Addiction Treatment Professionals: An Understudied Population within Recovery Settings

Editor’s note: In today’s post, we highlight a few recent dissertations on addiction treatment professionals as an occupational class. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Is There a Relationship Between Alcohol/Drug Counselor’s Strength of Belief in the Disease Concept of Addiction and Burnout?

Author: Dodd, Dan D.

Abstract: This study examined the association between substance abuse counselors’ (a) level of burnout and strength of belief in the disease concept of addiction, (b) level of burnout and recovery status, and (c) recovery status and strength of belief in the disease concept. Participants were recruited via a purposive convenience survey sampling method of counselors who were certified Chemical Dependency Professionals (CDPs) or Chemical Dependency Professional Trainees (CDPTs) who were employed in substance use disorder outpatient treatment facilities. A total of 130 surveys were distributed of which 72 were returned giving a 55% response rate. Six surveys were removed due to not providing evidence of informed consent or high frequency of missed answers. Of the remaining 66 participants, 45 were female, 20 were male, and one declined to report gender status. The largest age cohort was 41 years of age and over. Participants completed a demographic questionnaire, the Maslach Burnout Inventory-HSS (Maslach, Jackson, & Leiter, 1966), and the Addiction Belief Scale (Schaler, 1995). Analysis of data included Spearman rank order correlation, Chi-square Test for Independence, and Fisher’s Exact Test. Results indicated that as strength in the belief in the disease concept increased, level of emotional exhaustion/burnout decreased. There was no association for the burnout subscales of depersonalization and personal accomplishment. In addition, there was no significant association between (a) level of burnout and recovery status, or (b) recovery status and strength of belief in the disease concept. Future research should determine if results of this study can be replicated and shift its focus from why professionals are leaving the addiction field to why individuals remain working in the field.

Publication year: 2015

Committee member: Dunn, Christopher; Heusler, William; Suarez, Alejandra

University/institution: Antioch University

Department: Clinical Psychology

The Role of Spiritual Wellness as a Predictor of Employment Satisfaction in Addiction Treatment Professionals

Author: Leventhal, Belinda

Abstract: The focus of this quantitative research study was to ascertain the role of spiritual wellness as a predictor of employment satisfaction in addiction treatment professionals. Fisher’s (2013) Spiritual Health and Life Orientation Measurement 2 (SHALOM2), Maslach, Jackson, and Leiter’s (1996) Burnout Inventory the Human Services Survey (MBI-HSS), Weiss, Davis, England, and Lofquist’s (1967) Minnesota Satisfaction Questionnaire-Short Form (MSQ-Short Form), and a researcher-designed demographic survey were utilized to study nationwide members of The Association for Addiction Professionals (NAADAC). The method used to collect data was a web-based service: Survey Monkey. Descriptive statistics reported the data collected from the demographic survey. A determinate function analysis of the data collected ( n = 102) explored a correlation between spiritual wellness and job satisfaction, as well as between spiritual wellness and job burnout. The discriminant analysis revealed four discriminant functions; first function explained 51.9% of the variance; second function explained 24.2% of the variance; third function explained 18.4% of the variance; and the fourth explained 5.5% of the variance. In combination, these discriminant functions significantly differentiated among the five levels of spiritual wellness, Λ = .004, x 2 (180) = 228.47, p = .01, however, removing the first function indicated that the remaining functions did not significantly differentiate the spiritual wellness levels. The correlations between outcomes and the discriminant functions revealed that age, highest level of education, race, and relationship status have the highest loadings on all four functions, however three of the 15 hypotheses were supported: all variables taken together, type of license, and household income.

