Social Workers' Knowledge, Opinions, and Adoption of Pharmacological Treatment for Substance Use Disorders

Background and Purpose: Research on the pharmacological treatment of substance use disorders (SUDs) has shown these approaches to be effective in the prevention of relapse to substance use. However, the uptake of new medications is slow in SUD treatment programs. Social workers comprise a significant component of the SUD treatment workforce and are thus important stakeholders in organizational decisions to adopt and implement pharmacotherapy. The purpose of this study was to investigate social worker's knowledge and opinions regarding four pharmacological interventions for SUDs: methadone, buprenorphine, naltrexone, and acamprosate. To that end, we addressed the following research questions: (1) Do social workers differ from other substance abuse counselors in their knowledge and opinions of specific pharmacotherapies?; (2) What factors influence social workers' knowledge and opinions of specific pharmacotherapies.

Methods: The sampling frame was derived from a national sample of 318 treatment centers. All counselors employed in these centers were recruited to participate in a mailed survey. A total of 1140 questionnaires were completed and returned, including 285 social workers. Dependent variables included counselors' knowledge and perceptions of effectiveness and acceptability of four pharmacotherapies. Independent variables included counselors' education, experience, recovery status, endorsement of a 12-Step philosophy, attitudes toward EBPs, training in specific pharmacotherapies, and use of specific pharmacotherapies in their program. Chi-square analyses and t-tests were used to test for differences between social workers and other counselors on dependent variables. Logistic and OLS regression models were tested to identify factors influencing social workers' knowledge and perceptions of effectiveness and acceptability of the four pharmacotherapies.

Results: Social workers did not differ from other counselors in their knowledge of pharmacotherapies, but rated all four pharmacotherapies as more effective and more acceptable than did other counselors. Social workers' knowledge of all four pharmacotherapies was positively associated with training on the use of the treatment. With the exception of methadone, social workers were more likely to have knowledge of specific pharmacotherapies if it had been adopted in their program. Ratings of effectiveness of all but methadone were positively associated with positive attitudes towards integration of medications into SUD treatment. Rating of effectiveness of naltrexone was positively associated with a 12-Step orientation. Ratings of the acceptability of all four pharmacotherapies were positively associated with ratings of effectiveness. Acceptability of all but naltrexone was negatively associated with a 12-Step orientation. When used in their program, social workers rated methadone as more effective and more acceptable.

Conclusions: Dissemination efforts appear to be more successful in reaching social workers than other SUD counselors. Efforts to increase perceptions of effectiveness must take into consideration social workers' general attitudes towards the integration of medications into SUD treatment. Efforts to increase perceptions of the acceptability of pharmacotherapies must take into account social workers perceptions of effectiveness. In the case of methadone, exposure to the use of methadone may also increase perceptions of effectiveness and acceptability.