title: Community correctional agents' views of medication-assisted treatment: Examining their influence on treatment referrals and community supervision practices.
abstract: Alcohol and opioid use disorders are common among adults under community supervision. Although several medications (medication-assisted treatment or MAT) are Food and Drug Administration (FDA)-approved to treat such disorders, they are underutilized with this population despite established effectiveness at decreasing substance use. This paper examines how community correctional agents' understanding of addiction and views of MAT influence their professional actions regarding addiction medications.
  
  
  
  A total of 118 semistructured qualitative interviews were conducted with community correctional agents taking part in the CJ-DATS MATICCE implementation study across 20 parole/probation offices in 9 US states. Using grounded theory methodology and an iterative analytic approach, issues of role perception, views of MAT, current treatment referral, and community supervision practices were explored.
  
  
  
  Agents often had limited autonomy to make direct treatment referrals, regardless of their views of MAT, as they were required to follow court orders and their organization's policies and procedures. Within some organizations, community correctional agents held sufficient autonomy to make direct treatment referrals, with agents struggling to reconcile their desire to support their clients who needed MAT with concerns about the abuse potential of opioid agonist medications. Viewing MAT as a "treatment of last resort" was counterbalanced by the view that it was an effective evidence-based practice. Agents described how MAT impacted their ability to supervise clients and how their knowledge and understanding of MAT was directly influenced by watching their clients who were successful or unsuccessful on MAT. Even those agents who were more accepting of MAT were largely unsupportive of it long-term use.
  
  
  
  Community correctional agents' views of MAT were influenced by their understanding of addiction as well as their experiences supervising clients receiving treatment with medications, but whether or not MAT referrals were made was not always within their control.
authors: a Friends Research Institute, Inc. , Baltimore , Maryland , USA.
authors: Shannon Gwin
authors: SG
authors: Mitchell
authors: b School of Social Work , University of Connecticut , West Hartford , Connecticut , USA.
authors: Jennifer
authors: J
authors: Willet
authors: a Friends Research Institute, Inc. , Baltimore , Maryland , USA.
authors: Laura B
authors: LB
authors: Monico
authors: b School of Social Work , University of Connecticut , West Hartford , Connecticut , USA.
authors: Amy
authors: A
authors: James
authors: c Center for Advancing Correctional Excellence , George Mason University , Fairfax , Virginia , USA.
authors: Danielle S
authors: DS
authors: Rudes
authors: d University of Texas at San Antonio , San Antonio , Texsa , USA.
authors: Jill
authors: J
authors: Viglione
authors: a Friends Research Institute, Inc. , Baltimore , Maryland , USA.
authors: Robert P
authors: RP
authors: Schwartz
authors: a Friends Research Institute, Inc. , Baltimore , Maryland , USA.
authors: Michael S
authors: MS
authors: Gordon
authors: e Veteran Affairs Medical Center , Providence , Rhode Island , USA.|f Rhode Island Hospital , Providence , Rhode Island , USA.|g Alpert Medical School of Brown University , Providence , Rhode Island , USA.
authors: Peter D
authors: PD
authors: Friedmann
mesh_terms: D003153:Community Health Services / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy; D016495:Police / Q000523:psychology*; D036301:Qualitative Research; D012017:Referral and Consultation; D014481:United States
chemical_list: D008691:Methadone
keywords: Buprenoprhine; implementation; medication-assisted treatment; methadone; parole; probation