Skip to main content
Top
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment

Authors: Linn Gjersing, Helge Waal, John RM Caplehorn, Michael Gossop, Thomas Clausen

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes.

Methods

This study was a cross-sectional multicentre study. Norwegian OMT staff (n = 140) were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres.

Results

All invited staff (n = 140) participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings). In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate.

Conclusions

This study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.
Literature
1.
go back to reference Dole VP, Nyswander ME: Rehabilitation of heroin addicts after blockade with methadone. N Y State J Med. 1966, 66: 2011-2017.PubMed Dole VP, Nyswander ME: Rehabilitation of heroin addicts after blockade with methadone. N Y State J Med. 1966, 66: 2011-2017.PubMed
2.
go back to reference Ball J.C, Ross A: The effectivness of methadone maintenance treatment. 1991, New York: SpringerCrossRef Ball J.C, Ross A: The effectivness of methadone maintenance treatment. 1991, New York: SpringerCrossRef
3.
go back to reference Clausen T, Anchersen K, Waal H: Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug & Alcohol Dependence. 2008, 94: 151-157.CrossRef Clausen T, Anchersen K, Waal H: Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug & Alcohol Dependence. 2008, 94: 151-157.CrossRef
4.
go back to reference Joseph H, Stancliff S, Langrod J: Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med. 2000, 67: 347-364.PubMed Joseph H, Stancliff S, Langrod J: Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med. 2000, 67: 347-364.PubMed
5.
go back to reference Jaffe JH, O'Keeffe C: From morphine clinics to buprenorphine: Regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003, 70: S3-S11. 10.1016/S0376-8716(03)00055-3.CrossRefPubMed Jaffe JH, O'Keeffe C: From morphine clinics to buprenorphine: Regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003, 70: S3-S11. 10.1016/S0376-8716(03)00055-3.CrossRefPubMed
6.
go back to reference Stewart D, Gossop M, Marsden J: Methadone treatment: outcomes and variation in treatment response within NTORS. Methadone matters evolving community methadone treatment of opiate addiction. Edited by: Strang J, Tober G. 2003, London: Martin Dunitz, 249-291.CrossRef Stewart D, Gossop M, Marsden J: Methadone treatment: outcomes and variation in treatment response within NTORS. Methadone matters evolving community methadone treatment of opiate addiction. Edited by: Strang J, Tober G. 2003, London: Martin Dunitz, 249-291.CrossRef
7.
go back to reference Ball JC, Ross A: The effectivness of methadone maintenance treatment. 1991, New York: Springer, 1CrossRef Ball JC, Ross A: The effectivness of methadone maintenance treatment. 1991, New York: Springer, 1CrossRef
8.
go back to reference Roe G: Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction. Critical Public Health. 2005, 15: 243-250. 10.1080/09581590500372188.CrossRef Roe G: Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction. Critical Public Health. 2005, 15: 243-250. 10.1080/09581590500372188.CrossRef
9.
go back to reference Gossop M, Marsden J, Stewart D, Treacy S: Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug & Alcohol Dependence. 2001, 62: 255-264.CrossRef Gossop M, Marsden J, Stewart D, Treacy S: Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug & Alcohol Dependence. 2001, 62: 255-264.CrossRef
10.
go back to reference Gossop M, Grant M: Six country survey of the content and structure of heroin treatment programmes using methadone. Br J Addict. 1991, 86: 1151-1160. 10.1111/j.1360-0443.1991.tb01883.x.CrossRefPubMed Gossop M, Grant M: Six country survey of the content and structure of heroin treatment programmes using methadone. Br J Addict. 1991, 86: 1151-1160. 10.1111/j.1360-0443.1991.tb01883.x.CrossRefPubMed
11.
