Medication Assisted Treatment and the Three Legged Stool: Medical Providers, Chemical Dependency Professionals, and Clients

Opioid dependence has reached epidemic levels in the United States and around the world. With the increased prescribing of opioid pharmaceuticals and the influx of inexpensive heroin, the health care cost to society has topped $72.5 billion annually (Murphy et al., 2016). Opioid overdose deaths have now surpassed motor vehicle deaths and have tripled since 1990. In some age groups opioid overdose is the leading cause of death. This study seeks to analyze the only field that directly treats this primary brain disease: medication assisted treatment for opioid dependence. The three primary participants in this partnership include: (a) doctors and allied medical providers; (b) substance abuse counselors known in Washington State as Chemical Dependency Professionals (CDPs); and (c) clients affected by opioid dependence. Together they combine medical approaches and psychosocial counseling with clients to attain the goal of recovery. Attitudes and beliefs of these three groups of individuals vary, as do their views toward the medications currently being utilized in the treatment field. This study measures these differences and discusses the implications for clients, medical providers, and CDPs. It was hypothesized that differences in opinions across the three groups about medication assisted treatment, length of time clients should be on medications, and recovery limit positive outcomes. Data were collected via survey from more than 250 clients being treated for opioid dependency and from over 200 professionals (medical and counseling). Descriptive and comparative ANOVA and t-test statistics were used in the analysis. Results indicate that there remain large differences in beliefs and attitudes among the medical providers, CDPs, and clients on key issues related to medication assisted treatment. The gap appears to be especially evident when comparing the two professional groups who treat clients with opioid use disorder. CDPs and medical providers are working from a different set of paradigms and approaches especially as related to their beliefs about the use of medications. CDPs are generally less supportive of medication assisted treatment. Medical providers and CDPs disagree about the length of time clients should be on medications and the long term goals of opioid dependence treatments. In addition clients in opioid treatment programs that use methadone have significantly different views on many issues from those who use buprenorphine/naloxone (Suboxone®). Findings from this study can be used to improve the services provided to clients to increase provider awareness of the ways that attitudes and perceptions impact treatment outcomes. The electronic version of this dissertation is at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.ed