Background
Methods
Recruitment methods
Sample characteristics
Total N = 117 (%)
| |
---|---|
Gender
| |
Male | 41 (35%) |
Female | 76 (65%) |
Age
| |
18-30 | 43 (36.7%) |
31-43 | 46 (39.3%) |
44-56 | 20 (17.1%) |
57+ | 8 (6.9%) |
Highest level of schooling
| |
Ph.D. in clinical psychology | 8 (7%) |
Ed.D. (doctorate in education) | 2 (2%) |
M.D. | 5 (4%) |
Master of Social Work or Master of Education | 16 (13%) |
B.A. or B.S. | 41 (35%) |
High school or G.E.D. | 31 (26%) |
Other (included counseling certification, other Ph.D. or military substance abuse training) | 14 (12%) |
Addiction vignette
Paul goes to an addiction treatment center due to his inability to stop drinking without suffering withdrawal symptoms. He is having difficulty going to work and problems at home. He reports that at times, it is difficult for him to get out of bed in the morning. He reports having to drink twice as much as he used to just to feel "normal".
After a thorough evaluation, Paul is diagnosed with Psychoactive Substance Dependence (Alcohol). Paul’s clinician decides to treat him with Naltrexone (ReVia), a drug that claims to reduce or eliminate the rewarding effects of alcohol. He also recommends a 12-step program to Paul to attend. Another clinician at the clinic raises various objections to the use of Naltrexone for Paul’s treatment.
Attitudes toward the use of medication
Ratings of responsibility for the onset of and recovery from addiction
Statistical analysis plan
Results
Descriptive data on ratings of responsibility
Strongly disagree
|
Disagree
|
Neither agree nor disagree
|
Agree
|
Strongly agree
| |
---|---|---|---|---|---|
Responsibility for onset
| |||||
Persons with alcoholism are responsible for the onset of their dependency. | 2.6% | 24.8% | 22.2% | 35.0% | 15.4% |
Persons with alcoholism could have avoided their dependence. | 5.1% | 20.5% | 29.1% | 30.8% | 14.5% |
Responsibility for recovery
| |||||
Persons with alcoholism are personally responsible for their recovery. | 1.7% | 6.8% | 6.0% | 53.0% | 32.5% |
Persons with alcoholism are personally responsible for creating a solution. | 3.4% | 14.5% | 23.9% | 40.2% | 17.9% |
Objection
| |||||
Paul will be unlikely to comply with taking the medication. | 1.7% | 25.7% | 35.9% | 25.6% | 11.1% |
The medication’s side effects (which include nausea, headache, dizziness, anxiety and a small risk of withdrawal symptoms) are not worth its benefits. | 8.5% | 37.6% | 19.7% | 23.9% | 10.3% |
There’s a risk that Paul will use opioids that interfere with the medication and cause serious side effects. | 12.0% | 21.4% | 22.2% | 25.6% | 18.8% |
Naltrexone will treat the symptoms of Paul’s alcoholism, but it will not improve the underlying causes of his alcohol abuse. | 2.5% | 12.0% | 26.5% | 46.2% | 12.8% |
Overcoming alcoholism without the use of medication will strengthen Paul’s resolve and willpower. | 1.7% | 3.4% | 18.0% | 39.3% | 37.6% |
The medication will diminish Paul’s motivation to help himself and participate in the 12-step program. | 6.8% | 27.3% | 19.7% | 36.8% | 9.4% |
Regression models
Model 1
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Model 2
