Psychology Ph.D. Dissertations

Do psychological characteristics of addiction treatment professionals predict acceptance of harm reduction interventions?

Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Psychology/Clinical

First Advisor

Harold Rosenberg (Advisor)

Second Advisor

William O'Brien (Committee Member)

Third Advisor

Steve Jex (Committee Member)

Fourth Advisor

Marc Simon (Committee Member)

Abstract

I designed this study to assess the acceptability of 12 harm reduction interventions by American addiction treatment professionals, the availability of each intervention, and the association between professionals' reported acceptance and their stigmatizing attitudes (i.e., authoritarianism and benevolence), psychological flexibility, and burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment). I recruited a sample of 257 members of NAADAC, the Association for Addiction Professionals, to complete web-based questionnaires. Depending on the intervention and the severity of the client's substance use disorder diagnosis (mild-moderate or severe using DSM-5 criteria), 63% to 90% of participants rated five behavioral and three pharmaceutical interventions as acceptable. Smaller proportions (27% to 52%) rated limited or moderate use of cannabis, opioids, cocaine/crack cocaine, and amphetamines as acceptable. Whatever their acceptability, interventions were not available from most providers or their agencies. Exploratory factor analyses suggested two subscales of harm reduction interventions: 1) behavioral and pharmaceutical interventions and 2) limited or moderate use goals. Regression analyses revealed that higher benevolence and lower depersonalization significantly predicted greater acceptance of behavioral and pharmaceutical interventions for individuals diagnosed with a mild-moderate substance use disorder. Higher benevolence, higher emotional exhaustion, and lower depersonalization significantly predicted greater acceptance of behavioral and pharmaceutical interventions for individuals with a severe substance use disorder. Subsequent exploratory regression analyses revealed that these characteristics were associated with acceptance of the behavioral interventions but not of the pharmaceutical interventions. There was no association between participants' psychological characteristics and their acceptance of limited or moderate use goals. Acceptance of harm reduction was also unrelated to providers' political orientation, personal history of diagnosed substance use disorder, years providing addiction treatment, or legal status of marijuana in the provider's state. Several limitations could restrict the generalizability of this study. Specifically, I recruited a sample of older, more experienced counselors from a single professional organization and I had a low rate of usable responses. Additionally, participants may have provided what they felt were socially desirable responses. Consistent with this possibility, participants' mean scores on the psychological measures reflected high benevolence, low authoritarianism, low psychological flexibility, and low burnout, all with little variability.

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