Barriers to Addiction Care: Why Physicians Hesitate

Barriers to Addiction Care- Why Physicians Hesitate
Hands holding each other for support

The ongoing overdose epidemic in the United States, which saw 107,941 overdose deaths in 2022, continues to devastate countless lives. Despite extensive efforts to train and support physicians in implementing evidence-based practices (EBPs) for substance use disorder (SUD) interventions, the adoption of these practices remains low. A recent systematic review aimed to uncover the reasons behind physicians’ reluctance to address addiction in their clinical practices.

Study Objective and Design

The objective of the systematic review was to describe physician-reported reasons for reluctance to address substance use and addiction. The study analysed data from 283 articles sourced through a comprehensive literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network, covering publications from January 1, 1960, to October 5, 2021.

Data Sources and Study Selection

Publications included in the review had to meet specific criteria:

  • Involve physicians.
  • Discuss substance use interventions.
  • Present data on reasons for reluctance to intervene in addiction.

A total of 9308 studies were initially returned, but only 183 reporting data from 66,732 physicians were included in the final analysis. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the theoretical domains framework to systematically extract reasons for reluctance.

Main Outcomes and Measures

The primary outcome measured was the reasons for physician reluctance to address SUD. The study also examined the relationship between these reasons and practice settings, drug types, and intervention types.

Key Findings

Common Reasons for Reluctance

  1. Institutional Environment:
    • Lack of institutional support was cited as the most common reason for reluctance, appearing in 81.2% of articles (173 out of 213).
  2. Lack of Skill:
    • 73.9% of articles (170 out of 230) indicated that physicians felt they lacked the necessary skills to address addiction.
  3. Cognitive Capacity:
    • Cognitive capacity issues were noted in 73.5% of articles (136 out of 185).
  4. Lack of Knowledge:
    • 71.9% of articles (174 out of 242) reported that physicians lacked adequate knowledge about SUD interventions.

Other Reluctance Factors

  • Reimbursement Concerns: Reimbursement issues were also highlighted as a barrier for physicians addressing addiction.

Associations with Specialty and Intervention Type

Bivariate analyses revealed associations between the reasons for reluctance and certain variables:

  • Physician Specialty: Different specialties reported varying levels of reluctance based on their unique challenges and constraints.
  • Intervention Type: The type of intervention, whether it be screening, treatment, harm reduction, or recovery support, influenced the reasons for reluctance.
  • Drug Type: Alcohol, nicotine, and opioids were the most often studied substances, and the type of substance impacted physicians’ willingness to intervene.

This systematic review underscores the need for creating supportive institutional environments, improving access to education and training, and addressing reimbursement concerns to facilitate the delivery of evidence-based addiction care by physicians.

Source: JAMA Network

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