Publication year: 2016

Advisor: Lange, Amber

Committee member: Pate, George; Schooley, AnnaLynn

University/institution: Capella University

Department: Social and Behavioral Sciences



Factors Associated With Harm Reduction Model Use Among Substance Abuse Counselors

Author: Madden, Tiffany

Abstract: Drug overdose death rates in the United States have more than tripled since 1990 with more than 36,000 dying in 2008. In 2007 the estimated cost of drug use to U.S. society due to lost productivity, increased health care, and criminal justice costs was over $193 billion. Previous researchers have found that harm reduction is a viable treatment option within the field of addiction. The guiding premise in the harm reduction approach is that all people can achieve improved psychological and physiological health even if they are unable to be substance-free. However, there remains an important gap in the current literature regarding factors that may influence substance abuse counselors’ use of the harm reduction model. Specific individual counselor independent variables (recovery status, education level, age, length of time in the field, and understanding of substance abuse conceptualizations) may play a role in counselors’ acceptance of the harm reduction approach as a viable treatment for substance abuse. Therefore, the purpose of this quantitative study was to investigate which variables played a role in counselors’ acceptance of the harm reduction model. This research sampled 100 professional substance abuse counselors selected from the American Counseling Association (ACA) database. Multiple regression analyses were utilized to examine study research questions. Findings of this study indicated that disease and eclectic orientation conceptualizations were significant predictors of harm reduction acceptance, suggesting training targets for increasing acceptance of the harm reduction model among counselors. This is an important contribution to the existing literature and enhances social change initiatives by expanding the use of effective substance abuse treatment options.

Publication year: 2016

Advisor: Davis, Kelly

Committee member: Walters, Marlo

University/institution: Walden University

Department: Psychology





Mass Opium Addiction Treatment in Assam, 1939 (Part I)

by Kawal Deep Kour (PhD, Indian Institute of Technology)

The phenomenon of the “opium habit” was attracting worldwide attention by the 1920s. Most addiction historiography research has focused on the United States, where researchers including Arthur Light and Edward Torrance of the Philadelphia Committee for the Clinical Study of Opium Addiction Research, and Charles Terry and Mildred Pellens of the Bureau of Social Hygiene’s Committee on Drug Addictions, whose 1928 classic The Opium Problem is recognized as a seminal primary source of contemporary addiction study. But it was also an object of concern internationally: In January 1923, a joint sub-committee of the League of Nations Health Committee and the Advisory Committee on Traffic in Opium, consisting of Dr H. Carriere (Vice President, Director of the Swiss Federal Public Health Department, Berne), Dr W. Chodzko (delegate of the Polish government to the Office of International Hygiene), Dr. O.Anselimo (German Minister of Health) and J. Campbell (representative of the Indian government) presented a massive report on the illegitimacy of nonmedical opiate use. Continue reading →

Psychological Perspectives on Recovery

Editor’s note: In today’s post, we highlight a few recent psychology dissertations on recovery settings, their dynamics, and the people who populate them. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.


Adverse childhood experiences and their impact on substance abuse treatment in adults

Author: Cody, Linzi Bruch

Abstract: The purpose of this study was to expand upon prior research done on the effects of adverse childhood experiences (ACEs) throughout the lifespan within a population of substance abusing adults receiving treatment on a residential chemical dependency treatment facility. Specifically, this study sought to determine the extent to which ACE scores were predictive of a variety of physical, social, and financial variables. To explore these relationships, a sample of 164 behavioral health recipients (BHRs) was included. Additionally, 16 healthcare providers were interviewed with regard to their opinions on these proposed relationships. The medical and financial records of the BHRs included in the sample were compared against their ACE scores, and a series of simple linear and logistic regressions were run in an effort to determine the ability of ACE scores to predict each variable. The contents of the interviews with healthcare providers were transcribed, and run in a content analysis in order to identify themes and patterns in their responses. The results indicated that ACE scores were not significantly predictive of any of the variables with the exception of age of first substance use, and number of days to readmission to treatment. Further, the results indicated that healthcare providers believed ACE scores to be highly predictive of the variables in question. These two sets of results were contradictory to one another, and as such, a discussion regarding the reasons for these discrepancies was included. This information can be of use to practitioners working with survivors of trauma and the substance abuse population in that it illuminates some of the confusion inherent in working with these groups. This study demonstrates that further research is needed in the area of adverse childhood experiences as they relate to the substance abuse population. Future directions for research should make efforts to control for confounding variables, and to make connections between the opinions of healthcare providers and the realities of the behavioral health recipients to whom they are providing treatment. Continue reading →

