment practices. Clinicians play an essential role in implementation of shifts in practice patterns and use of EBPs, but little is understood about how legislative efforts impact clinicians' sentiments and decision-making. This study presents longitudinal data from focus groups and interviews completed during the planning phase (n = 66) and early implementation of the mandate (n = 73) to investigate provider attitudes toward this policy change. Results reflect three emergent themes: (1) concern about retaining individualized treatment and clinical latitude, (2) distrust of government involvement in clinical care, and (3) the need for accountability and credibility for the field. We conclude with recommendations for state agencies considering EBP mandates.

Rieckmann T; Farentinos C; Tillotson CJ; Kocarnik J; McCarty D. The substance abuse counseling workforce: Education, preparation, and certification. Substance Abuse 32(4): 180-190, 2011. (24 refs.)

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. A workforce survey distributed to those providing direct services in 295 treatment units in the CTN obtained responses from 1750 individuals with a job title of counselor (n = 1395) or counselor supervisor (n = 355). A secondary analysis compares and describes both groups. 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.

Rieckmann TR; Kovas AE; McFarland BH; Abraham AJ. A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment. Journal of Substance Abuse Treatment 41(4): 374-385, 2011. (83 refs.)

Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation 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 study uses hierarchical linear modeling to examine National Treatment Center Study data 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.

Ross J; Darke S; Kelly E; Hetherington K. Suicide Risk Assessment and Intervention Strategies: Current Practices in Australian Residential Drug and Alcohol Rehabilitation Services. NDARC Technical Report No. 315. Sydney: National Drug and Alcohol Research Centre (Australia), 2010

EXECUTIVE SUMMARY: Suicide is a leading cause of death among people who misuse drugs and alcohol. The annual prevalence of attempted suicide among dependent drug users is equivalent to the lifetime prevalence in the general population. Yet little is known about how suicide risk is currently managed in Australian drug and alcohol treatment settings. Research has identified a number of risk factors for suicide and established that individuals with drug and alcohol use disorders have a very high prevalence of these risk factors. Risk needs to be assessed continuously throughout treatment, from intake through to discharge. Currently there is no tool available that reliably predicts suicide. The current study sought to examine current suicide risk assessment practices in Australian residential drug and alcohol treatment settings. Specifically, the aims of the study were: 1) To examine existing suicide risk assessment and intervention strategies used by drug and alcohol staff in residential rehabilitation programmes across Australia; 2) To determine the extent of staff training in suicide risk assessment; 3) To assess staff knowledge of suicide risk factors; 4) To describe the barriers to conducting suicide risk assessments; 5) To identify additional and/or under-utilised opportunities for intervention; and 6) To outline the core components of a potential suicide risk assessment tool for drug and alcohol workers, and make recommendations about the dissemination of the tool in order to maximise its usefulness. Results: The major findings of the study were that: 1) A third of agencies have no documented policy for managing suicide risk; 2) A quarter of staff have never been formally trained in SRA; 3) One in five staff report having lost a client to suicide; 4) In more than a third of agencies, staff are not expected to use structured assessment tools when assessing acute suicide risk; and 5) To varying degrees, agencies are gathering information about psychiatric comorbidity but this information does not appear to be routinely integrated into the client's risk assessment. This study confirms that suicide is an important clinical issue confronting drug and alcohol treatment staff, and highlights several gaps in suicide risk assessment practice. Many services are lacking clearly documented policies and procedures relating to the management of suicide risk, and do not provide staff with adequate training. The development of structured assessment tools for residential drug and alcohol treatment settings would significantly assist staff in fulfilling this important role.

Public Domain

Rothrauff TC; Abraham A; Roman PM. Differences in substance abuse counselors' knowledge of tobacco cessation medication effectiveness: 2002-2008. Journal of Drug Issues 41(1): 135-150, 2011. (20 refs.)

