The University of Georgia

Training and exposure to evidence-based practices: Changing attitudes

among the addiction treatment workforce

J. Aaron Johnson, Ph.D.Meredith Huey Dye, MA

The University of Georgia

With research grant support from the National Institute on Drug Abuse (R01DA14976 and R01DA14482)

The University of Georgia

Background• Significant efforts devoted to moving

evidence-based treatment from research settings into community-based treatment programs – Development of treatment techniques, including

medications and psycho-social approaches– Testing and disseminating these EBPs – NIDA

CTN, SAMHSA ATTC’s, RWJF initiatives– Our research – devoted to identifying barriers as

well as factors facilitating adoption/implementation

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Background (cont.)

• Research in other organizations - attitudes of members critical to successful implementation of new innovation

• Previous research on innovation adoption in addiction treatment:– “Exposure” to buprenorphine through specific training or use

by program led to more positive attitudes among counselors (Knudsen et al., 2005)

– Counselor computer access relatively high, use of internet to learn about new techniques low = possible “technology gap” in diffusion of EBPs (Ducharme et al, 2005)

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Research Questions

• What is the impact of training and exposure to EBPs on counselor attitudes toward pharmaceutical and behavioral interventions?

• What are the implications of these findings on current efforts to disseminate EBPs into community-based treatment programs?

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The National Treatment Center Study

• Monitoring the organization, management, delivery, and content of addiction treatment in the U.S.

• Includes Nationally Representative Samples of:– Privately-funded treatment programs (N=401)– Publicly-funded treatment programs (N=362)

• Programs must offer a level of care for addiction treatment at least equivalent to structured outpatient as defined by ASAM– Excludes: methadone maintenance-only facilities,

clinicians in private practice, DUI-only programs, halfway houses

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NTCS Instrument Design• Multiple data collection methods used:

– Detailed on-site interviews with program administrator Focus - organizational characteristics, services

offered, use of innovations– Mail questionnaire from program administrator

Focus - leadership and management practices– Mail questionnaire from counselors

Focus - services received by clients, attitudes toward innovations

– Brief telephone follow-ups w/ program administrator at six month intervals Focus - major program changes

• Today’s presentation: data from counselor questionnaires collected between November 2004 and July 2006 (N=880)

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Counselor DemographicsFemale 64.5%

Race/Ethnicity

Caucasian 63.6%

African American 25.1%

Hispanic 6.7%

Master’s degree or higher 41.3%

In Recovery 46.1%

Mean age (in years) 45.5

Mean yrs in field 9.4

Mean yrs at program 5.4

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Counselor Training and Accessto Computers w/ Internet

Formal “in-house” training (hrs) 29.0

Cont. Ed. Outside Program (hrs) 32.1

Computer/Internet Access

No Computer/Internet 26.5%

Shared Computer/Internet 19.4%

Own Computer/Internet 54.1%

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Prevalence of “Exposure” to EBPs

Buprenorphine(October 2002)

Acamprosate(July 2004)

MET Vouchers

Used in Program(1=yes)

15.3% 9.8% 80.1% 34.4%

Specific Training(1-7)

2.04 1.58 3.95 2.39

How Acceptable (1-7)

4.28 4.07 5.97 4.76

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Counselor “Exposure” and Attitudes toward EBPs

Buprenorphine

Acamprosate

MET Vouchers

Used in Program

5.88** 5.76** 6.34** 5.54**

Not Used in Program

4.14 3.76 5.45 4.74

• In each case counselors report significantly more positive attitudes toward EBPs when exposed to those practices.

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Computer Access & Attitudes toward EBPs

Buprenorphine

Acamprosate

MET Vouchers

No Computer

4.31 4.17 6.04 4.93

Shared Computer

4.17 3.80 5.99 4.84

Own Computer

4.96** 4.69** 6.38* 5.17

• Counselors report significantly more positive attitudes toward EBPs when provided with their own computer/internet access

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Regression ModelsBuprenorphine

Acamprosate

MET Vouchers

Gender (1=male)

- -

Age

Educ (Masters +)

+ +

In Recovery +Cont. Ed. Hrs -Specific Training

+ + + +

Used in Program

+ + + +

Comp./w internet

+

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Discussion• Regardless of whether pharmacological or

psychosocial, “Exposure” to specific EBPs has significant impact on counselors’ attitudes toward those practices

• Only attitudes toward psychosocial therapies impacted by counselor education

• Having access to computer w/ internet has limited impact on attitudes

• Males have significantly more negative attitudes toward use of MET and vouchers than females?

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Conclusion/Implications

• On-site training and testing of EBPs will likely have significant positive impact on counselor attitudes

• Dissemination of information via computer (CD-ROM, website, etc.) will likely have little impact (limited access, limited time)

• For Psychosocial EBPs, might consider tailoring training to specific genders

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For more information…

• Visit us at www.uga.edu/ntcs

• Data summaries• Recent and upcoming

presentations• Publication abstracts