More than 80 percent of 296 practicing psychologists said they had discussed substance abuse with a specific client who was randomly selected from their practice, according to a new PracticeNet survey, although most of the practitioners surveyed reported that their most recent clinical encounter with this client did not focus primarily on substance abuse.
PracticeNet uses real-time behavior sampling (RTBS) methodology to gather instantaneous information about the practice of psychology from volunteer PracticeNet participants. The surveys focus on practice activities with a client seen at a specific time that is randomly selected from the practitioner's normal practice hours. In effect, the surveys provide snapshots of practitioner activity by looking only at practitioners' most recent episodes of care within a 72-hour window.
The PracticeNet substance abuse survey is especially important because it "will help illuminate how clients with substance-related problems present and are treated in general psychology practice settings, which appears to be more common than presentation to specialty programs for substance abuse," says Jalie Tucker, PhD, who served on an advisory group to PracticeNet's initial development.
The fact that psychologists are talking to their clients about substance abuse, regardless of whether it's a presenting issue is encouraging, says Geoffrey Reed, PhD, assistant executive director for professional development in APA's Practice Directorate. The survey indicates that psychologists are providing substance abuse services, even if they're not practicing in substance abuse settings.
The research also found that nearly half the practitioners said that previous clinical encounters with the selected client had included discussions about substance abuse by the client's spouse, family member or another member of the client's social network.
Roughly 20 percent of the respondents said their most recent client has an established or suspected substance abuse problem. Of those who do have problems, three-quarters have trouble with drinking and one-third smoke. The next most commonly abused substances, according to this survey, are marijuana, cocaine and sedative tranquilizers--generally prescription.
So how do practitioners help their substance abusing clients? Forty-two percent use motivational interviewing strategies (also known as motivational enhancement therapy), which involve a detailed behavioral assessment of a client's substance abuse problem, an assessment of motives and disincentives to positive change, as well as advice on how to change, 40 percent employ cognitive-behavior therapy, and 31 percent say they use relapse prevention counseling techniques.
Also encouraging, says Reed, is that these strategies are consistent with the latest scientific and clinical knowledge in the substance abuse arena. In fact, PracticeNet participants reported having an average of eight hours of continuing education that included a significant focus on substance abuse during the past year. Tucker agrees these findings are "encouraging about the services that psychologists in general practice are providing to clients with substance-related problems--one of the most common behavioral health problems in the general population and among people who utilize health and behavioral services."
Three-quarters of the participants in the PracticeNet survey are in solo or group independent practice. In addition to the findings related to substance abuse, this PracticeNet survey gathered some interesting practice data on these practitioners, such as:
More than one-third of the clients were referred by other health-care providers.
Almost one-quarter of the practitioners said the clients in their most recent clinical encounter pay for therapy out of pocket, even though half of those who do so have insurance plans.
Almost one-quarter of the practitioners said their most recent clinical encounter involved formal assessment or evaluation--alone or in combination with therapy.
Because PracticeNet employs a volunteer sample, the information gathered cannot be generalized to all psychology practitioners. But, says Tucker, "PracticeNet will help us understand how psychological services transpire at the individual episode of care, and they can be aggregated over large numbers of care episodes to reveal trends in current practice patterns and how patterns change over time as the health-care environment changes."
--J. DAW HOLLOWAY
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