Counselors play a supportive role in patients' substance abuse treatment, including tobacco cessation. Thus, counselors should be knowledgeable about tobacco cessation medications (TCMs). This study examined differences in counselors' knowledge of and familiarity with (i.e., diffusion) bupropion and nicotine replacement therapy (NRT) between 2002 and 2008 and identified predictors of diffusion. Repeated cross-sectional questionnaire data were obtained in 2002/04 from 992 counselors and in 2007/08 from 1,226 counselors working in private treatment programs. Results indicated that more counselors in 2007/08 did not know about bupropion to rate its effectiveness than in 2002/04; no differences were found for NRT. Among both samples of counselors who were familiar with TCMs, effectiveness was rated higher in 2007/08 than in 2002/04. Findings suggest that educated and trained counselors are important in diffusing TCMs. Knowledgeable counselors may be able to educate patients interested in tobacco cessation about available treatments and encourage compliance with TCMs.

Rothrauff TC; Eby LT. Counselors' knowledge of the adoption of tobacco cessation medications in substance abuse treatment programs. American Journal on Addictions 20(1): 56-62, 2011. (37 refs.)

This study assessed counselors' knowledge of the adoption of evidence-based tobacco cessation medications (TCMs)-varenicline, bupropion, and five nicotine replacement therapies (NRTs)-and predictors of adoption in diverse substance abuse treatment settings. We used Managing Effective Relationships in Treatment Services (MERITS I) data from 658 counselors working in 26 programs. Adoption of varenicline was reported by 16% of counselors, bupropion by 11%, and NRTs by 27%. Knowledge of the adoption of all types of TCMs was more likely to be reported by counselors who worked in treatment programs that adhered less to a 12-step orientation and restricted outdoor smoking for employees. Several additional unique predictors of varenicline and NRTs were identified.

Rothrauff TC; Eby LT. Substance abuse counselors' implementation of tobacco cessation guidelines. Journal of Psychoactive Drugs 43(1): 6-13, 2011. (32 refs.)

This study assessed the extent of implementation of the Public Health Service tobacco cessation guidelines among a national sample of counselors working in five different types of substance abuse treatment programs. Further, we identified implementation patterns among counselors using cluster analysis and considered differences in counselor characteristics based on their cluster membership. Data were obtained from the 2008 Managing Effective Relationships in Treatment Services (MERITS I) project. Counselors (N = 615) working in Clinical Trials Network (CTN) affiliated community treatment programs completed paper-and-pencil surveys. Implementation of the guidelines was inconsistent and selective. Counselors could be grouped into low versus high implementers. Some counselor characteristics differed based on their implementation cluster membership.

Roy AK; Miller MM. The medicalization of addiction treatment professionals. Journal of Psychoactive Drugs 44(2): 107-118, 2012. (43 refs.)

In a previous article, the authors described the changes initiated by recent health care legislation, and how those changes might affect the practice of medicine and the delivery of addiction services. This article reviews the same changes with respect to how they have the potential to change the practice activities of addiction physicians, addiction therapists, addiction counselors and addiction nurses, as well as the activities of administrators and service delivery financial personnel. Developments in delivery systems and the impact of those developments on professionals who work in addiction treatment are considered; current problems, potential solutions, and opportunities for clinicians under health reform are addressed. The goals envisioned for health system reform and the potential for realization of those goals via changes in addiction service delivery design and clinical practice are discussed.

Russell C; Davies JB; Hunter SC. Predictors of addiction treatment providers' beliefs in the disease and choice models of addiction. Journal of Substance Abuse Treatment 40(2): 150-164, 2011. (58 refs.)

Addiction treatment providers working in the United States (n = 219) and the United Kingdom (n = 372) were surveyed about their beliefs in the disease and choice models of addiction, as assessed by the 18-item Addiction Belief Scale of J. Schaler (1992). Factor analysis of item scores revealed a three-factor structure, labeled "addiction is a disease," "addiction is a choice," and "addiction is a way of coping with life," and factor scores were analyzed in separate hierarchical multiple regression analyses. Controlling for demographic and addiction history variables, treatment providers working in the United States more strongly believe addiction is a disease, whereas U.K.-based providers more strongly believe that addiction is a choice and a way of coping with life. Beliefs that addiction is a disease were stronger among those who provide for-profit treatment, have stronger spiritual beliefs, have had a past addiction problem, are older, are members of a group of addiction professionals, and have been treating addiction longer. Conversely, those who viewed addiction as a choice were more likely to provide public/not-for-profit treatment, be younger, not belong to a group of addiction professionals, and have weaker spiritual beliefs. Additionally, treatment providers who have had a personal addiction problem in the past were significantly more likely to believe addiction is a disease the longer they attend a 12-step based group and if they are presently abstinent.