New Perspectives on Global Drug Control

Editor’s note: In today’s post, we highlight a few recent dissertations on drug control and politics from national, international, and transnational perspectives. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, which was formerly published in the Social History of Alcohol and Drugs journal but is now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Martin Behrman and the Regulars: Beer, War, Sex, and the Roots of Modern American Politics

Author: Criss, Ralph Eric

Abstract: The proper role of government at all levels—local, state and federal—has been debated since the birth of the Republic. This project explores that debate by illustrating how a variety of social and political issues manifested themselves in the real life of New Orleans’ longest serving mayor, Martin Behrman, and the lives of millions of other Americans, in the early twentieth century. Integral to the story of Martin Behrman’s life is the tale of Storyville—the infamous red-light district—the growth of the beer industry, and World War I. These matters were bound together in a ball of confusion surrounding the act of congress authorizing the war and its funding. Specifically, questions poured in from across the nation, asking which parts of American cities sailors could visit, whether or not sailors and soldiers were to be treated equally under the law, and even whether or not a civilian could buy a soldier a cold beer to say “thank you” for his service. In this way, the politics of beer, sex, and reform exploded across the United States. In Louisiana, these issues contributed to the defeat of Martin Behrman in the mayoral election of 1920, the weakening of the “Regular” political machine, and the ascent Huey Long, the “Kingfish.” Many of the same legal and moral questions that were asked in 1915 are now asked in 2015 as presidential candidates jockey for position in the presidential primaries of both major parties. How much federal government intrusion into the private lives of citizens is appropriate, given the urgent need to protect the nation from terrorism? Which civil liberties may be encroached upon and to what extent? What is government’s role in promoting public health, fair wages, and morality? What is the appropriate role of the federal government versus states and localities, especially during wartime? How do we handle the large numbers of immigrants flocking to our shores—from both a policy and rhetorical perspective? Answers to such questions constituted the political fault lines of the early twentieth century, as they do today. This study does not attempt to answer the policy questions above. Rather, it seeks to add context to debates surrounding them and to demonstrate their durability. The challenge is how to discuss these complex issues in a concise and cohesive manner. The author chose the political career of the longest serving mayor in the history of New Orleans to act as the glue that holds the narrative together. Continue reading →

Opium, Empire, and India (Part II)

Editor’s note: Today’s post is a continuation of last week’s piece by Dr. Kawal Deep Kour. Make sure to check out Part I


Southeast Asia

References to the significance attached to trade with China abound in British diplomatic correspondences, treaties and conventions. Yunnan (in China), with its rich reserves of gold and silver was alluring to adventurer-entrepreneurs, merchants, and explorers alike as much as for its “opium geography.” Of great interest was the location of Yunnan- from here, opium could travel to its destined locations: Hong Kong and Shanghai. Correspondences between the Bengal government and an imperial agent deployed in British Burma refer to instructions relating to the safe passage of Chinese labour to clear ground for tea plantations in Assam, and also to the conveying of Indian opium to Yunnan at the insistence of the British merchants following Chinese hostility. Further, a large amount of goods were smuggled through Margherita (Assam) to the villages of the Khampti and Singpho people inhabiting the area, what is present day Arunachal Pradesh (northeast India), bordering China. The trans-border tribesmen from Borkhamti and from the Hukong valley smuggled large quantities via Margherita and even as far as Titabar in Assam. It was therefore considered that the opening of the Borkhamti country would uncover tremendous possibilities of Assam-China trade being conducted through the river routes-Irrawady-Salwin (present day Myanmar) and thence into Yang-tse-kiang (China). Surveying the region in 1826, Captain Wilcox in his memoirs had taken incidental note of the great demand for opium, apart from salt, among all Indo-Chinese nations. Continue reading →

