title: A multi-level analysis of counselor attitudes toward the use of buprenorphine in substance abuse treatment.
abstract: 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.
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97239, USA. rieckman@ohsu.edu
authors.forename: Traci R
authors.initials: TR
authors.lastname: Rieckmann
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Abraham
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D001290:Attitude; D001291:Attitude of Health Personnel; D002047:Buprenorphine / Q000627:therapeutic use*; D003376:Counseling / Q000193:education*; D003469:Culture; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone