JBS-Supported Systematic Review Explores Physician Reluctance to Intervene in Addiction

July 19, 2024
Female healthcare specialist listens to her patient talk about her medical history

The overdose epidemic in the United States continues to persist, claiming more than 107,000 lives in 2023.1,2 Despite the widespread availability of safe, effective, and evidence-based interventions and approaches to address substance use disorder (SUD), including screening, treatment, and harm reduction strategies and practices, SUD treatment capacity is not meeting demand.3

Through a systematic review conducted in collaboration with staff from the National Institute on Drug Abuse (NIDA), the JBS NIDAMED* team sought to investigate the barriers that physicians face in adopting and implementing these evidence-based interventions to address addiction. The review, “Physician Reluctance to Intervene in Addiction: A Systematic Review,” pulling 283 studies published on this topic in the last 61 years, found that the most common reasons for physician reluctance include the lack of:

  • Institutional Support (81%): Shortage of trained staff and resources to train staff, nonacceptance of addiction treatment among staff or leadership, and competing priorities and demands among clinicians
  • Cognitive Capacity (74%): Limited clinician time, competing priorities, and general sense of being overwhelmed with clinical tasks
  • Skills (74%): Insufficient skills and/or experience for conducting effective behavior change interventions, initiating and managing treatment, and delivering interventions
  • Knowledge (72%): Lack of both knowledge related to treatment and of familiarity with the evidence of SUD as a medical condition, harm reduction strategies, and substance use screening

The review also found that stigma-related factors (e.g., negative social influences or emotions toward people who use substances), as well as fear of harming the patient-physician relationship, are frequently cited among physicians as barriers for intervention in addiction. Research shows that stigma can reduce the willingness of people with SUD to seek treatment and negatively affect the care clinicians provide to patients with SUD. Learn more about stigma, its impact on people with SUD, and how to avoid it when talking to patients about substance use and addiction. 
Conversely, the authors identified several factors that facilitate physicians’ intervention in substance use and addiction, which may inform strategies to strengthen and maximize their confidence in and likelihood of addressing it with patients. These include community outreach efforts, patient and family education, and public health campaigns promoting non-stigmatizing language.

Overall, these findings emphasize both the need for institutional changes to support the adoption and implementation of evidence-based practices to identify, address, and treat SUD among physicians, as well as the expansion of efforts focused on community engagement and widespread education on substance use and addiction.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, or substance use conditions, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357).

*NIDAMED is NIDA’s translational research initiative that supports health care professionals in addressing SUDs through practical, evidence-based information and resources to facilitate practice change and to optimize patient care. JBS has worked with NIDA to support the NIDAMED initiative since 2004.

References

1 U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC). (reviewed 2024, May 15). U.S. overdose deaths decrease in 2023, first time since 2018. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm
2 HHS, CDC, National Center for Health Statistics. (2024). Provisional drug overdose death counts. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
3 HHS, Office of the Assistant Secretary for Planning and Evaluation. (2017, December). Examining substance use disorder treatment demand and provider capacity in a changing health care system: Final report. https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//183121/ExamSUDfr.pdf