New Research on Drug Use: TGIF Edition

Editor’s note: Happy Friday! In today’s post, we present a sampling of new research on drug use among different professions. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, which was formerly published in the Social History of Alcohol and Drugs journal but is now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Workplace smoking bans and daily smoking patterns: Implications for nicotine maintenance and determinants of smoking in restricted environments

Author: Dunbar, Michael Stephen

Abstract: Background : Daily smokers are thought to strive to maintain blood nicotine levels above a certain threshold. Workplace smoking bans pose a substantial barrier to nicotine maintenance. Individuals may compensate for time spent in smoking-restricted environments by smoking more before (“anticipatory”) or after work (“make-up” compensation), but this has not been quantitatively examined. Continue reading →

Opium, Empire, and India (Part I)

Editor’s Note: Today’s post is from new contributing editor Kawal Deep Kour, who received her PhD from the Indian Institute of Technology. Contact the author at Stay tuned for Part II!

malwapoppy For many years before the British incursion in the Indian subcontinent, the “hubble-bubble” (tobacco smoking) along with opium had served as a favourite pastime of the aristocracy and the commoners alike. Opium was both an aristocratic luxury being a coveted item in the list of royal household of the Mughals and the Rajputs while being an integral part of the daily life of the common folk. Abul Fazl, the famous court historian of Mughal Emperor Abkar, in his Ain-i- Akbari, dated around 1590, has described poppy as growing “luxuriantly” in the region of Malwa and Benaras and Punjab. It is claimed to contain the earliest authentic reference to opium cultivation. Opium poppy was extensively cultivated in Bengal, north-western provinces and in the Malwa region of central and western India.  Trade in opium in Mughal India was an Imperial Monopoly. Until the British monopoly, the Dutch were the chief foreign purchasers of opium, though the Agency System which was introduced in 1797 which established the Benaras Opium Agency. By Regulation XIII of 1816, opium cultivation was legalised in Bengal under the supervision of the Commercial Resident of Rungpore. The control of the Opium Department went from the Board of Revenue in the Customs, Salt and the Opium Departments by the Regulation IV of 1819. In 1850, by Act XLIV, the Customs, Salt and Opium Board was merged in the Board of Revenue at Calcutta. In 1797, prohibition was imposed on the private cultivation of poppy in Bengal proper and in Behar division of the province. It was then that the attention of the Government proper was being met by ‘systematic smuggling and clandestine production’

In India, opium is variously referred to as kanee/kappa(the juice of opium being reduced to a dry state, the opium paste was then spread on narrow slips of cloth and later rolled into small bales);  amalpaani or kusumbhi/kusumbha(the opium is cut into small pieces, a little water added to it and mixed to a thick consistency. The mass is then put the mass into a thick woollen cloth, allowed to cool and then strained through. The decoction is drunk without any addition of sugar or anything to destroy the bitter taste. The proportion is usually one part of opium to 20 parts of water. It is a drink prepared from an infusion of poppy heads in water. The great Indian classics of Ayurveda (the traditional system of medicine incorporated in the Atharveda, the last of Vedas [regarded as the source of all knowledge in the Hindu system of philosophy]) like Caraka Samhita, Susruta Samhita and Ashtanga Hrdaya are silent on the use of opium. In the Indian classical texts, opium finds its first mention in the Sarangdhara Samhita, which is primarily a book on pharmacy and popular amongst the physicians of Rajasthan, supposed to be written in the thirteenth or fourteenth century AD, as aphiphena and nagaphena. A fifteenth century text contains reference to the extensive use of opium and its various preparations by the Hindu physicians are recorded. It appears from the available classical Indian medical literature that opium was first used as an aphrodisiac, then as anti-diarrhoeal and thereafter as an analgesic and sleep-inducer.