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Model 3
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Model 4
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor
|
B
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SE B
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β
|
B
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SE B
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β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
Gender (0 = female; 1 = male) | 0.05 | 0.20 | 0.02 | 0.02 | 0.19 | 0.01 | 0.05 | 0.20 | 0.02 | 0.05 | 0.19 | 0.02 |
Age | 0.02 | 0.01 | 0.18 | 0.02 | 0.01 | 0.19 | 0.02 | 0.01 | 0.18 | 0.02 | 0.01 | 0.18 |
Type of schooling | ||||||||||||
PhD | −0.46 | 0.38 | −0.13 | −0.48 | 0.36 | −0.13 | −0.46 | 0.38 | −0.13 | −0.46 | 0.37 | −0.13 |
MD | −0.19 | 0.48 | −0.04 | −0.39 | 0.47 | −0.08 | −0.19 | 0.49 | −0.04 | −0.17 | 0.47 | −0.03 |
Master’s-level | −0.13 | 0.31 | −0.04 | −0.19 | 0.30 | −0.07 | −0.13 | 0.31 | −0.04 | −0.16 | 0.31 | −0.06 |
Bachelor’s-level | −0.02 | 0.24 | −0.01 | −0.08 | 0.23 | −0.04 | −0.02 | 0.24 | −0.01 | −0.05 | 0.23 | −0.03 |
Other education | 0.11 | 0.34 | 0.03 | 0.15 | 0.33 | 0.05 | 0.11 | 0.34 | 0.03 | 0.14 | 0.34 | 0.05 |
Years working with substance abuse | −0.19* | 0.09 | −0.21* | −0.17 | 0.09 | −0.19 | −0.19 | 0.09 | −0.21 | −0.17 | 0.09 | −0.20 |
Percentage privately insured clients | 0.00 | 0.00 | −0.03 | 0.00 | 0.00 | −0.09 | 0.00 | 0.00 | −0.03 | 0.00 | 0.00 | −0.07 |
Percentage publicly insured clients | 0.01 | 0.00 | 0.19 | 0.00 | 0.00 | 0.10 | 0.01 | 0.00 | 0.19 | 0.00 | 0.00 | 0.14 |
Percentage out of pocket clients | 0.00 | 0.00 | 0.14 | 0.01 | 0.00 | 0.16 | 0.00 | 0.00 | 0.14 | 0.01 | 0.00 | 0.16 |
Personally recovering from addiction (0 = no; 1 = yes) | 0.34 | 0.22 | 0.16 | 0.23 | 0.21 | 0.10 | 0.34 | 0.22 | 0.16 | 0.25 | 0.22 | 0.11 |
Responsibility for addiction onset
| 0.32** | 0.10 | 0.31** | |||||||||
Responsibility for addiction recovery
| 0.00 | 0.12 | 0.00 | |||||||||
Combined responsibility | 0.27 | 0.14 | 0.20 | |||||||||
R
2
| 0.16 | 0.23 | 0.16 | 0.19 | ||||||||
F
| F (12, 104) = 1.68 | F (13, 103) = 2.44** | F (13, 103) = 1.54 | F (13, 103) = 1.89* |
Model 1
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Model 2
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Model 3
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Model 4
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
Gender (0 = female; 1 = male) | 0.14 | 0.24 | 0.06 | 0.11 | 0.23 | 0.04 | 0.16 | 0.24 | 0.07 | 0.13 | 0.23 | 0.06 |
Age | 0.01 | 0.01 | 0.12 | 0.01 | 0.01 | 0.13 | 0.01 | 0.01 | 0.12 | 0.01 | 0.01 | 0.12 |
Type of schooling | ||||||||||||
PhD | 0.04 | 0.46 | 0.01 | 0.03 | 0.44 | 0.01 | 0.05 | 0.45 | 0.01 | 0.04 | 0.43 | 0.01 |
MD | 0.06 | 0.59 | 0.01 | −0.20 | 0.56 | −0.04 | 0.30 | 0.58 | 0.05 | 0.09 | 0.55 | 0.02 |
Master’s-level | −0.25 | 0.38 | −0.07 | −0.33 | 0.36 | −0.10 | −0.27 | 0.37 | −0.08 | −0.33 | 0.36 | −0.10 |
Bachelor’s-level | −0.12 | 0.29 | −0.05 | −0.19 | 0.28 | −0.08 | −0.13 | 0.28 | −0.05 | −0.18 | 0.27 | −0.07 |