Saarnio P. Therapists' big five personality traits and interpersonal functioning in the substance abuse field: A cluster-analytic study. Journal of Substance Use 16(5): 348-358, 2011. (40 refs.)

Background: Considerable differences exist between therapists in the outcomes of psychotherapy and substance abuse treatment. There is no clear understanding of the extent to which these differences can be explained by the personality traits or interpersonal functioning of the therapists. Aims: This study seeks to shed some light on their personal qualities. The aim was to group Finnish substance abuse therapists (N = 97) based on their personality traits and interpersonal functioning. Methods: Personality traits were measured using a test based on the five-factor model and interpersonal functioning with a vignette task. Results: The cluster analysis yielded a three-group model. The first two groups differed considerably in their personality traits, yet their interpersonal functioning was on almost the same level. The personality traits of the third group were close to standard average. Their interpersonal functioning was clearly on a lower level than that of the other two groups. The groups also differed from each other with respect to some background variables and therapeutic orientation. Conclusions: In the future, the grouping should be linked to treatment processes and outcomes. The results are also of interest with an eye to student selection, recruitment of therapists, and supervision at work.

Schulte SJ; Meier PS; Stirling J; Berry M. Dual diagnosis competency among addiction treatment staff: Training levels, training needs and the link to retention. European Addiction Research 16(2): 78-84, 2010. (28 refs.)

Background: Dually diagnosed clients are described as one of the most challenging treatment populations, often leading to staff frustration, helplessness and negative attitudes. As yet it is unclear whether dual diagnosis (DD)-specific competency and therapeutic optimism among staff are related to client outcomes. Methods: The study used a 3-month follow-up design involving 124 DD clients starting treatment at 6 UK addiction services. Practitioners (n = 46) treating these clients were assessed regarding their DD specialisation levels. Cox regression analyses were performed to examine predictors of clients' 3-month retention rates. Results: Staff reported a median of 7 years work experience with DD clients, and 80% had received co-morbidity-specific training. Practitioners provided high average ratings on both the DD competency and the therapeutic optimism scale. Nevertheless, 78% of the sample indicated additional support needs in dealing with this client group. Higher levels of DD competencies among staff predicted better client retention. Conclusion: The increased provision of support packages for practitioners is vital for improving competency levels in dealing with DD clients, which in turn may lead to improved client outcomes.

Smith BD; Manfredo IT. Frontline counselors in organizational contexts: A study of treatment practices in community settings. Journal of Substance Abuse Treatment 41(2): 124-136, 2011. (71 refs.)

This study addresses the challenge of implementing evidence-based treatment approaches in typical community settings. It identifies individual and organizational characteristics associated with two contrasting treatment approaches used by frontline practitioners. One treatment approach involves techniques supported by research; the other approach involves techniques primarily supported by experience and tradition. The study uses a nested probability sample of 45 organizations and 279 frontline practitioners. Multilevel (hierarchical linear modeling) regression models appropriately address the nested sample. The findings indicate that practitioner beliefs and components of organizational social contexts are associated with treatment approach. The use of an evidence-supported treatment approach is associated with opportunities to use training and with transformational leadership. A traditional treatment approach is more commonly used when practitioners have more positive perceptions of the organizational climate. The findings underscore the challenge of implementing evidence-based treatment techniques among counselors committed to traditional approaches.

Smith DE. Editor's Note: The medicalization of therapeutic communities in the era of health care reform. (editorial). Journal of Psychoactive Drugs 44(2): 93-95, 2012. (14 refs.)

Recent health care reform legislation has prompted greater efforts to divert substance abusers to addiction treatment facilities. A major component of reform has been the acknowledgement that mental health and addiction issues must be treated on a par with medical issues. The merger of the Haight Ashbury Free Clinics and Walden House offers a model for the medicalization of therapeutic communities to provide a medical home for previously underserved, marginalized populations.

Smith JL; Carpenter KM; Amrhein PC; Brooks AC; Levin D; Schreiber EA et al. Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing. Journal of Consulting and Clinical Psychology 80(3): 450-464, 2012. (38 refs.)

