Why physicians tend to be reluctant to intervene in addiction

Physicians should intervene in cases of substance use and addiction, yet many of them are wary of doing so.That’s according to a systematic review published in JAMA Network Open that examined reported reasons given by physicians in the U.S. for not addressing these matters in their clinical practices.Amid an overdose epidemic, it’s all-the-more necessary for physicians to implement evidence-based practices for substance use disorder, according to the review. However, adoption of these interventions—which include screening, treatment, harm reduction and recovery support—remains low.This reluctance creates “missed opportunities” for intervention and for preventing the patient’s substance use from progressing to a severe disorder.Overdose is a leading cause of “injury-related death” in the U.S., according to the review, with 107,941 such deaths occurring in 2022. From 2015 to 2019, the number of annual deaths due to alcohol exceeded 140,000.In Canada, it’s estimated that 67,000 deaths per year are “attributable” to substance use, according to data provided by the Centre for Addiction and Mental Health. This includes over 47,000 deaths attributable to tobacco and nearly 15,000 deaths attributable to alcohol.In the face of this ongoing crisis, physicians have described many barriers for addressing substance use and addiction in their practices. The review examined a total of 283 studies published between 1960 and 2021 (97.3% of the studies were published in 2000 or later). The reported reasons for not intervening include:Lack of institutional support: “Reasons for reluctance related to the institutional environment included lack of trained staff or resources to train staff” as well a lack of acceptance of addiction interventions among staff or leadership.Lack of knowledge: “[K]nowledge was more deficient for treatment than for screening or diagnosis and for drug use than for alcohol and tobacco use. Physicians were unfamiliar with the evidence for substance use disorders as biomedical conditions, harm reduction strategies, and screening for risky substance use. Some physicians lacked awareness of the extent of substance use by their patients.”Lack of skill: Physicians reported lacking the skills to intervene effectively enough to change their patients’ behaviours. “They also described a lack of skill needed to initiate or manage treatment, especially for substance use disorders other than alcohol or tobacco. In some studies, they equated their lack of skill with lack of experience with observing or delivering a substance use disorder intervention under supervision.”Lack of cognitive ability (mental load): “Lack of cognitive capacity was not often characterized beyond a general sense of overwhelm with clinical tasks . . . and the need to prioritize patients’ competing needs.”There are several means for addressing these barriers and facilitating physician intervention, according to the report. These include the need for physicians to receive “adequate education and training in areas like managing pharmacology.”It also helps if the physician understands addiction as within their scope of practice.Furthermore, there should be a “great commitment by health systems to make essential workflow and staffing changes,” (i.e. more human resources).The barriers between addiction services, medical health care and mental healthcare also need to be dismantled.

Why physicians tend to be reluctant to intervene in addiction

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