Other education | −0.17 | 0.42 | −0.05 | −0.11 | 0.40 | −0.03 | −0.13 | 0.41 | −0.04 | −0.09 | 0.40 | −0.02 |
Years working with substance abuse | −0.15 | 0.11 | −0.15 | −0.13 | 0.11 | −0.12 | −0.14 | 0.11 | −0.14 | −0.13 | 0.11 | −0.12 |
Percentage privately insured clients | 0.00 | 0.00 | 0.06 | 0.00 | 0.00 | −0.01 | 0.00 | 0.00 | 0.02 | 0.00 | 0.00 | −0.02 |
Percentage publicly insured clients | 0.00 | 0.00 | 0.11 | 0.00 | 0.00 | 0.01 | 0.00 | 0.00 | 0.09 | 0.00 | 0.00 | 0.02 |
Percentage out of pocket clients | 0.01 | 0.00 | 0.17 | 0.01* | 0.00 | 0.19* | 0.01* | 0.00 | 0.20* | 0.01* | 0.00 | 0.21* |
Personally recovering from addiction (0 = no; 1 = yes) | 0.30 | 0.26 | 0.12 | 0.15 | 0.26 | 0.06 | 0.19 | 0.26 | 0.07 | 0.09 | 0.26 | 0.04 |
Responsibility for addiction onset
| 0.42*** | 0.12 | 0.34*** | |||||||||
Responsibility for addiction recovery
| 0.33* | 0.14 | 0.23* | |||||||||
Combined Responsibility | 0.59*** | 0.16 | 0.37*** | |||||||||
R
2
| 0.09 | 0.18 | 0.14 | 0.20 | ||||||||
F
| F (12, 104) = 0.85 | F (13, 103) = 1.74 | F (13, 103) = 1.25 | F(13, 103) = 1.93* |
Model 1
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Model 2
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Model 3
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Model 4
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor
|
B
|
SE B
|
β
|
B
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SE B
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β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
Gender (0 = female; 1 = male) | 0.12 | 0.26 | 0.04 | 0.10 | 0.26 | 0.04 | 0.14 | 0.26 | 0.05 | 0.12 | 0.26 | 0.04 |
Age | −0.01 | 0.01 | −0.07 | −0.01 | 0.01 | −0.06 | −0.01 | 0.01 | −0.07 | −0.01 | 0.01 | −0.07 |
Type of schooling | ||||||||||||
PhD | 0.76 | 0.50 | 0.16 | 0.75 | 0.50 | 0.16 | 0.76 | 0.50 | 0.17 | 0.76 | 0.49 | 0.16 |
MD | 1.11 | 0.64 | 0.17 | 0.94 | 0.64 | 0.15 | 1.28 | 0.65 | 0.20 | 1.13 | 0.63 | 0.18 |
Master’s-level | 0.67 | 0.42 | 0.18 | 0.62 | 0.41 | 0.16 | 0.66 | 0.41 | 0.17 | 0.62 | 0.41 | 0.16 |
Bachelor’s-level | 0.45 | 0.32 | 0.17 | 0.40 | 0.31 | 0.15 | 0.44 | 0.31 | 0.16 | 0.41 | 0.31 | 0.15 |
Other education | 0.54 | 0.46 | 0.14 | 0.58 | 0.45 | 0.15 | 0.57 | 0.45 | 0.14 | 0.60 | 0.45 | 0.15 |
Years working with substance abuse | 0.00 | 0.12 | 0.00 | 0.01 | 0.12 | 0.01 | 0.00 | 0.12 | 0.00 | 0.01 | 0.12 | 0.01 |
Percentage privately insured clients | 0.00 | 0.00 | 0.04 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | 0.02 | 0.00 | 0.00 | −0.01 |
Percentage publicly insured clients | 0.01 | 0.00 | 0.12 | 0.00 | 0.00 | 0.06 | 0.00 | 0.00 | 0.10 | 0.00 | 0.00 | 0.06 |
Percentage out of pocket clients | 0.01* | 0.00 | 0.20* | 0.01* | 0.00 | 0.21* | 0.01* | 0.00 | 0.22* | 0.01* | 0.00 | 0.23* |
Personally recovering from addiction (0 = no; 1 = yes) | 0.09 | 0.29 | 0.03 | 0.00 | 0.29 | 0.00 | 0.02 | 0.29 | 0.01 | −0.04 | 0.29 | −0.02 |
Responsibility for addiction onset
| 0.28 | 0.14 | 0.20 | |||||||||
Responsibility for addiction recovery
| 0.23 | 0.15 | 0.15 | |||||||||
Combined responsibility | 0.40* | 0.18 | 0.22* | |||||||||
R
2
| 0.12 | 0.17 | 0.14 | 0.16 | ||||||||