go back to reference Stewart D, Gossop M, Marsden J, Strang J: Variation between and within drug treatment modalities: data from the National Treatment Outcome Research Study (UK). Eur Addict Res. 2000, 6: 106-114. 10.1159/000019022.CrossRefPubMed Stewart D, Gossop M, Marsden J, Strang J: Variation between and within drug treatment modalities: data from the National Treatment Outcome Research Study (UK). Eur Addict Res. 2000, 6: 106-114. 10.1159/000019022.CrossRefPubMed
12.
go back to reference D'Aunno T: The role of organization and management in substance abuse treatment: Review and roadmap. J Subst Abuse Treat. 2006, 31: 221-233. 10.1016/j.jsat.2006.06.016.CrossRefPubMed D'Aunno T: The role of organization and management in substance abuse treatment: Review and roadmap. J Subst Abuse Treat. 2006, 31: 221-233. 10.1016/j.jsat.2006.06.016.CrossRefPubMed
13.
go back to reference Grella CE, Greenwell L, Prendergast M, Farabee D, Hall E, Cartier J, et al: Organizational characteristics of drug abuse treatment programs for offenders. J Subst Abuse Treat. 2007, 32: 291-300. 10.1016/j.jsat.2007.01.001.CrossRefPubMedPubMedCentral Grella CE, Greenwell L, Prendergast M, Farabee D, Hall E, Cartier J, et al: Organizational characteristics of drug abuse treatment programs for offenders. J Subst Abuse Treat. 2007, 32: 291-300. 10.1016/j.jsat.2007.01.001.CrossRefPubMedPubMedCentral
14.
go back to reference Rich JD, Boutwell AE, Shield DC, Key RG, McKenzie M, Clarke JG, et al: Attitudes and practices regarding the use of methadone in US state and federal prisons. J Urban Health. 2005, 82: 411-419.CrossRefPubMedPubMedCentral Rich JD, Boutwell AE, Shield DC, Key RG, McKenzie M, Clarke JG, et al: Attitudes and practices regarding the use of methadone in US state and federal prisons. J Urban Health. 2005, 82: 411-419.CrossRefPubMedPubMedCentral
15.
go back to reference Rieckmann T, Daley M, Fuller BE, Thomas CP, McCarty D: Client and counselor attitudes toward the use of medications for treatment of opioid dependence. J Subst Abuse Treat. 2007, 32: 207-215. 10.1016/j.jsat.2006.09.002.CrossRefPubMed Rieckmann T, Daley M, Fuller BE, Thomas CP, McCarty D: Client and counselor attitudes toward the use of medications for treatment of opioid dependence. J Subst Abuse Treat. 2007, 32: 207-215. 10.1016/j.jsat.2006.09.002.CrossRefPubMed
16.
go back to reference Cameron IM, Matheson CI, Bond CM, van Teijlingen ER, Wardell FA, Cronkshaw G, et al: A national survey of nurses working in the management of illicit drug misuse in Scotland. International Journal of Drug Policy. 2006, 17: 442-446. 10.1016/j.drugpo.2006.06.002.CrossRef Cameron IM, Matheson CI, Bond CM, van Teijlingen ER, Wardell FA, Cronkshaw G, et al: A national survey of nurses working in the management of illicit drug misuse in Scotland. International Journal of Drug Policy. 2006, 17: 442-446. 10.1016/j.drugpo.2006.06.002.CrossRef
17.
go back to reference Arfken CL, Agius E, Dickson MW, Anderson HL, Hegedus AM: Clinicians' Beliefs and Awareness of Substance Abuse Treatments in Research- and Nonresearch-Affiliated Programs. Journal of Drug Issues. 2005, 35: 547-558.CrossRef Arfken CL, Agius E, Dickson MW, Anderson HL, Hegedus AM: Clinicians' Beliefs and Awareness of Substance Abuse Treatments in Research- and Nonresearch-Affiliated Programs. Journal of Drug Issues. 2005, 35: 547-558.CrossRef
18.
go back to reference Andrews S, Sorensen J, Guydish J, Delucchi K, Greenberg B: Knowledge and Attitudes About Methadone Maintenance Among Staff Working in a Therapeutic Community. Journal of maintenance in the addictions. 2005, 3: 47-59. 10.1300/J126v03n01_05.CrossRefPubMedPubMedCentral Andrews S, Sorensen J, Guydish J, Delucchi K, Greenberg B: Knowledge and Attitudes About Methadone Maintenance Among Staff Working in a Therapeutic Community. Journal of maintenance in the addictions. 2005, 3: 47-59. 10.1300/J126v03n01_05.CrossRefPubMedPubMedCentral
19.
