Physicians say they need more institutional support to treat addiction

Physicians say they don’t have institutional support needed to assist patients struggling with addictions to drugs and alcohol.

A new study surveyed decades of addiction research and quantified the reasons why doctors may be reluctant to intervene when patients present with substance use disorder. Lack of support from employers, insufficient staff and training, challenges in organizational culture and competing demands all added to an “institutional environment” not conducive to addiction treatment.

“People with substance use disorders must be able to access compassionate and evidence-based care at any touchpoint they have with a health care provider,” National Institute on Drug Abuse (NIDA) Director Nora D. Volkow, MD, said in an accompanying news release. “To make that vision a reality, clinicians across all medical disciplines need greater training, resources, and support in caring for people with addiction, so that they feel prepared to proactively offer prevention, screening, treatment, harm reduction, and other tools that can help save lives.”

Need is there

It is a pressing issue, according to the study: “The overdose epidemic continues in the U.S., with 107,941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.”

The same year, almost 49 million people had at least one substance use disorder, but about 13 million received treatments. More than 9 million adults needed treatment for opioid use disorder, but 46% of them received any form of treatment and only 25% received medications for it, the news release said.

What to review

The study, “Physician Reluctance to Intervene in Addiction: A Systematic Review,” published in JAMA Network Open, examined thousands of articles dealing with addiction published since 1960. There were 183 that collected data from 66,732 physicians. Alcohol, nicotine and opioids the most studied substances and screening and treatment were the most studied interventions.

Along with institutional environment, physicians also cited lack of knowledge and lack of skill. They also noted lack of cognitive capacity, but that “was not often characterized beyond a general sense of overwhelm with clinical tasks (e.g., ‘just too busy’) and the need to prioritize patients’ competing needs,” the study said.

Changing the environment

The researchers noted several strategies that could alter physicians’ feelings about the institutional environment:

• Health systems could have greater commitment to making needed workflow and staffing changes.
• Health systems could break down barriers between addiction services and medical and mental health care.
• Insurers should provide reimbursement that covers the actual cost of addiction interventions.

The researchers said reimbursement can be considered part of the institutional environment and it is “a perennial point of concern in adopting evidence-based interventions for addiction.” But physicians who expand their knowledge and skills to treat addiction also should be eligible for continuing medical education credits and more pay.

Substance use stigma

The study addressed stigma associated with substance use disorder and treatment for it. To counter that, the researchers found potentially helpful solutions could include educational materials for patients and families, community outreach, and public health campaigns that encourage nonstigmatizing language.

Other institutional environment changes that could be beneficial include investments in staffing and training, adopting standard practices or protocols for addiction treatment, and conducting addiction-specific quality assurance, the study said.

Limited literature

The review was limited due to the evolving nature of medications, regulations and the unregulated drug market. The scientific literature did not always include best practices in developing the surveys, and terminology and reporting were inconsistent, so future research should focus on high-quality studies.

“Developing new addiction treatments is crucial, but it is equally important to rigorously study how to implement these treatments so that they make it into the doctor’s office and reach the people who need them,” senior author Wilson M. Compton, MD, said in the news release. Compton is deputy director of NIDA.

“Survey results have helped us better understand the treatment landscape, so the next step is to test ways to change behavior and attitudes around providing addiction treatment, in order to break down barriers to the addiction care that people seek,” Compton said.