Press release
Wednesday July 17, 2024
NIH study highlights need for better education, training and policies to increase adoption of evidence-based addiction care among physicians.
A new study has identified the main reasons why some physicians may be reluctant to intervene in the area of addiction. The comprehensive review, which looked at 283 studies published on the topic over the past 61 years, found that “institutional environment” was the most commonly cited reason in these 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 skills (74%), lack of cognitive capacity to manage a certain level of care (74%) and inadequate knowledge (72%).
About 66% of studies cited negative social influences—or beliefs about public and community acceptance of addiction care—while 56% of studies cited fear of harming the patient-physician relationship as a deterrent for physicians from intervening in addiction treatment. These factors may represent a manifestation of the stigma associated with substance use disorders, the authors say. Concerns about reimbursement for the cost of addiction interventions were also noted.
The study results highlight the need for institution-wide changes to improve physicians’ adoption of evidence-based substance use disorder treatment practices. These changes include increased organizational support, leadership and staff buy-in, and education and training. The study, published in Opening of the JAMA networkwas led and funded by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health.
“People with substance use disorders need access to compassionate, evidence-based care every time they see a health care provider,” said Nora D. Volkow, MD, NIDA Director. “To make this vision a reality, clinicians across all medical disciplines need more training, resources, and support to care for people with addictions so they feel equipped to proactively offer prevention, screening, treatment, harm reduction, and other tools that can help save lives.”
Despite effective interventions to treat substance use disorders, including medications and behavioral therapies, adoption of these practices remains low and demand exceeds treatment capacity. In 2022, nearly 49 million people in the United States had at least one substance use disorder, although only about a quarter (13 million people) received treatment in the past year. More than 9 million adults needed treatment for an opioid use disorder in 2022, but less than half (about 46%) received any form of treatment, and only 25% received medication for the disorder. Although recent federal policy changes have reduced barriers to drug treatment, helping to increase the number of prescribers of buprenorphine, a medication for opioid use disorder, for example, this has not yet translated into an increase in the number of patients receiving treatment.
To better understand the factors limiting access to treatment, the researchers examined studies conducted between 1960 and 2021, focusing on physician-described barriers to adopting evidence-based practices in addiction. The researchers pulled studies from this 61-year period to ensure data collection was comprehensive, though they note that about 97% of the studies were published in 2000 or later, with the number of studies increasing over time. The studies analyzed—most of which reported survey data—were drawn from various databases of scientific literature, and the data included input 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 commonly studied interventions.
The study also examined factors that facilitate physician intervention in substance abuse and suggests potential benefits of community outreach efforts, educational materials for patients and families, and public health campaigns that encourage non-stigmatizing language.
The researchers conducted this study using standard systematic review protocols. They noted that many studies did not use or report best practices for survey design and that there were inconsistencies in terminology and reporting. Future direction for this field should therefore focus on developing high-quality studies that address these limitations, the authors say.
“Developing new treatments for addiction is critical, but it’s equally important to rigorously study how to implement these treatments so they get to the doctor’s office and reach the people who need them,” said NIDA Deputy Director Dr. Wilson M. Compton, one of the study’s lead authors. “The survey results have helped us better understand the treatment landscape. The next step is to test ways to change behaviors and attitudes about the delivery of addiction treatment to remove barriers to the addiction care people seek.”
As treatment practices evolve over time, the authors also recommend that future studies closely examine the role of stigma in limiting treatment implementation, as well as explore unintended impacts of increased physician intervention, such as strain on the physician-patient relationship, decreased opportunities for the physician to address the patient’s other health needs due to the focus on addiction, and the potential for patients to experience stigmatizing interactions with other health care providers due to broader documentation of their substance use disorder diagnosis.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.orgTo learn how to get help for mental health or addiction, visit FindSupport.gov. If you are ready to find a treatment center or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357).
About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, part of the U.S. Department of Health and Human Services. NIDA supports much of the world’s research on the health aspects of drug use and addiction. The Institute conducts a wide range of programs to inform policy, improve practice, and advance the science of addiction. For more information about NIDA and its programs, visit www.nida.nih.gov.
About the National Institutes of Health (NIH):
NIH, the nation’s health research agency, is comprised of 27 institutes and centers and is part of the U.S. Department of Health and Human Services. NIH is the primary federal agency that conducts and supports basic, clinical, and translational medical research and studies the causes, treatments, and cures for common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH…Transforming Discovery into Health®