title: Views about responsibility for alcohol addiction and negative evaluations of naltrexone.
abstract: BACKGROUND
  Moral philosophers have debated the extent to which persons are individually responsible for the onset of and recovery from addiction. Empirical investigators have begun to explore counselors' attitudes on these questions. Meanwhile, a separate literature has investigated counselors' negative attitudes towards naltrexone, an important element of medication-assisted treatment for alcohol addiction. The present study bridges the literature on counselor views about responsibility for addiction with the literature on attitudes towards naltrexone. It investigates the extent to which a counselor's views of individual responsibility for alcohol addiction are related to that counselor's views of naltrexone.
  
  
  METHODS
  Using a vignette-based survey of 117 addiction treatment professionals, the study analyzes the relationship between an addiction counselor's views about individual responsibility for alcohol addiction and using naltrexone to treat it.
  
  
  RESULTS
  We find a significant difference in counselors who assign greater responsibility to a person for the onset of alcohol addiction. They agreed more strongly with several objections to naltrexone, including worries about compliance, naltrexone's side effects outweighing its benefits, naltrexone treating symptoms but not underlying causes, and the idea that medication may undermine a person's motivation to recover. Combined views of greater responsibility for addiction's onset and recovery also significantly predicted stronger agreement with objections.
  
  
  CONCLUSIONS
  We conclude that there is a strong relationship between a counselor assigning higher individual responsibility for addiction and holding more negative views about naltrexone. The study also sheds light on one reason why the model of addiction as a brain disease has had limited impact on clinical practice.
authors.affiliation: Department of Sociology, Princeton University, 117 Wallace Hall, NJ 08544, Princeton, U.S.A. raj2@princeton.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Johnson
authors.affiliation: Salem State University, School of Social Work, 352 Lafayette Street, 01970, Salem, MA, USA. jlukens@salemstate.edu.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Lukens
authors.affiliation: Hasbro/Bradley's Children's Hospitals, Brown University, 593 Eddy St, Physician's Office Building Suite 122, 02906, Providence, RI, USA. jonathan_kole@brown.edu.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Kole
authors.affiliation: Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, 3401 Market Street, Suite 320, 19104, Philadelphia, PA, USA. sistid@upenn.edu.
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Sisti
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000188:drug therapy / Q000523:psychology*; D001291:Attitude of Health Personnel; D003376:Counseling; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone