Who works in addictions treatment services? Some results from an Ontario survey.

This paper summarizes results from a survey of staff of specialized addiction treatment agencies in Ontario and includes information on demographic characteristics, education and related issues for those working in different types of agencies. Across all agencies 80% of staff had some sort of post secondary academic qualification and the majority reported taking professional development courses in the previous 12 months. However, only 20% of all respondents were "certified" as either an addictions counsellor or as another type of human service provider. There were differences within and between different agencies, and between respondents with and without administrative/supervisory responsibilities, with respect to education and certification status. Discussion concerns professionalization of the addiction treatment field, preparatory training for work in addictions treatment, and the generalizability of results.     

Addiction Medicine: Current Status of Certification,Maintenance of Certification,Training, and Practice

Addiction medicine (ADM) is an emerging medical field. It will soon be recognized by the American Board of Medical Specialties as a multispecialty subspecialty, sponsored by the American Board of Preventive Medicine. Certification and maintenance of certification in ADM are available currently through the American Board of Addiction Medicine (ABAM). There is an urgent need for trained and certified ADM physicians to serve the needs of patients and society. Thirty-seven addiction medicine fellowships of 12 months duration are now available, and their number is increasing. Physicians specializing in medical toxicology have educational, training, and practice overlap with addiction medicine. Medical toxicology physicians usually meet ADM examination eligibility requirements, based on clinical practice experience and continuing medical education activities. Those with fellowship training or in a fellowship bring training experience which has commonalities to ADM fellowship training, and therefore are particularly prepared for examination and practice in ADM. There are opportunities for partnerships in training, practice, and leadership between addiction medicine and medical toxicology.     

American Society of Clinical Oncology--34th Annual Meeting. Treatments for prostate cancer and new molecular targets. 16-19 May 1998, Los Angeles, California, USA

The American Society of Clinical Oncology (ASCO) is the world's largest professional society representing physicians and researchers in the field of cancer treatment. Almost 19,000 clinicians, researchers and specialists from academia and industry attended this 34th Annual Meeting. The four-day meeting consisted of lecture sessions, education sessions, "meet the professor" sessions, tumor panel sessions, plenary sessions, oral sessions, scientific and integrated symposia and poster presentations. A wide range of topics of interest to the oncologist were discussed, broadly covering the biology, prevention, diagnosis, staging, management and treatment of cancer, as well as psychosocial and economic implications.     

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.     

Drinking Alcohol Surrogates Among Clients of an Alcohol-Misuser Treatment Clinic in Novosibirsk,Russia

This paper summarizes results from a survey of staff of specialized addiction treatment agencies in Ontario and includes information on demographic characteristics, education and related issues for those working in different types of agencies. Across all agencies 80% of staff had some sort of post secondary academic qualification and the majority reported taking professional development courses in the previous 12 months. However, only 20% of all respondents were “certified” as either an addictions counsellor or as another type of human service provider. There were differences within and between different agencies, and between respondents with and without administrative/supervisory responsibilities, with respect to education and certification status. Discussion concerns professionalization of the addiction treatment field, preparatory training for work in addictions treatment, and the generalizability of results. [Translations are provided in the International Abstracts Section of this issue.]     

Improving acceptance of naltrexone in community addiction treatment centers: a pilot study

Alcoholism pharmacotherapies are underused in community addiction treatment settings, in part because individuals who practice in these settings—nonmedical addiction counselors and administrators—lack knowledge about and confidence in the value of adjunctive alcohol pharmacotherapies. We developed and tested an intervention to improve knowledge and attitudes about naltrexone. A team of researchers, physicians, addiction treatment counselors, and administrators collaborated to develop a naltrexone educational intervention designed for nonmedical addiction professionals. The intervention was compared with a control condition in a pilot study with 6 addiction treatment agencies (3 agencies per group). Participants (counselors and administrators, N = 84) were assessed before and 6 months after the intervention. Results revealed that the intervention significantly improved naltrexone knowledge, and participants who received the intervention reported greater satisfaction with the education they received, as well as greater use of the information. The effect of the intervention on attitudes about naltrexone was encouraging but did not to reach statistical significance. This study is the first reported attempt to develop and test an intervention specifically to improve acceptance of adjunctive medications for alcoholism among nonmedical addiction professionals.     

Introduction: New Directions for Vocational Rehabilitation in Substance User Treatment: Rebuilding Damaged Lives

If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.     

Introduction: new directions for vocational rehabilitation in substance user treatment: rebuilding damaged lives

If an important objective of addiction treatment is to increase patient employment, then it makes sense to locate vocational assistance within treatment programs. The purpose of this special issue is to present new research on the improvement of vocational services in addiction treatment. The volume begins with a critical review and synthesis of three decades of research on the effectiveness of specialized vocational services for addiction treatment patients. The new evaluation studies in this volume break down into those conducted in methadone treatment vs. other types of treatment settings. The volume concludes with a framework for evaluating the cost-effectiveness of vocational rehabilitation within addiction treatment. Critical issues that need resolution in this field are identified.     

《抗菌药物临床应用指导原则》依从性分析

目的:了解不同级别医师执行《抗菌药物临床应用指导原则》的依从性。方法:对2005年上半年和2006年上半年2家医院急诊科不同级别医师(副高职称A组、中级职称B组、初级职称医师C组、进修医师D组)处理急性上呼吸道感染、急性细菌性肠炎、外伤感染的抗菌药物处方进行统计、分析。结果:针对急性上呼吸道感染医师执行《抗菌药物临床应用指导原则》的依从率,A组最高,C组最低,P<0.01;2年比较,B组选药依从率降低(P<0.05)。针对急性细菌性肠炎,各组以选择氟喹诺酮类药物为主;医师执行《抗菌药物临床应用指导原则》2年比较,B组依从率提高(P<0.05),C组依从率降低(P<0.01)。针对外伤感染,D组医师执行《抗菌药物临床应用指导原则》的依从率较低;其首选药物应用率,D组低于A、B、C组(P<0.01)。结论:职称较高的医师比职称较低的医师有较稳定的高依从性,坚持进行抗菌药物分级管理极有必要。     

Training and Fidelity Monitoring of Alcohol Treatment Interventions Integrated Into Routine Tuberculosis Care in Tomsk,Russia: the IMPACT Effectiveness Trial

IMPACT (Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis patients) is a randomized, controlled effectiveness trial based in Tomsk, Russia, that assesses the effect of oral naltrexone and brief behavioral counseling on tuberculosis outcomes and alcohol use in 200 patients. Tuberculosis physicians without addiction experience delivered interventions as part of routine care over a 6-month period, focusing on alcohol intake reduction to support successful tuberculosis treatment. We describe design, training, and fidelity monitoring using a Russian and American team of physicians, bilingual coders, and supervisors. Culturally appropriate adaptations, limitations, and implications for future trials are discussed. The clinical trial identification number is NCT00675961. Funding came from the National Institutes of Health and National Institute on Drug Abuse.     

Recovered addicts working in the addiction field: Pitfalls to substance abuse relapse

In the 1940s, due to a shortage of professional counselors, combined with the hope of rehabilitation for the addict, there grew a belief that the recovered alcoholic could be trained to enter the field of addiction treatment as a paraprofessional. These early stages of addiction treatment and the emergence of the recovered substance abuser as a counselor fostered a discussion in the role played by the paraprofessional. This discussion subsequently encouraged an accumulation of literature during the early stages of substance abuse treatment in North America, which later began to diminish as the field moved forward towards the twenty-first century. This paper reviews the literature to examine the perceived potential risks for relapse associated with recovered addicts working in the addictions field. Potential risks for relapse discussed are the ex-addict's motivation for entering the addiction field, personal help from self-help groups may be lost once in the field, over involvement with clients, over involvement with work, over identification with clients and the repercussions of relapse. The paper also addresses the limitations of the studies conducted to date, provides recommendations for further research and proposes that this topic be explored using a qualitative approach, so that recovered counselors can construct their own narratives.     

Lay and professional concepts of alcohol dependence in the process of recovery from addiction among treated and non-treated individuals in Poland: A qualitative study

The study identifies and categorizes concepts of addiction among treated and non-treated former alcohol dependents, and their function in the process of recovery from addiction within the post-communist treatment system dominated by the Minnesota model. This qualitative study is based on a media recruited sample of 29 former alcohol dependents (ICD-10) in Warsaw/Poland 2006/2007. They reported a recovery time of at least 2 years (M_recovery?=?11, SD?=?9). In-depth interviews were analysed according to the Problem-Centred Interview method using Atlas.ti software. The applied triangulation procedures ensure reliability and validity of the data collected and the analysis of the narrative accounts. The results of the study show that professional concepts of addiction reconstructed on the basis of narratives from treated respondents resemble the disease model of addiction. A first category of lay concepts of self-changers adopt a medical–moral model of dependence including strong will as a key element of the successful recovery. A second category describes dependence as a symptom of maladaptive social functioning and recovery as a process of understanding one's role in society and fulfilling social expectations. While self-changers relied on one of these lay concepts, treated respondents were confronted with a conflict between lay and professional definition of dependence. It is argued that lack of recognition of lay concepts of addiction by treatment providers may weaken help-seeking and increase drop-out rates. The disease model implies the stability of the status of the alcoholic – which potentially weakens the individual's chance to reach the stage of stable recovery.     

The business of addiction treatment: A research agenda

The social and economic costs of addiction are substantial and of great concern to society. Research in the past decade has led to promising therapies that appear to be highly effective but not widely diffused. This leads one to wonder if there is something about the structure, dynamics, or structure and dynamics of the addiction treatment industry that is getting in the way. However, there has been very little research in the areas of organization, finance, or management practices within the substance abuse treatment field-the kinds of issues that reduce the potential impact of addiction treatment industrywide. With this as background, this article introduces the Center for Organization and Management in Addiction Treatment (COMAT) and a special section on research in the "business of addiction treatment." Many other industries have experienced significant problems that are similar, in many respects, to those seen in substance abuse treatment, but research in leadership, innovation, investment, organization, and consolidation strategies has helped to overcome those problems. COMAT is dedicated to implementing and testing evidence-based methods from other industries to improve the outcomes performance and, ultimately, the clinical effectiveness of service providers in the addiction treatment field.     

Addicts on Parole: Short-Term and Long-Term Prognosis

Much attention has recently been focused on the question of the extent of heroin use in America. In a worthwhile effort to call public attention to the problem, many estimates of its size have evidenced a tendency toward exaggeration and aggrandizement. This paper presents methods of estimation of the extent of heroin addiction which, when carefully employed, should effectively correct such distorted estimates.

Two general types of estimation are employed, incidence and prevalence. Incidence estimates are concerned with new cases of heroin addiction that occur in a specific population within a given amount of time. These estimates are based upon self-report data from addicts regarding date of first addiction. When corrected for the “lag phase” (that period of time between onset of first addiction and eventual visit to a treatment program), these data permit accurate retrospective charting of incidence trends. Prevalence estimates focus on all known cases of heroin addiction in a specific population within a given amount of time. Three separate types of prevalence estimates from three separate sources are outlined in this article: estimates based on overdose death data, estimates based on crime statistics, and estimates of “unknown” addicts.

In outlining these methods, this article describes the fluctuations in heroin addiction in one major American city, San Francisco, California. After analyzing data gathered from a sample of 2,367 addicts contacted over a 3-year period, this study suggests that the incidence of heroin addiction seems to have declined after 1970. Possible factors underlying this apparent decline in heroin addiction are then discussed, including the post-1970 maturation of the “population at risk,” the effectiveness of antidrug media messages, the changing drug fashions in the heroin subculture, and the gradual deterioration of the quality and potency of street heroin.     

Practices,Perceptions, and Concerns of Primary Care Physicians About Opioid Dependence Associated with the Treatment of Chronic Pain

ABSTRACT

When prescribing opioids to treat chronic pain, physicians face the dilemma of balancing effective pain management while avoiding iatrogenic opioid addiction. Through mailed surveys, the current study assessed concerns, perceptions, and practices of primary care physicians related to this dilemma. Of the 35 (43%) physicians that replied, 32 (91.4%) reported to prescribe opioids for pain. Twenty-six (81.3%) physicians mentioned that “legitimate pain” was the main reason why most patients who are opioid dependent begin using opioids. Most physicians (71.5%) rated their knowledge/comfort of treatment/management of opioid dependence as being low. Although these physicians believed training is essential to learning about the risks involved with chronic pain and opioid dependence, many of these physicians evaluated their own medical training in these areas as unsatisfactory. Training programs may better equip primary care physicians when addressing the treatment of chronic pain and addiction to opioids.