F
| F (12, 104) = 1.17 | F(13, 103) = 1.40 | F (13, 103) = 1.27 | F(13, 103) = 1.49 |
Model 1
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Model 2
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Model 3
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Model 4
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor
|
B
|
SE B
|
β
|
B
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SE B
|
β
|
B
|
SE B
|
Β
|
B
|
SE B
|
β
|
Gender (0 = female; 1 = male) | −0.38* | 0.18 | −0.19* | −0.40* | 0.18 | −0.20* | −0.37* | 0.18 | −0.19* | −0.38* | 0.18 | −0.19* |
Age | −0.01 | 0.01 | −0.11 | −0.01 | 0.01 | −0.10 | −0.01 | 0.01 | −0.11 | −0.01 | 0.01 | −0.10 |
Type of schooling | ||||||||||||
PhD | 0.66 | 0.35 | 0.19 | 0.65 | 0.34 | 0.19 | 0.66 | 0.35 | 0.20 | 0.66 | 0.34 | 0.19 |
MD | 0.37 | 0.45 | 0.08 | 0.20 | 0.44 | 0.04 | 0.52 | 0.45 | 0.11 | 0.39 | 0.43 | 0.08 |
Master’s-level | 0.33 | 0.29 | 0.12 | 0.27 | 0.28 | 0.10 | 0.31 | 0.29 | 0.11 | 0.28 | 0.28 | 0.10 |
Bachelor’s-level | 0.28 | 0.22 | 0.14 | 0.23 | 0.22 | 0.12 | 0.27 | 0.22 | 0.13 | 0.24 | 0.21 | 0.12 |
Other education | 0.59 | 0.32 | 0.20 | 0.63* | 0.31 | 0.22* | 0.62 | 0.32 | 0.21 | 0.65* | 0.31 | 0.22* |
Years working with substance abuse | 0.02 | 0.09 | 0.02 | 0.03 | 0.08 | 0.04 | 0.02 | 0.09 | 0.02 | 0.03 | 0.08 | 0.04 |
Percentage privately insured clients | 0.01* | 0.00 | 0.25* | 0.01* | 0.00 | 0.19* | 0.01 | 0.00 | 0.22 | 0.01 | 0.00 | 0.18 |
Percentage publicly insured clients | 0.00 | 0.00 | −0.12 | −0.01* | 0.00 | −0.20* | 0.00 | 0.00 | −0.14 | −0.01* | 0.00 | −0.20* |
Percentage out of pocket clients | 0.01* | 0.00 | 0.25* | 0.01** | 0.00 | 0.26** | 0.01** | 0.00 | 0.27** | 0.01** | 0.00 | 0.28** |
Personally recovering from addiction (0 = no; 1 = yes) | −0.05 | 0.20 | −0.02 | −0.14 | 0.20 | −0.07 | −0.12 | 0.20 | −0.06 | −0.18 | 0.20 | −0.08 |
Responsibility for addiction onset
| 0.27** | 0.10 | 0.27** | |||||||||
Responsibility for addiction recovery
| 0.21* | 0.11 | 0.19* | |||||||||
Combined responsibility | 0.38** | 0.13 | 0.29** | |||||||||
R
2
| 0.19 | 0.25 | 0.22 | 0.26 | ||||||||
F
| F (12, 104) = 2.05* | F(13, 103) = 2.59** | F(13, 103) = 2.25* | F(13, 103) = 2.74** |
Model 1
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Model 2
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Model 3
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Model 4
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
Gender (0 = female; 1 = male) | −0.26 | 0.19 | −0.13 | −0.26 | 0.19 | −0.14 | −0.24 | 0.19 | −0.12 | −0.26 | 0.19 | −0.13 |
Age | 0.01 | 0.01 | 0.11 | 0.01 | 0.01 | 0.12 | 0.01 | 0.01 | 0.11 | 0.01 | 0.01 | 0.12 |
Type of schooling | ||||||||||||
PhD | 0.12 | 0.37 | 0.04 | 0.12 | 0.37 | 0.04 | 0.13 | 0.36 | 0.04 | 0.12 | 0.36 | 0.04 |
MD | −0.32 | 0.47 | −0.07 | −0.35 | 0.47 | −0.08 | −0.09 | 0.46 | −0.02 | −0.30 | 0.46 | −0.07 |
Master’s-level | 0.00 | 0.30 | 0.00 | −0.01 | 0.31 | −0.01 | −0.02 | 0.29 | −0.01 | −0.04 | 0.30 | −0.01 |
Bachelor’s-level | 0.10 | 0.23 | 0.05 | 0.09 | 0.23 | 0.05 | 0.09 | 0.22 | 0.05 | 0.07 | 0.23 | 0.04 |
