One study found that support staff*--who make
up 24 percent of the treatment provider
workforce in the National Institute on Drug
Abuse’s (NIDA) Clinical Trial Network (CTN)†
and have more direct patient contact than
professional counselors and medical personnel--
showed little enthusiasm for evidence-based
practices; they also were more likely to support
intervention techniques that employ
confrontation and coercion--techniques that
contradict evidence-based practice.^171 In
contrast, treatment providers affiliated with CTN
who advocated for the use of new evidence-
based practices tended to be more highly
educated.^172
A study of counselors’ attitudes toward
evidence-based psychosocial and pharmaceutical
practices‡ found that those who had more
specific training in the practices and those who
worked in treatment centers where the particular
practices were used routinely tended to perceive
evidence-based practices as more acceptable for
treating addiction.^173 Providers with higher
educational degrees are more likely to be
supportive of evidence-based practices than
those with lower-level degrees.^174 In contrast,
providers with a strong 12-step orientation to
treatment tend to perceive evidence-based
practices as less acceptable.^175
- Support staff is distinct from counselors, managers
or supervisors and medical personnel.
† CTN is a partnership between NIDA researchers
and community treatment providers to deliver new
evidence-based treatments to a broader population of
patients and to conduct multi-site clinical trials to
determine the effectiveness of new therapies in
diverse settings.
‡ Including the use of buprenorphine, methadone,
naltrexone, disulfiram, motivational enhancement
therapy and voucher-based motivational incentives.
Health Professionals do not Implement
Evidence-Based Addiction Care Practices§
Mainstream medical and other health
professionals do not adequately address risky
substance use or the disease of addiction in their
professional practice, in part because they are
not trained to do so.** 176 and in part because
they do not see it as a legitimate element of their
role as health professionals.Education and training alone, however, is
insufficient to change practice. For example,
while numerous guidelines have been produced
and disseminated by government agencies,†† 178
professional associations^179 and quality
improvement organizations such as the National
Quality Forum (NQF)^180 and the Agency for
Healthcare Research and Quality (AHRQ),^181 to
help health professionals conduct evidence-
based practices related to risky substance use
and addiction, physicians and other health care
providers commonly fail to adhere to these
clinical practice guidelines.^182A recognized cadre of addiction physician
specialists is essential to help educate and train
other physicians, serve as equal partners in
regular medical practice and provide specialty
care.^183Efforts also must be made to translate physician
training into practice. A lack of time and
resources make it difficult for physicians to
remain up to date with the latest guidelines and
recommendations, and limited reimbursement
may prevent some physicians from taking the
time to implement practice recommendations.^184§ See Chapter IX for a detailed discussion of the
addiction-related credentialing requirements for
health professionals.
** Most of the research related to the training of
health professionals in addiction-related services
focuses on tobacco cessation rather than interventions
for addiction involving alcohol and other drugs.
†† e.g., The Substance Abuse and Mental Health
Services Administration (SAMHSA) produces the
National Registry of Evidence-Based Programs and
Practices (NREPP), an online searchable database of
evidence-based interventions for mental health and
addiction prevention and treatment.For many recovering paraprofessional
counselors, their counseling “trump card” is
that their personal experience is exemplary of
how recovery works.^177