go back to reference Albery IP, Heuston J, Ward J, Groves P, Durand MA, Gossop M, et al: Measuring therapeutic attitude among drug workers. Addict Behav. 2003, 28: 995-1005. 10.1016/S0306-4603(01)00288-X.CrossRefPubMed Albery IP, Heuston J, Ward J, Groves P, Durand MA, Gossop M, et al: Measuring therapeutic attitude among drug workers. Addict Behav. 2003, 28: 995-1005. 10.1016/S0306-4603(01)00288-X.CrossRefPubMed
20.
go back to reference Caplehorn JR, Lumley TS, Irwig L: Staff attitudes and retention of patients in methadone maintenance programs. Drug Alcohol Depend. 1998, 52: 57-61. 10.1016/S0376-8716(98)00047-7.CrossRefPubMed Caplehorn JR, Lumley TS, Irwig L: Staff attitudes and retention of patients in methadone maintenance programs. Drug Alcohol Depend. 1998, 52: 57-61. 10.1016/S0376-8716(98)00047-7.CrossRefPubMed
21.
go back to reference Caplehorn JR, Irwig L, Saunders JB: Physicians' attitudes and retention of patients in their methadone maintenance programs. Subst Use Misuse. 1996, 31: 663-677. 10.3109/10826089609045833.CrossRefPubMed Caplehorn JR, Irwig L, Saunders JB: Physicians' attitudes and retention of patients in their methadone maintenance programs. Subst Use Misuse. 1996, 31: 663-677. 10.3109/10826089609045833.CrossRefPubMed
22.
go back to reference Pollack HA, D'Aunno T: Dosage patterns in methadone treatment: results from a national survey, 1988-2005. Health Serv Res. 2008, 43: 2143-2163. 10.1111/j.1475-6773.2008.00870.x.CrossRefPubMedPubMedCentral Pollack HA, D'Aunno T: Dosage patterns in methadone treatment: results from a national survey, 1988-2005. Health Serv Res. 2008, 43: 2143-2163. 10.1111/j.1475-6773.2008.00870.x.CrossRefPubMedPubMedCentral
23.
go back to reference D'Ippoliti D, Davoli M, Perucci CA, Pasqualini F, Bargagli AMI: Retention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage. Drug Alcohol Depend. 1998, 52: 167-171. 10.1016/S0376-8716(98)00091-X.CrossRefPubMed D'Ippoliti D, Davoli M, Perucci CA, Pasqualini F, Bargagli AMI: Retention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage. Drug Alcohol Depend. 1998, 52: 167-171. 10.1016/S0376-8716(98)00091-X.CrossRefPubMed
24.
go back to reference Caplehorn JR, McNeil DR, Kleinbaum DG: Clinic policy and retention in methadone maintenance. Int J Addict. 1993, 28: 73-89.CrossRefPubMed Caplehorn JR, McNeil DR, Kleinbaum DG: Clinic policy and retention in methadone maintenance. Int J Addict. 1993, 28: 73-89.CrossRefPubMed
25.
go back to reference Ajzen I: Attitudes, personality, and behavior. 2005, Maidenhead, Berkshire, England: Open University Press Ajzen I: Attitudes, personality, and behavior. 2005, Maidenhead, Berkshire, England: Open University Press
26.
go back to reference Sherif M: The psychology of social norms. 1973, New York: Octagon Books Sherif M: The psychology of social norms. 1973, New York: Octagon Books
27.
go back to reference Asch SE: Studies of Independence and Conformity .1. A Minority of One Against A Unanimous Majority. Psychol Monogr. 1956, 70: 1-70.CrossRef Asch SE: Studies of Independence and Conformity .1. A Minority of One Against A Unanimous Majority. Psychol Monogr. 1956, 70: 1-70.CrossRef
28.
go back to reference Rabinovich A, Morton T, Postmes T: Time perspective and attitude-behaviour consistency in future-oriented behaviours. Br J Soc Psychol. 2010, 69-89. 10.1348/014466608X401875. Rabinovich A, Morton T, Postmes T: Time perspective and attitude-behaviour consistency in future-oriented behaviours. Br J Soc Psychol. 2010, 69-89. 10.1348/014466608X401875.
29.
go back to reference Bretteville-Jensen AL, Amundsen EJ: Injecting drug use in Norway. 5. 2006, Oslo, SIRUS Bretteville-Jensen AL, Amundsen EJ: Injecting drug use in Norway. 5. 2006, Oslo, SIRUS
30.
go back to reference Waal H, Clausen T, Håseth A, Lillevold PH: The 2007 annual assessment of the Norwegian OMT programme. 1. 2008, Oslo Norwegian Centre for Addiction Research University of Oslo Waal H, Clausen T, Håseth A, Lillevold PH: The 2007 annual assessment of the Norwegian OMT programme. 1. 2008, Oslo Norwegian Centre for Addiction Research University of Oslo
31.
go back to reference Waal H: Merits and problems in high-threshold methadone maintenance treatment. Evaluation of medication-assisted rehabilitation in Norway 1998-2004. Eur Addict Res. 2007, 13: 66-73. 10.1159/000097935.CrossRefPubMed Waal H: Merits and problems in high-threshold methadone maintenance treatment. Evaluation of medication-assisted rehabilitation in Norway 1998-2004. Eur Addict Res. 2007, 13: 66-73. 10.1159/000097935.CrossRefPubMed
32.
go back to reference Waal H, Clausen T, Aamodt C, Lillevold PH: The 2005 annual assessment of the Norwegian OMT programme. 1. 2006, Norwegian Centre for Addiction Research, University of Oslo Waal H, Clausen T, Aamodt C, Lillevold PH: The 2005 annual assessment of the Norwegian OMT programme. 1. 2006, Norwegian Centre for Addiction Research, University of Oslo
33.
go back to reference Waal H, Clausen T, Aamodt C, Lillevold PH: The 2006 annual assessment of the Norwegian OMT programme. 1. 2007, Oslo, Norwegian Centre for Addiction Research, University of Oslo Waal H, Clausen T, Aamodt C, Lillevold PH: The 2006 annual assessment of the Norwegian OMT programme. 1. 2007, Oslo, Norwegian Centre for Addiction Research, University of Oslo
34.
go back to reference Gjersing L, Caplehorn JR, Clausen T: Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol. 2010, 10: 13-10.1186/1471-2288-10-13.CrossRefPubMedPubMedCentral Gjersing L, Caplehorn JR, Clausen T: Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol. 2010, 10: 13-10.1186/1471-2288-10-13.CrossRefPubMedPubMedCentral
35.
go back to reference Likert R: A technique for the measurement of attitudes. Archives of psychology. 1932, 140: 5-53. Likert R: A technique for the measurement of attitudes. Archives of psychology. 1932, 140: 5-53.
36.
go back to reference Vånar M: Evaluering av datakvaliteten til "Statusrapportskjemaet" -et måleinstrument for pasienter i legemiddelassistert rehabilitering. 1. 2005, Oslo, Norwegian Centre for Addiction Research, University of Oslo Vånar M: Evaluering av datakvaliteten til "Statusrapportskjemaet" -et måleinstrument for pasienter i legemiddelassistert rehabilitering. 1. 2005, Oslo, Norwegian Centre for Addiction Research, University of Oslo
37.
go back to reference SPSS Inc: SPSS (release 16.0) statistical software. 2008, Chicago, Illinois, SPSS Inc SPSS Inc: SPSS (release 16.0) statistical software. 2008, Chicago, Illinois, SPSS Inc
38.
go back to reference Rothman KJ: Epidemiology an introduction. 2002, Oxford: Oxford University Press Rothman KJ: Epidemiology an introduction. 2002, Oxford: Oxford University Press
39.
go back to reference Matheson C, Bond CM, Mollison J: Attitudinal factors associated with community pharmacists' involvement in services for drug misusers. Addiction. 1999, 94: 1349-1359. 10.1046/j.1360-0443.1999.94913497.x.CrossRefPubMed Matheson C, Bond CM, Mollison J: Attitudinal factors associated with community pharmacists' involvement in services for drug misusers. Addiction. 1999, 94: 1349-1359. 10.1046/j.1360-0443.1999.94913497.x.CrossRefPubMed
40.
go back to reference Van DM, Sleegers P, Hutschemaekers G: Professionals' attitudes toward reducing restraint: The case of seclusion in The Netherlands. Psychiatric Quarterly. 2008, 79: 97-109. 10.1007/s11126-007-9063-x.CrossRef Van DM, Sleegers P, Hutschemaekers G: Professionals' attitudes toward reducing restraint: The case of seclusion in The Netherlands. Psychiatric Quarterly. 2008, 79: 97-109. 10.1007/s11126-007-9063-x.CrossRef
41.
go back to reference Stewart D, Gossop M, Marsden J: Increased caseloads in methadone treatment programs: Implications for the delivery of services and retention in treatment. J Subst Abuse Treat. 2004, 27: 301-306. 10.1016/j.jsat.2004.08.006.CrossRefPubMed Stewart D, Gossop M, Marsden J: Increased caseloads in methadone treatment programs: Implications for the delivery of services and retention in treatment. J Subst Abuse Treat. 2004, 27: 301-306. 10.1016/j.jsat.2004.08.006.CrossRefPubMed
42.