Other education | −0.01 | 0.33 | −0.01 | −0.01 | 0.33 | 0.00 | 0.02 | 0.32 | 0.01 | 0.02 | 0.33 | 0.01 |
Years working with substance abuse | −0.01 | 0.09 | −0.02 | −0.01 | 0.09 | −0.01 | −0.01 | 0.09 | −0.01 | 0.00 | 0.09 | 0.00 |
Percentage privately insured clients | 0.00 | 0.00 | −0.03 | 0.00 | 0.00 | −0.04 | 0.00 | 0.00 | −0.07 | 0.00 | 0.00 | −0.07 |
Percentage publicly insured clients | 0.00 | 0.00 | 0.11 | 0.00 | 0.00 | 0.09 | 0.00 | 0.00 | 0.08 | 0.00 | 0.00 | 0.05 |
Percentage out of pocket clients | 0.00 | 0.00 | −0.04 | 0.00 | 0.00 | −0.03 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | −0.01 |
Personally recovering from addiction (0 = no; 1 = yes) | −0.13 | 0.21 | −0.07 | −0.15 | 0.21 | −0.07 | −0.23 | 0.21 | −0.12 | −0.22 | 0.21 | −0.11 |
Responsibility for addiction onset
| 0.05 | 0.10 | 0.05 | |||||||||
Responsibility for addiction recovery
| 0.30** | 0.11 | 0.28** | |||||||||
Combined responsibility | 0.26 | 0.13 | 0.21 | |||||||||
R
2
| 0.06 | 0.07 | 0.13 | 0.10 | ||||||||
F
| F(12, 104) = 0.62 | F(13, 103) = 0.58 | F(13, 103) = 1.21 | F(13, 103) = 0.88 |
Model 1
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Model 2
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Model 3
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Model 4
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---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
B
|
SE B
|
β
|
Gender (0 = female; 1 = male) | −0.10 | 0.24 | −0.04 | −0.13 | 0.23 | −0.05 | −0.09 | 0.24 | −0.04 | −0.10 | 0.23 | −0.04 |
Age | −0.01 | 0.01 | −0.06 | −0.01 | 0.01 | −0.05 | −0.01 | 0.01 | −0.06 | −0.01 | 0.01 | −0.06 |
Type of schooling | ||||||||||||
PhD | 0.22 | 0.45 | 0.05 | 0.21 | 0.44 | 0.05 | 0.22 | 0.45 | 0.06 | 0.22 | 0.44 | 0.05 |
MD | −0.02 | 0.57 | 0.00 | −0.24 | 0.56 | −0.04 | 0.06 | 0.58 | 0.01 | 0.00 | 0.56 | 0.00 |
Master’s-level | −0.29 | 0.37 | −0.09 | −0.36 | 0.36 | −0.11 | −0.30 | 0.37 | −0.09 | −0.34 | 0.37 | −0.10 |
Bachelor’s-level | −0.13 | 0.28 | −0.05 | −0.19 | 0.28 | −0.08 | −0.13 | 0.28 | −0.06 | −0.17 | 0.28 | −0.07 |
Other education | −0.24 | 0.41 | −0.07 | −0.19 | 0.40 | −0.05 | −0.22 | 0.41 | −0.06 | −0.19 | 0.40 | −0.05 |
Years working with substance abuse | −0.02 | 0.11 | −0.02 | 0.00 | 0.11 | 0.00 | −0.01 | 0.11 | −0.01 | 0.00 | 0.11 | 0.00 |
Percentage privately insured clients | 0.01 | 0.00 | 0.16 | 0.00 | 0.00 | 0.10 | 0.01 | 0.00 | 0.15 | 0.00 | 0.00 | 0.11 |
Percentage publicly insured clients | 0.00 | 0.00 | 0.04 | 0.00 | 0.00 | −0.05 | 0.00 | 0.00 | 0.03 | 0.00 | 0.00 | −0.03 |
Percentage out of pocket clients | 0.00 | 0.00 | 0.10 | 0.00 | 0.00 | 0.12 | 0.00 | 0.00 | 0.11 | 0.00 | 0.00 | 0.13 |
Personally recovering from addiction (0 = no; 1 = yes) | −0.07 | 0.26 | −0.02 | −0.19 | 0.25 | −0.08 | −0.11 | 0.26 | −0.04 | −0.20 | 0.26 | −0.08 |
Responsibility for addiction onset
| 0.35** | 0.12 | 0.29** | |||||||||
Responsibility for addiction recovery
| 0.11 | 0.14 | 0.08 | |||||||||
Combined responsibility | 0.37* | 0.16 | 0.24* | |||||||||
R
2
| 0.07 | 0.13 | 0.07 | 0.11 | ||||||||
F
| F (12, 104) = 0.62 | F(13, 103) = 1.21 | F(13, 103) = 0.62 | F(13, 103) = 1.00 |