How do counselors feel about the role medication plays in the treatment setting? Are they resistant? If yes, why?
This was the discussion at an afternoon session of the NAADAC (National Association for Alcoholism and Drug Abuse Counselors) conference today. The session, titled “SUD Counselors on the Job: A Bi-Directional Workshop on New Data on Job Satisfaction and Utilization of Medication-assisted Treatment,” illustrated data from the National Treatment Center Study (NTCS).
These were longitudinal studies of organizations that were privately funded, publicly funded, alcohol-focused or CTN (Clinical Trials Network) participants. The studies did not look at methadone clinics or detox-only programs.
The studies asked about specific medications including buprenorphine, naltrexone (tablet or injection), disulfiram, and acamprosate, as well as general questions about medication-assisted treatment. Results showed that the primary predictors of higher ratings of effectiveness and acceptability were specific training about the medication and use of the medication in the current treatment center the counselor was working in. Similarly, those counselors whose supervisors supported the use of medications in treatment reported higher points towards the idea as well.
Some aspects that negatively affected individuals’ attitudes about medication-assisted treatment seemed to be 12-Step orientation and the counselor being in recovery themselves. On the flip side, it was found that the higher the education level and tenure in the field, the more positive the attitude about medication-assisted treatment.
The floor was opened to discussion after the presentation of the data to find out what the counselors in attendance had to say about this form of treatment. One attendee said when he worked in treatment centers with psychiatrists who were knowledgeable about Suboxone and how it works, aware of proper administration, and able to train counselors, the counselors in those settings were in favor. However, after leaving that community to go into private practice, he now finds that psychiatrists are handling Suboxone treatment in their offices but have little to no information about it.
Paul M. Roman, PhD, the presenter of this session says he has heard many times of physicians prescribing Subutex, usually because it’s cheaper. He says this is more dangerous because it’s “like a live opiate.” He says many people who are on Buprenorphine do not want this on their insurance even though insurance will cover it, because they believe it will give them a record that will ruin them later on. “And they may be right,” he said.
He also said it’s hard to find any research that has been conducted regarding medication-assisted treatment. “If you go to NIDA and ask what the evidence-based practices are for counseling to provide in association with buprenorphine treatment, they haven’t done the research. It’s not a priority.”
An attendee who teaches a substance abuse course at Georgia State said she talks to her class about opiates, naltrexone, buprenorphine and then shows them a film about legal heroin clinics in Europe.