Objective: Training through traditional workshops is relatively ineffective for changing counseling practices. Teleconferencing supervision (TCS) was developed to provide remote, live supervision for training motivational interviewing (MI). Method: Ninety-seven drug treatment counselors completed a 2-day MI workshop and were randomized to live supervision via teleconferencing (TCS; n = 32), standard tape-based supervision (tape; n = 32), or workshop alone (workshop; n = 33). Supervision conditions received 5 weekly supervision sessions at their sites using actors as standard patients. Sessions with clients were rated for MI skill with the Motivational Interviewing Treatment Integrity (MITI) Coding System pre-workshop and 1, 8, and 20 weeks post-workshop. Mixed-effects linear models were used to test training condition on MI skill at 8 and 20 weeks. Results: TCS scored better than workshop on the MM for spirit (mean difference = 0.76; p < .0001; d = 1.01) and empathy (mean difference = 0.68; p < .001; d = 0.74). TCS was superior to workshop in reducing MI non-adherence and was superior to workshop and tape in increasing reflection to question ratio. Tape was superior to TCS in increasing complex reflections. Percentage of counselors meeting proficiency differed significantly between training conditions for the most stringent threshold (spirit and empathy scores >= 6). Conclusions: TCS shows promise for promoting new counseling behaviors following participation in workshop training. However, further work is needed to improve supervision methods to bring more clinicians to high levels of proficiency and facilitate dissemination of evidence-based practices.

Steenbergh TA; Runyan JD; Daugherty DA; Winger JG. Neuroscience exposure and perceptions of client responsibility among addictions counselors. Journal of Substance Abuse Treatment 42(4): 421-428, 2012. (49 refs.)

Members of the National Association of Alcoholism and Drug Abuse Counselors (n = 231) participated in a survey concerning their view of the role of personal responsibility in addictions treatment and its relation to their exposure to neuroscience (i.e., the amount to which members considered themselves familiar with current neuroscience research). We used the two-dimensional model of responsibility (Responsible/not responsible for development x Responsible/not responsible for recovery) proposed by P. Brickman et al. (1982) to guide our assessment of responsibility, thus inquiring about counselors' views of clients' responsibility for both the development of a substance-related addiction and its resolution. Findings suggest that counselors rate biological factors as most influential in the development of an addiction and assign clients less personal responsibility for the development of an addiction than for recovery from an addiction. Counselors' level of neuroscience exposure was negatively correlated with their ratings of client responsibility for the development of an addiction but positively correlated to ratings of client responsibility for recovery. This suggests that counselors are integrating neuroscientific findings with what is learned from other modes of enquiry in a way that diminishes the view that clients are responsible for addiction development but accentuates the view that clients are responsible for recovery. We explore reasons for why this is and why this approach may be beneficial.

Thurang A; Fagerberg I; Palmstierna T; Tops AB. Women's experiences of caring when in treatment for alcohol dependency. Scandinavian Journal of Caring Sciences 24(4): 700-706, 2010. (41 refs.)

Despite the fact of increased levels of alcohol dependency in women and gender differences in how the disease affects men and women, the research on alcohol dependency continues to have a dominating perspective on men. The meaning of the phenomenon of caring in formal care for women with alcohol dependency is not well known. Thus, formal caregivers may find it problematic to know what is caring for women with alcohol dependency. The aim of the study was to illuminate the meaning of caring in formal care for women with alcohol dependency, as narrated by the women. The study was performed using a phenomenological-hermeneutic method. Data were collected in ten in-depth interviews with alcohol-dependent women. The themes presented are availability, being a patient and being a learner. The findings reveal that the women with alcohol dependency receiving a mandate from formal care, experience the relation between them and their caregiver as a mutual transformation. Within the mutual transformation, the participants experienced being respected as a responsible human being which renders possibilities for the women with alcohol dependency to continue in formal care even when the struggle against the disease became hard. Continual meetings with the caregiver allowed the women to gain structure in their daily life as well as allowing the women and their caregivers to develop mutual transformation, which both relieved the women's suffering and increased their experience of being involved in the care process.

Titus JC; Smith DC; Dennis ML; Ives M; Twanow L; White MK. Impact of a training and certification program on the quality of interviewer-collected self-report assessment data. Journal of Substance Abuse Treatment 42(2, special issuse): 201, 2012. (28 refs.)