go back to reference Ghose T: Organizational- and individual-level correlates of posttreatment substance use: a multilevel analysis. J Subst Abuse Treat. 2008, 34: 249-262. 10.1016/j.jsat.2007.04.007.CrossRefPubMed Ghose T: Organizational- and individual-level correlates of posttreatment substance use: a multilevel analysis. J Subst Abuse Treat. 2008, 34: 249-262. 10.1016/j.jsat.2007.04.007.CrossRefPubMed
43.
go back to reference Moos RH, King MJ, Burnett EB, Andrassy JM: Community residential program policies, services, and treatment orientations influence patients' participation in treatment. J Subst Abuse. 1997, 9: 171-187. 10.1016/S0899-3289(97)90015-8.CrossRefPubMed Moos RH, King MJ, Burnett EB, Andrassy JM: Community residential program policies, services, and treatment orientations influence patients' participation in treatment. J Subst Abuse. 1997, 9: 171-187. 10.1016/S0899-3289(97)90015-8.CrossRefPubMed
44.
go back to reference Magura S, Nwakeze PC, Kang SY, Demsky S: Program quality effects on patient outcomes during methadone maintenance: a study of 17 clinics. Subst Use Misuse. 1999, 34: 1299-1324. 10.3109/10826089909039410.CrossRefPubMed Magura S, Nwakeze PC, Kang SY, Demsky S: Program quality effects on patient outcomes during methadone maintenance: a study of 17 clinics. Subst Use Misuse. 1999, 34: 1299-1324. 10.3109/10826089909039410.CrossRefPubMed
45.
go back to reference McLellan AT, Hagan TA, Levine M, Meyers K, Gould F, Bencivengo M, et al: Does clinical case management improve outpatient addiction treatment. Drug & Alcohol Dependence. 1999, 55: 91-103.CrossRef McLellan AT, Hagan TA, Levine M, Meyers K, Gould F, Bencivengo M, et al: Does clinical case management improve outpatient addiction treatment. Drug & Alcohol Dependence. 1999, 55: 91-103.CrossRef
46.
go back to reference Gar MC, Marina S, Elizabeth KM, Hoffman Robert, Nelson Lewis: Testing Positive for Methadone and Either a Tricyclic Antidepressant or a Benzodiazepine Is Associated with an Accidental Overdose Death: Analysis of Medical Examiner Data. Acad Emerg Med. 2006, 13: 543-547. 10.1111/j.1553-2712.2006.tb01006.x.CrossRef Gar MC, Marina S, Elizabeth KM, Hoffman Robert, Nelson Lewis: Testing Positive for Methadone and Either a Tricyclic Antidepressant or a Benzodiazepine Is Associated with an Accidental Overdose Death: Analysis of Medical Examiner Data. Acad Emerg Med. 2006, 13: 543-547. 10.1111/j.1553-2712.2006.tb01006.x.CrossRef
47.
go back to reference Mikolaenko I, Robinson CA, Davis GG: A review of methadone deaths in Jefferson County, Alabama. American Journal of Forensic Medicine & Pathology. 2002, 23: 299-304.CrossRef Mikolaenko I, Robinson CA, Davis GG: A review of methadone deaths in Jefferson County, Alabama. American Journal of Forensic Medicine & Pathology. 2002, 23: 299-304.CrossRef
48.
go back to reference Darke S, Swift W, Hall W, Ross M: Drug use, HIV risk-taking and psychosocial correlates of benzodiazepine use among methadone maintenance clients. Drug Alcohol Depend. 1993, 34: 67-70. 10.1016/0376-8716(93)90047-T.CrossRef Darke S, Swift W, Hall W, Ross M: Drug use, HIV risk-taking and psychosocial correlates of benzodiazepine use among methadone maintenance clients. Drug Alcohol Depend. 1993, 34: 67-70. 10.1016/0376-8716(93)90047-T.CrossRef
49.
go back to reference Clausen T, Waal H, Thoresen M, Gossop M: Mortality among opiate users: opioid maintenance therapy, age and causes of death. Addiction. 2009, 104: 1356-1362. 10.1111/j.1360-0443.2009.02570.x.CrossRefPubMed Clausen T, Waal H, Thoresen M, Gossop M: Mortality among opiate users: opioid maintenance therapy, age and causes of death. Addiction. 2009, 104: 1356-1362. 10.1111/j.1360-0443.2009.02570.x.CrossRefPubMed
Metadata
Title
Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment
Authors
Linn Gjersing
Helge Waal
John RM Caplehorn
Michael Gossop
Thomas Clausen
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-194

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue