JULY 26, 2024
A comprehensive review by the National Institutes of Health has identified why physicians may be reluctant to intervene in addiction. “Institutional environment” was the reason most frequently reported in the included studies.
Institutional environment refers to factors such as lack of support from a physician’s institution or employer; insufficient resources, such as staff and training; challenges in organizational culture; and competing demands. This reason was cited in
A comprehensive review by the National Institutes of Health has identified why physicians may be reluctant to intervene in addiction. “Institutional environment” was the reason most frequently reported in the included studies.
Institutional environment refers to factors such as lack of support from a physician’s institution or employer; insufficient resources, such as staff and training; challenges in organizational culture; and competing demands. This reason was cited in 81% of the studies reviewed, followed by insufficient skill (74%), lack of cognitive capacity to manage a certain level of care (74%) and inadequate knowledge (72%).
Around 66% of the 283 studies published on this topic within the last 61 years and reviewed in the current study cited negative social influences—or beliefs about public and community acceptance of addiction care—while 56% cited fear of harming the patient–physician relationship as physician deterrents to intervene in addiction. “These may represent the manifestation of stigma associated with substance use disorder,” according to the authors. Reimbursement concerns for the cost of delivering addiction interventions were also observed.
To better understand the factors limiting treatment access, the researchers reviewed studies from 1960 to 2021 focusing on physician-described barriers to adopting evidence-based practices for addiction. They noted approximately 97% of studies were published in 2000 or later, with the number increasing over time. Analyzed studies—most of which reported survey data—were taken from various science literature databases, and data included feedback from 66,732 physicians, primarily in general practice, internal medicine and family medicine. Alcohol, nicotine and opioids were the most commonly studied substances, and screening and treatment were the most often studied interventions.
“The study’s findings point to the need for institution-wide changes to improve the adoption of evidence-based substance use disorder treatment practices among physicians,” according to the study authors, in a statement. These changes include increasing organizational support, leadership and staff buy-in, and education and training.”
The study, published in JAMA Network Open (2024 Jul 17. doi:10.1001/jamanetworkopen.2024.20837), was led and funded by the NIH’s National Institute on Drug Abuse (NIDA).
“People with substance use disorders must be able to access compassionate and evidence-based care at any touchpoint they have with a healthcare provider,” said Nora D. Volkow, MD, the director of NIDA. “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.”
Adoption of effective interventions for treating substance use disorders—including medications and behavioral therapies—remains low and demand exceeds treatment capacity. More than 9 million adults (link is external) needed treatment for opioid use disorder in 2022, but fewer than half (around 46%) received any form of treatment, and only 25% received medications for opioid use disorder.
Based on a press relief from the NIH