The purpose of this study was to evaluate the impact of an assessment training and certification program on the quality of data collected from clients entering substance abuse treatment. Data were obtained from 15,858 adult and adolescent clients entering 122 treatment sites across the United States using the Global Appraisal of Individual Needs-Initial (GAIN-1). GAIN Administration and Fidelity Index (GAFI) scores were predicted from interviewer certification status, interviewer experience, and their interactions. We controlled for client characteristics expected to lengthen or otherwise complicate interviews. Initial bivariate analyses revealed effects for certification status and experience. A significant interaction between certification and experience indicates interviewers attaining certification and having more experience far outperformed certified interviewers with low experience. Although some client characteristics negatively impacted fidelity, interviewer certification and experience remained salient predictors of fidelity in the multivariate model. The results are discussed with regard to the importance of ongoing monitoring of interviewer skill.

Tracy K. Six key areas when working with addicts. (Chapter 10). IN: Brizer D; Castandea R, eds. Clinical Addiction Psychiatry. New York: Cambridge University Press, 2011

This book is described as an anthology of essays setting forth the most current and authoritative information on addiction theory, practice and research. Each chapter is authored by a recognized authority in the field. The volume covers diverse material, from the environment, to genetics, culture and spirituality, treatment and pharmacology. The book, with 24 essays, is organized in three parts. This chapter, outlining central features to consider in treating those with substance use problems, is the concluding chapter in Part I of this book, the section which considers the basic constructs of addiction medicine. Other topics in this section include the disease concept, medical problems emerging from substance use, suicide, other psychotherapeutic paradigms.

Urgelles J; Donohue B; Wilks C; Van Hasselt VB; Azrin NH. A standardized method of preventing and managing emergencies within the context of evidence-based therapy implementation. Behavior Modification 36(4, special issue): 558-579, 2012. (66 refs.)

Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed therapy sessions. In this study, the authors empirically developed a standardized intervention to assist mental health providers in emergency prevention and management (EPM) with their clients. EPM includes assessment of emergent conditions and a self-control procedure that may be utilized by consumers to prevent or resolve emergencies. EPM responses of 26 mothers referred by Child Protective Services for 6 months of evidence-supported treatment were examined. Relevant to clinical utility, the results indicated that providers implemented EPM in a little more than half (56.9%) of their treatment sessions, and all emergencies assessed in EPM were endorsed by at least 8% of the sample throughout their treatment. EPM was implemented with fidelity according to service providers, and corroborated by blind raters. Participants were found to be compliant and satisfied with EPM. The average number of emergencies endorsed over the course of EPM administrations was negatively correlated with the frequency of EPM administrations, suggesting that EPM may have helped reduce emergencies. Pretreatment factors (e.g., household income, child abuse potential, family functioning, parental stress, child behavior problems, number of days child removed from home) and hard drug use (but not marijuana or alcohol) during treatment were associated with the number of emergencies reported by participants.

Vilardaga R; Luoma JB; Hayes SC; Pistorello J; Levin ME; Hildebrandt MJ et al. Burnout among the addiction counseling workforce: The differential roles of mindfulness and values-based processes and work-site factors. Journal of Substance Abuse Treatment 40(4): 323- 335, 2011. (97 refs.)

Although work-site factors have been shown to be a consistent predictor of burnout, the importance of mindfulness and values-based processes among addiction counselors has been little examined. In this study, we explored how strongly experiential avoidance, cognitive fusion, and values commitment related to burnout after controlling for well-established work-site factors (job control, coworker support, supervisor support, salary, workload, and tenure). We conducted a cross-sectional survey among 699 addiction counselors working for urban substance abuse treatment providers in six states of the United States. Results corroborated the importance of work-site factors for burnout reduction in this specific population, but we found that mindfulness and values-based processes had a stronger and more consistent relationship with burnout as compared with work-site factors. We conclude that interventions that target experiential avoidance, cognitive fusion, and values commitment may provide a possible new direction for the reduction of burnout among addiction counselors.

Weiss RD; Connery HS. Integrated Group Therapy for Bipolar Disorder and Substance Abuse. New York: Guilford Press, 2011

This is a how-to guide for clinicians wishing to care for those with bipolar disorder and co-occurring substance abuse disorder. It provides an introduction to the nature of bipolar disorder and substance abuse, their interactions, and the role of group therapy in promoting recovery. The book also provides useful clinical tools, such as a guide with clear goals, and clinical techniques for each session, and tools for monitoring clients' status and adherence to treatment plans.

