Academic journal article Health and Social Work

Counselor Attitudes toward and Use of Evidence-Based Practices in Private Substance Use Disorder Treatment Centers: A Comparison of Social Workers and Non-Social Workers

Academic journal article Health and Social Work

Counselor Attitudes toward and Use of Evidence-Based Practices in Private Substance Use Disorder Treatment Centers: A Comparison of Social Workers and Non-Social Workers

Article excerpt

Emphasis on the identification and use of evidence-based practices (EBPs) is increasingly prominent in social work and in the substance use disorders (SUD) treatment field, yet uptake of psychosocial interventions with demonstrated effectiveness in the treatment of SUDs continues to be low (Bride, Abraham, & Roman, 2011; Compton et al., 2005). Research on factors that facilitate or impede the adoption of EBPs in SUD treatment settings has largely focused on organizational variables, with much less attention paid to the role of direct service providers. Being at the point of service delivery, SUD counselors are critical arbiters of clients' acceptance and use of innovations. Such support or the lack thereof depends on their knowledge of and attitudes toward particular innovations (Abraham, Ducharme, & Roman, 2009; Rieckmann, Daley, Fuller, Thomas, & McCarty, 2007). However, most studies that have considered counselors' roles in the adoption of EBPs have focused on pharmacological rather than psychosocial treatments; no studies have examined the role of social workers in the adoption of EBPs in the SUD treatment environment. Because of their presence in a wide range of service delivery systems, social workers are often the first service providers to come into contact with individuals experiencing SUD, and therefore they are in a unique position to refer clients or to provide appropriate treatment (Smith, Whitaker, & Weismiller, 2006). Social workers also comprise a significant portion of the specialty SUD treatment workforce (Roman, Johnson, Ducharme, & Knudsen, 2006). For these reasons, social workers are often key opinion leaders who may influence decisions regarding service delivery in the SUD treatment sector. As such, it is important to have an understanding of social workers' perceptions and use of evidence-based psychosocial interventions for SUD as well as how they may differ from other substance abuse counselors.

The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial EBPs for the treatment of SLID in comparison to other SUD counselors who are non-social workers. As the targets of our inquiry, we selected motivational interviewing (MI) and contingency management (CM). Both interventions were introduced more than 25 years ago and have been the subject of a copious amount of professional and research literature documenting their effectiveness. Thus, there has been sufficient opportunity for the diffusion and adoption of these practice innovations.

MI

Developed as an alternative approach to the widely used confrontational interventions in SUD treatment, MI is "a collaborative, person-centered form of guiding to elicit and strengthen motivation for change" (Miller & Rollnick, 2009, p. 137). MI uses strategies from client-centered counseling, cognitive therapy, systems theory, and the psychology of persuasion, such as eliciting self-motivational statements, affirming client self-worth, presenting addictive behavior as modifiable, and using reflective listening to encourage clients to openly discuss their use of substances and related life events while providing a highly empathetic and supportive environment to enhance the clients' motivation to change (Miller & Rollnick, 2002; Schneider, Casey, & Kohn, 2000). MI employs a counseling style that is generally quiet and eliciting. Readiness to change is seen as fluctuating in relation to interpersonal interaction, and the counseling relationship is more like a partnership or companionship than expert-recipient roles (Miller, 1996). The results of several meta-analyses indicate that MI is effective in the treatment of a variety of substances of abuse and the positive effects are durable (Burke, Arkowitz, & Menchola, 2003; Hettema, Steele, & Miller, 2005; Lundahl & Burke, 2009; Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010; Vasilaki, Hosier, & Cox, 2006). …

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