Prior experiences with family members’ addiction related to importance placed on addressing patients’ substance use among health professionals in training

J. Aaron Johnson, PhD1 and J. Paul Seale, MD2

1Institute of Public and Preventive Health and Department of Psychology, Georgia Regents University, Augusta, GA2Department of Family Medicine, Navicent Health and Mercer University School of Medicine, Macon, GA

ABSTRACT

BACKGROUND

METHODS RESULTS

CONCLUSIONS

BackgroundOver the past decade, there have been significant efforts to support the adoption and implementation of screening and brief intervention (SBI) for unhealthy alcohol and drug use into general healthcare settings including a number of training grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) to train residents and other health professions. A recent request for applications from SAMHSA will fund up to an additional 49 training grants in 2015. Evaluation of these projects has demonstrated significant need for SBI training, success in increasing levels of importance and confidence placed on identifying and addressing patients’ unhealthy substance use, and increased use of SBI services post-graduation. Other results have reported ambivalence toward SBI, possibly due to health professionals own drinking practices. In an effort to further explore some of the possible barriers and facilitators associated with increasing use of SBI practices among health professionals in training, the present study examines the possible relationship between personal experience with addictions and the level of importance placed on identifying and addressing patients’ unhealthy substance use.MethodsData (N=930) are from questionnaires administered to family and internal medicine residents and advance practice registered nursing (APRN) students as part of the Southeastern Consortium on Substance Abuse Training (SECSAT). SECSAT is comprised of two SAMHSA-funded training grants providing SBI training in 6 residency clinics in Georgia, South Carolina, and North Carolina and to APRN students in 8 nursing programs in Georgia, Alabama and Maryland. In this study, data are from questionnaires administered to trainees before SBI training to measure trainees’ baseline levels of confidence in performing SBI, level of importance placed on SBI, and attitudes toward working with patients with alcohol and/or drug use. In addition to these measures, trainees were asked whether they had a family member in recovery or a family member with an active substance use disorder. Responses to these questions were combined so that a positive response to either was coded as having previous experience with family members’ addiction.ResultsA surprisingly large number of trainees reported having experience with a family members’ addiction, with APRN students significantly more likely than residents to report this experience (43.6% to 22.8%, p<.001). Independent samples t-tests were conducted to identify differences between trainees reporting previous addiction experiences and those who did not. Results indicated significantly higher means among trainees with previous addiction experiences on several single-item measures of importance including asking permission to talk with patients about their drug use, importance of educating patients about the risks associated with drug use, and the importance of referring patients to a self-help or formal treatment program.ConclusionsPrior life experiences with addictive behaviors is related to health professionals’ views toward identifying and addressing unhealthy substance use among their patients. Higher level of importance placed on addressing unhealthy substance use prior to receiving SBI training could impact implementation of SBI services once trainees complete training and move into practice.

• Significant efforts have been made to promote adoption and implementation of alcohol and drug screening and brief intervention (SBI) into general healthcare settings.

• Among learners, projects have demonstrated increasing levels of importance and confidence in addressing unhealthy substance use, and post-graduation use of SBI.

• Learners’ background, life experiences, and present behaviors could impact their views of SBI.

Study Purpose: To examine the relationship between personal experience with addictions and the importance placed on identifying and addressing patients’ unhealthy substance use.

Study Sample: Family and internal medicine medical residents and Advanced Practice Registered Nursing (APRN) Students (N=930) at 14 sites (6 medical residency programs and 8 nursing programs) surveyed prior to SBI training.

Survey Design:• Self-administered survey• Measures:

• Attitudes toward working with patients with unhealthy alcohol and/or drug use patterns

• Importance and confidence in addressing alcohol and drug use issues in patients

• Screening and brief intervention behavior• Personal drinking patterns• Personal or family history of alcohol or drug abuse

• Prior life experience with addictive behaviors is related to health professionals’ views toward identifying and addressing unhealthy substance use among their patients.

• These differences, seen prior to receiving SBI training, could impact implementation of SBI services once trainees complete training and move into practice.

DEMOGRAPHICS

APRN Students Residents

Percent Female 91.0% 42.0%

Race

African American

14.2% 11.1%

Caucasian 75.7% 60.8%

Asian 5.3% 16.1%

Other 4.7% 12.1%

Average Age 33.3yrs 29.7yrs

RESULTS

Funded by: SAMHSA Grants TI025372 and TI020278

• Similar differences were found in measures of importance in addressing drug use.

• Those with addiction experiences also scored significantly higher on items measuring positive outcomes associated with addressing patients’ substance use.

0%5%

10%15%20%25%30%35%40%45%50%

1.2%

23.9%*

46.0%a

36.4%*

43.1%*

0.3%

19.7%

0.0%

16.7%22.8%

APRN Students and Residents Reporting Addiction Experiences

APRN Students Residents*p<.01a= Not included in aggregate measure

Using a Validated Instrument

Classifying Pt as At-risk

Providing Feedback

About Risk Level

Educating Pt About Lower Risk

Limits

Advising At-risk Pt to Stop or Reduce

Referring to Treatment

0.01.02.03.04.05.06.07.08.09.0

10.0

7.9 7.8 8.2 8.08.6 8.38.4* 8.3* 8.5* 8.4*

8.9* 8.8*

Importance Placed on Aspects of Addressing Patient Alcohol Use

No Addiction Experience Addiction Experience

Mea

n

* p<.01