It was used in wide and various ways by the people, depending on their means and tastes. The essential product was mixed with tobacco or spices and either drunk or smoked. The common mode of consuming opium in India was in the form of pills. In some parts of the country and chiefly on social and ceremonial occasions, a decoction of opium was served. In Punjab and a few other tracts in upper India, an infusion of the capsule of the poppy, called the posth was drunk in the villages. In Patiala of Punjab, a compound called the ‘Barsh’ or the ‘Judwa’ (of which opium formed an important part) was administered by the native medical practitioner-the Hakim, though this practice is reported to be uncommon. In Rajputana, the popular mode of consumption was a drink made of opium called ‘Gholua’ and a refined form of the decoction called the ‘Beni’ in Kathaiwar. This common and well established custom was replaced by smoking preparations of opium in India is known as chandu and madak around 1700 AD and was a Chinese novelty. Though initially confined to the larger towns and military cantonments, it soon percolated down to the lowest rungs of the society. The habit of smoking ‘madak’ though already in vogue in eastern parts of India, was looked down upon in some other societies.


Nevertheless, every province had its share of percentage of regular users as well as a large number of people who used opium only on special occasions. In India, it was a favourite with the native practitioners- the Hakims, Vaids, Bej, Ojha etc., who used it to treat a variety of afflictions of the body and mind. It was used to treat headaches, fevers and chills (including malaria), stomach aches, diarrhea, dysentery and asthma, tuberculosis (“bloody coughing”), fatigue and anxiety. Opium was also used for symptoms of venereal diseases and gynaecological afflictions and for pain caused by injuries such as sprains, dislocations and broken bones. Because of its analgesic and other medicinal properties, ingested opium clearly provided relief from the pain associated with these conditions and ameliorated many other symptoms as well. It was also prescribed for many bovine ailments which also explains its popularity among a people for whom agricultural pursuits constituted the main source of livelihood. For many people, opium smoking took the edge off the routine physical discomforts of life. Women also ate and smoked opium with their male counterparts.

In the tea gardens and rice growing tracts of the east where malaria and kala-azar had reached epidemic proportions, and where the cultivator had to spend several hours exposed to the wet and the chill, it was used to cure fevers and chills. Opium was occasionally issued on the advice of a medical officer in special circumstances, particularly for troops employed in fighting and road making amongst the snowy ranges of Sikkim. The use of opium as a stimulant in physical emergencies seems to prevail more in the north of India, particularly in Punjab to ward off the severity of the winter months. The Sikh soldiers were known to be among the heaviest consumers of opium. Administering of opium to infants was an ordinary part of the domestic life of the country.  The practice of giving ‘balagoli’ to infants was given up to the age of 2 and a half years and even 3 years of age was common.

How intertwined was opium to the lives of the people of most part of India can be gauged from the potentially wide range of social and religious activities of which it formed a significant aspect. Whether it was celebrations as marriages, birth of a child, as a gesture of greeting friends and relatives or a seal of reconciliation between warring states or adversaries and even at funerals, consumption of opium was seen as a marker of social status, custom and a ritual. Tobacco smoking and betel-chewing cultures of the eastern part and of bhang in most part of the country had assisted opium’s favourable acceptance in the way of life of various cultures in the country. It certainly was a favourite indulgence, which was cherished by the users, as is evidenced by the distinctive mode of preparation which imparted to it a distinctive characteristic. Whether to the wide and varied users of opium, it was a favourite pastime or an aphrodisiac or panacea is yet to be ascertained with certainty. However, it was the proliferation among the lower strata, the ‘downward diffusion’ as Yangwen (2003:1-39) makes us believe, as was the case with tea and opium in China, that made it a visible social problem. The imageries of ‘opium intoxicated, effeminate and opium sot’ began to dominate the imperial accounts and the missionary literature including vernacular writings from the end of the nineteenth century. This was attended by a host of economic, social, administrative and legal ramifications for the provinces where it was consumed by the majority as culture and custom. The variant patterns of usage enabled in exploring the ‘indigenous use of psychoactives alongside mirroring the society’s level of political complexity. The identification of India as a land of ‘great opium eaters’ spawned up the propaganda of the ‘civilising mission’ ushering in a new era of material exploitation and political domination. The identification was to have a significant impact on the development of regulation of opium and its use.