Significant Proportion of Abuse Counselors Lack Knowledge of Bupropion for Tobacco Cessation

Barbara Boughton

April 27, 2010

April 27, 2010 (San Francisco, California) — A significant percentage of substance abuse counselors — about 40% — have little knowledge of the tobacco cessation medication bupropion, according to a new study presented here at the American Society of Addiction Medicine 41st Annual Medical-Scientific Conference.

Raising awareness of bupropion's effectiveness among substance abuse counselors is vital to tobacco cessation efforts for those with drug and alcohol addiction, said researcher Tanja C. Rothrauff, PhD, of the Institute for Behavioral Research at the University of Georgia in Athens.

"Although counselors cannot prescribe medications, they have a lot of input in terms of patient selection of available tobacco cessation services," she said. "They can help patients navigate the maze of different pharmacotherapies."

Dr. Rothrauff emphasized that tobacco use among patients in treatment for substance abuse disorders is pandemic, and many want to quit. Since bupropion can play a role in aiding tobacco cessation by decreasing severity of cravings and withdrawal symptoms, it is crucial that substance abuse counselors be knowledgeable about the drug and its effectiveness, she said.

To study substance abuse counselors' knowledge of bupropion, Dr. Rothrauff and colleagues used data from the National Treatment Center Study (NTCS). The NTCS is a family of related National Institutes of Health–funded studies in addiction health services research. Each study in the NTCS is designed to gather information on the organization, management, staffing, and services of substance abuse treatment programs.

In the bupropion study, repeated cross-sectional data in 2002 to 2004 and 2007 to 2008 from the NTCS were used to assess substance abuse counselors' knowledge of the medication and its effectiveness. The researchers also analyzed individual and organizational factors that predicted knowledge of bupropion and its effectiveness.

Need for Training

From 2002 to 2004, 992 substance abuse counselors working in 217 community alcohol and drug treatment programs completed mail-in questionnaires and in 2007-2008 a total of 1226 counselors in 254 centers did the same in the NTCS. Counselors were asked to rate bupropion's effectiveness on a scale of 1 to 7, with 1 being "not at all effective" to 7 being "very effective." If they were unfamiliar with the medication and its effectiveness, counselors could select a response of "don't know." Administrators and clinic directors provided organizational data during in-depth face-to-face interviews.

Results indicated that 38% of counselors tested in 2002-2004 were unaware of the effectiveness of bupropion and 44% of counselors in 2007-2008 were unfamiliar with the medication's usefulness for tobacco cessation.

Among those counselors who were familiar with bupropion, effectiveness was rated higher in the 2007-2008 cohort than in those tested in 2002-2004 (P < .05). The researchers looked at a variety of factors that might have predicted bupropion knowledge, including the counselors' education, their experience in the addiction field, and the amount of bupropion training they had received.

They also assessed organizational factors, such as the percentage of patients receiving bupropion in the centers where the counselors worked, and whether or not the clinics taught tobacco cessation. Only the extent of bupropion training predicted knowledge of the drug's effectiveness, Dr. Rothrauff said.

"We really need to focus on training substance abuse counselors about bupropion. A well-trained workforce is important for tobacco cessation and substance abuse treatment," she said.

Unexpected Finding

Dr. Rothrauff added that it was puzzling that more substance abuse counselors were unfamiliar with bupropion in 2007-2008 than they were in 2002-2004 — a finding the researchers did not expect. Dr. Rothrauff hypothesized that lack of insurance coverage for the medication for some patients undergoing substance abuse treatment might account for some of this deterioration in knowledge.

The bupropion study was important because it looked at knowledge of tobacco cessation therapies among providers in substance abuse settings — who are often on the frontline of addiction treatment, commented Judith Prochaska, PhD, MPH, associate professor in residence in the Department of Psychiatry at the University of California, San Francisco.

"My concern is that the measures that they used weren't that strong. A single-item rating scale doesn't test knowledge to the same extent as specific questions such as, 'Has bupropion been shown to be effective' or 'What dose would you prescribe?'" she said.

Dr. Prochaska and colleagues authored a meta-analysis of tobacco cessation therapies among individuals in substance abuse and recovery (J Couns Clin Psychol. 2004;72:1144-1156).

During her research, she found only 1 study that looked at the effectiveness of bupropion in substance abuse populations, and there have been only 2 studies since then that have analyzed the medication's effectiveness among those addicted to drugs or alcohol, she said. None of these studies found that bupropion was significantly effective either alone or in combination with nicotine replacement therapy, she said.

"I can see why substance abuse counselors might question the effectiveness of bupropion given these results. Because there are so few studies on bupropion in the substance abuse population, whether it's effective in these patients is still an unknown," Dr. Prochaska said. "But if substance abuse counselors had not heard of the medication, or did not know whether it was effective in the general population, that would be a real concern."

Dr. Rothrauff and Dr. Prochaska have disclosed no relevant financial relationships.

American Society of Addiction Medicine (ASM) 41st Annual Medical-Scientific Conference: Abstract 8. Presented April 16, 2010.


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