Treatment for People with Coexisting Problems: Opinions and Practices of Alcohol and Other Drug Workers

Abstract

Little is known about the opinions and practices of the New Zealand addiction workforce in addressing coexisting problems with individuals accessing alcohol and other drug (AOD) treatment, despite coexisting problems being the norm in clinical settings. The aim of this study was to survey the New Zealand addiction workforce about workers' opinions and practices in addressing coexisting problems with individuals accessing AOD services. More specifically, the objective was to investigate the mental health assessment and treatment practices of workers. It also sought to explore gender differences in regard to workers' opinions and practices of coexisting problems. Finally, it sought to identify the mental health training needs of workers that would build their capability in addressing coexisting problems with individuals. Specific questions for this study were included in the 2008 National Telephone Survey of the addiction workforce undertaken by the National Addiction Centre. Independent interviewers conducted phone interviews with 232 AOD workers. This sample comprised an aging, stable workforce of predominantly New Zealand pakeha as well as 15% indigenous Maori workers. A third of the workers described themselves as 'in recovery' from a substance use problem. Counsellors comprised the largest professional group (58%). Close to half of the sampled workforce held a postgraduate qualification and nearly two-thirds possessed an AOD specific qualification. Findings from this study highlighted several differences in the opinions and practices of workers in addressing coexisting problems with clients. Primarily, workers' reported assessment practice did not match what they perceived to be optimal assessment practices or their reported mental health treatment practices. Less than a third of workers who undertook a comprehensive assessment asked about all five listed coexisting mental health disorders. This substantial underdiagnosis is cause for concern given the wide recognition and best practice guidelines emphasising the necessity of screening for these coexisting problems during a comprehensive AOD assessment. Workers reported routinely using a broad range of mental health interventions when addressing coexisting problems with clients and strongly endorsed most interventions as part of the optimal treatment of depression and post-traumatic stress disorder (PTSD). However, as a group they were significantly less likely to endorse referral to mental health support groups, referral to counselling or provide gender-specific treatment as part of the optimal treatment for depression and PTSD. Workers' opinions and practices were significantly associated with their previous formal education relating to mental health issues, qualification level, professional group and ethnicity as well as with how frequently they reported addressing clients' coexisting problems. Formal education relating to mental health issues appeared to have mixed effects on practice. Formal education relating to mental health assessment failed to predict workers' assessment practice, whereas, formal education about mental health interventions and coexisting problems strongly predicted workers' mental health intervention practices. The only significant gender difference observed was that women reported that they were more confident, in comparison with their male colleagues, in addressing coexisting problems with clients, suggesting, overall, that male and female workers are similar in their practice. However, little is known about the influence of gender on workers' practice and, therefore, requires further investigation. Most AOD workers wanted further education about coexisting problems to assist them in their practice. However, taken overall, the findings from this study and the broader literature suggest up-skilling the workforce is complex and requires workforce development strategies to address the factors influencing practice at both individual and organisational levels. Implications for clinical practice, workforce development and research are discussed with attention to building the capabilities and competences of the AOD workforce in accordance with the overall goal of providing effective comprehensive treatment for individuals with coexisting problems.