‘Physicians don’t feel comfortable’ treating addiction due to poor training, lack of resources

Key takeaways:

• Some of the top cited reasons for reluctance included a lack of skill, cognitive capacity and knowledge.
• Health care systems making workflow and staffing changes could be a possible strategy to address barriers.

Most physicians who are reluctant to treat addiction cited poor training and other institutional factors as major reasons for their hesitancy, a systematic review in JAMA Network Open showed.

“The findings were pretty much expected,” Nora D. Volkow, MD, director of the National Institute on Drug Abuse, told Healio. “Prior research has been describing that physicians don’t feel comfortable actually treating people with substance use disorder because they don’t feel that the setting in which they work has the support to allow them to do it properly.”

According to an NIH press release, almost 49 million people in the United States had a substance use disorder in 2022, yet only around 13 million people received treatment.

In the study, Melinda Campopiano von Klimo, MD, a senior medical adviser at JBS International, and colleagues searched several databases like PubMed and Scopus for studies to determine the most cited reasons for physician reluctance to treat addiction.

Overall, 283 articles published from 1960 to Oct. 5, 2021, were included in the review. Alcohol, nicotine and opioids were the most studied substances, whereas screening and treatment were the most studied interventions.

The most common reason for reluctance to treat addiction was the “institutional environment,” which was cited in 81.2% of articles and refers to factors like:

• insufficient resources;
• poor training;
• regulatory and liability concerns; and
• acceptance of interventions by staff or leadership.

Other frequently cited reasons for reluctance included:

• a lack of skill to effectively conduct and manage treatment and interventions (73.9%);
• a lack of cognitive capacity (73.5%); and
• a lack of knowledge, especially about treatment (71.9%).

About 66% of studies cited beliefs about public and community acceptance of addiction care as a reason, according to the release, whereas 56% “cited fear of harming the patient-physician relationship as deterrents for physicians to intervene in addiction.”

The top three cited combinations of reasons for reluctance were a lack of knowledge and lack of skill (61.1%), a lack of cognitive capacity and institutional environment (60%) and a lack of skill and institutional environment (59.2%).

“These are issues that should be addressed,” Volkow said. “When you’re a physician working in a health care organization, there are opportunities for discussion in terms of how you improve the care of the patients.”

The researchers highlighted several strategies that could address barriers tied to institutional environment, which includehealth care systems making necessary changes to workflow and staff, breaking barriers between addiction services and medical and mental health care, andhealth insurers providing reimbursement for the actual costs of the interventions.

Volkow pointed out that the strategies are feasible and that clinicians working with a trained staff “may feel much more supported, and even though they may not necessarily have the level of training that they want, they can always consult with someone else.”

She added that improper reimbursement for interventions for substance use disorders is a primary driver behind physician reluctance to provide treatment.

“The models of reimbursement are crucial in determining the extent to which a clinician is willing to do the training that will make them better prepared to take care of patients, but also for the health care system itself to bring in the expertise and the resources necessary,” she said.

References:

• Campopiano von Klimo, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.20837.
• Doctors reluctant to treat addiction most commonly report “lack of institutional support” as barrier. Available at: https://www.nih.gov/news-events/news-releases/doctors-reluctant-treat-addiction-most-commonly-report-lack-institutional-support-barrier. Published July 17, 2024. Accessed July 17, 2024.