Counselor Attitudes toward Buprenorphine in the Clinical Trials Network* Hannah K. Knudsen, Ph.D., 1 & Paul M. Roman, Ph.D. 2 1 Department of Behavioral.

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Counselor Attitudes toward Buprenorphine in the Clinical Trials Network* Hannah K. Knudsen, Ph.D., 1 & Paul M. Roman, Ph.D. 2 1 Department of Behavioral Science & Center on Drug and Alcohol Research, University of Kentucky 2 Institute for Behavioral Research and Department of Sociology, University of Georgia *Supported by the National Institute on Drug Abuse (2R01DA14482) BACKGROUND Early research on counselor attitudes toward buprenorphine indicated knowledge gaps about its effectiveness and low acceptability. A survey from found that two-thirds of counselors did not know whether buprenorphine was effective. 1 Lack of buprenorphine-specific training and greater endorsement of a 12-step treatment orientation were identified as barriers to perceiving buprenorphine as an acceptable treatment technology. A comparison of counselors working in treatment programs affiliated with the National Drug Abuse Treatment Clinical Trials Network (CTN) and counselors outside the CTN found that differences in perceived acceptability were largely a function of greater access to training and greater implementation of buprenorphine within the CTN. 2 In this research, we examine more recent data on CTN counselors’ attitudes toward buprenorphine and identify counselor characteristics associated with perceived effectiveness and acceptability. RESEARCH QUESTIONS 1.In , to what extent did CTN counselors view buprenorphine as effective and acceptable? 2.What characteristics differentiate counselors who view buprenorphine as effective from those who perceive buprenorphine as a) ineffective, b) don’t know if it is effective, or c) neither effective nor ineffective? 3.What characteristics differentiate counselors who view buprenorphine as acceptable from those who perceive buprenorphine as a) unacceptable, b) don’t know if it is acceptable, or c) neither acceptable nor unacceptable? 1 Knudsen, Ducharme, Roman, & Link. (2005). Journal of Substance Abuse Treatment, 29, Knudsen, Ducharme, & Roman. (2007). The American Journal on Addictions, 16, METHODS Data Collection 198 community-based treatment program (CTP) administrators participated in face-to-face interviews in (84.7%) and were asked to provide lists of counselors Surveys were mailed to each identified counselor 934 counselors working in 175 CTPs participated in the survey (62% response rate; $40 honorarium) Measures Perceived effectiveness categorizes counselors into those rating buprenorphine as effective, ineffective, don’t know, or neither effective nor ineffective Perceived acceptability categorizes counselors into those rating buprenorphine as acceptable, unacceptable, don’t know, or neither acceptable nor unacceptable See “Sample Characteristics” (below) for independent variables Data Analysis Multiple imputation by chained equations (“ice” in Stata 11) used to address missing data on the independent variables; cases missing on either dependent variable were excluded from the analysis (final N = 918) Two multinomial logistic regressions with effective/acceptable as the reference group, using robust standard errors to adjust for clustering of counselors within CTPs SAMPLE CHARACTERISTICS CONCLUSIONS Compared to earlier studies, these data from CTN counselors show improved attitudes regarding the effectiveness and acceptability of buprenorphine. The percentages choosing the “don’t know” options were much lower than our prior surveys, suggesting greater diffusion of buprenorphine-related information. Strong associations between training and the two attitudes suggest that additional investments in training may yield benefits in counselors’ receptivity to buprenorphine. Counselors who more strongly endorse a 12-step treatment philosophy were more likely to rate buprenorphine as unacceptable and ineffective. Future research should consider what steps are needed to address the concerns of these counselors. % or Mean (SD) % or Mean (SD) Female66.7%Personally in recovery41.2% Hispanic ethnicity9.9% Twelve-step treatment orientation (1=strongly disagree, 7 = strongly agree) 3.89 (1.56) RaceCertified or licensed addictions counselor71.9% White73.7%Master’s level degree51.7% African American21.8%Works in a CTP that uses buprenorphine41.9% Other4.4% Extent of buprenorphine training (1=no extent, 7 = very great extent) 3.78 (2.15) Years working at CTP5.33 (5.65) Believes scientifically supported treatments are useful (1=strongly disagree, 7 = strongly agree) 5.89 (1.26) RESULTS Few CTN counselors had negative attitudes toward buprenorphine. The majority rated buprenorphine as effective (Figure 1). Two-thirds of the counselors indicated that buprenorphine was acceptable (Figure 2). Fewer than 20% of counselors chose the “don’t know” option for these measures of perceived effectiveness and acceptability. Multinomial logistic regressions were conducted to identify significant correlates of perceived effectiveness and acceptability among CTN counselors. Both models include all variables presented in “Sample Characteristics,” but only significant variables appear in Figures 3 and 4. Buprenorphine is Effective (Reference Category) Odds of Being in the “Not Effective” Category Negatively Associated with: Training (RRR =.72***) Program-level adoption (RRR =.56, p =.06) Odds of Being in the “Not Effective” Category Positively Associated with: 12-step orientation (RRR = 1.16, p =.07) Odds of Being in the “Don’t Know” Category Negatively Associated with: Training (RRR =.41***) Having a master’s-level degree (RRR =.54*) Odds of Being in the “Don’t Know” Category Positively Associated with: Being Hispanic (RRR = 2.15*) Being in the other race category (vs. white; RRR = 2.66, p =.07) Odds of Being in the “Neither” Category Negatively Associated with: Training (RRR =.82***) Belief in the utility of scientifically-supported treatments (RRR =.85, p =.06) Being certified/licensed (RRR =.62, p =.07) Odds of Being in the “Neither” Category Positively Associated with: 12-step treatment orientation (RRR = 1.15, p =.05) Figure 3: Multinomial Logistic Regression of Perceived Effectiveness of Buprenorphine Figure 4: Multinomial Logistic Regression of Perceived Acceptability of Buprenorphine Buprenorphine is Acceptable (Reference Category) Odds of Being in the “Not Acceptable” Category Negatively Associated with: Training (RRR =.65***) Being certified/licensed (RRR =.50*) Odds of Being in the “Not Acceptable” Category Positively Associated with: Twelve-step orientation (RRR = 1.25*) Odds of Being in the “Don’t Know” Category Negatively Associated with: Training (RRR =.39***) Having a master’s-level degree (RRR =.56*) Odds of Being in the “Don’t Know” Category Positively Associated with: Being Hispanic (RRR = 2.07, p =.07) Being in the other race category (vs. white; RRR = 3.99*) Odds of Being in the “Neither” Category Negatively Associated with: Training (RRR =.75***) Belief in the utility of scientifically-supported treatments (RRR=.83, p =.05) Being certified/licensed (RRR =.55*) Odds of Being in the “Neither” Category Positively Associated with: Being African American (vs. white; RRR=1.95, p =.06) *p<.05, **p<.01, ***p<.001 (two-tailed)