Woods M; Butler S. 'A victim of its own success'? The diploma in addiction studies at Trinity College Dublin. Drugs: Education, Prevention and Policy 18(4): 243-250, 2011. (13 refs.)

This article reviews and reflects on the Diploma in Addiction Studies: a 1-year, full-time programme taught at the School of Social Work and Social Policy in Trinity College Dublin since the academic year 1983/1984, which has recently had its external funding withdrawn. The programme was aimed at multidisciplinary classes, including students from backgrounds in community responses to drug problems and in personal recovery from alcohol and drug problems. Drawing on its status as a university-based programme, Addiction Studies saw its function as educational rather than training, and saw itself as having particular value against the somewhat dogmatic policy and practice background of the Irish addictions scene. This article sets out the background to the programme, as well as its teaching philosophy and its attempts to deal with the issue of transfer of learning.

Wu F; Hser YI. Workforce professionalism in drug treatment services: Impact of California's Proposition 36. Journal of Substance Abuse Treatment 40(1): 44-55, 2011. (61 refs.)

This article investigates whether California's Proposition 36 has promoted the workforce professionalism of drug treatment services during its first 5 years of implementation. Program surveys inquiring about organizational information, Proposition 36 implementation, and staffing were conducted in 2003 and 2005 among all treatment providers serving Proposition 36 clients in five selected California counties (San Diego, Riverside, Kern, Sacramento, and San Francisco). A I-hour self-administered questionnaire was completed by 118 treatment providers representing 102 programs. This article examines five topics that are relevant to drug treatment workforce professionalism: resources and capability, standardized intake assessment and outcome evaluation, staff qualification, program accreditation, and information technology. Results suggest that Proposition 36 had a positive influence on the drug treatment workforce's professionalism. Improvements have been observed in program resources, client intake assessment and outcome evaluation databases, staff professionalization, program accreditation, and information technology system. However, some areas remain problematic, including, for example, the consistent lack of adequate resources serving women with children.

Wylie LWJ. Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature. (review). Drugs: Education, Prevention and Policy 17(5): 618-631, 2010. (57 refs.)

Although the potential range of the workforce that may positively interact with substance users is large, and takes in all who may have to deal with substance use issues in some way, the literature mainly focuses on user views of specialist substance use or health and social care staff. With client-centred care a key policy of modern service delivery, this review assesses the available literature on service user perceptions of staff abilities and comments on possible training needs. Many service users rated a positive attitude towards the user as the key staff attribute that enhanced quality of care. There was also evidence that generally users desired more knowledgeable staff, both professional and ex-user, and that staff working within sub-specialties require advanced training. However, a positive attitude towards the user in interpersonal therapeutic situations was potentially able to overcome a staff member's knowledge deficiency. Potential methods of instilling positive attitudes within the substance use workforce are discussed, including organizational culture and potential educational requirements.

Zafiridis P; Lainas S. Alcoholics and Narcotics Anonymous: A radical movement under threat. Addiction Research & Theory 20(2): 93-104, 2012. (118 refs.)

In recent decades, the considerable proliferation of the self-help groups (especially those of the Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)) has attracted the interest of those engaged in the social sciences as well as of those responsible for mapping out health policies. This article is based on the 10-year involvement of the authors in a participatory action research project for the promotion of self-help groups in Greece as well as to an extensive literature review of the AA and NA movements. Based on this methodology, the objective of this article is twofold. First, it identifies the radical perspective of self-help groups, as the main source for their effectiveness, while it attempts an assessment of their effect on traditional professional attitudes. Second, it raises concerns over the radical perspective of these initiatives in the framework of their transition from an alternative stance towards their integration in formal Health Systems. This transition process is manifested in the following developments: the constantly increasing number of old members who quit the role of the volunteer sponsor and undertake the financially beneficial role of (para-) professional addiction counselor; the instrumentalization of 12 steps; the increasing number of members who adopt the nosological perspective of addiction. The various adverse effects of dominant culture on the internal working of the groups are studied. Moreover, this article attempts a comparative assessment of the produced experience with the AA and NA movements in Greece and abroad.