— Lack of Institutional Support and Knowledge rank as Key Factors

A recent systematic review of 283 studies has determined that a lack of institutional backing remains the top reason clinicians hesitate to intervene in addiction cases, as highlighted by the findings.

In their analysis, Wilson Compton, MD, MPE, deputy director of the National Institute on Drug Abuse (NIDA), and his colleagues reported in JAMA Network Open that 81.2% of the reviewed articles cited the institutional environment as the leading obstacle for not addressing addiction.

The authors further emphasized other major barriers, with a lack of knowledge (71.9%), insufficient skill (73.9%), and a limited cognitive capacity (73.5%) also being critical factors contributing to this hesitation.

"Our research indicates several reasons why addiction services face challenges in implementation, but the standout issue was the immense impact of insufficient institutional support," Compton shared with MedPage Today. "Essentially, this points to the fact that there is a deficiency in leadership and institutional funding necessary to offer comprehensive addiction services. This includes everything from proper screening and intervention, to seamless referrals for treatment, access to medications, and long-term patient care."

Marlene Martin, MD, an addiction medicine expert at the University of California San Francisco and San Francisco General Hospital, echoed these findings when speaking to MedPage Today. She noted that although the results aren’t surprising, some healthcare systems have begun increasing institutional support and improving physician education on addiction management.

However, she added that these initiatives often necessitate a systemic cultural shift within healthcare organizations.

"Given the widespread treatment gap for patients suffering from substance use disorders, along with the persistent crisis of overdoses and addiction, we must implement policies, incentives, and educational programs to tackle the institutional, knowledge-based, skills-related, and cognitive hurdles that are preventing physicians from addressing addiction comprehensively in healthcare settings," Martin pointed out.

Despite the availability of effective treatments for substance use disorders, only roughly a quarter of the 49 million Americans estimated to have experienced substance use disorder in 2022 received any form of treatment, as cited by data from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Compton and his team also discovered that other reasons for clinicians' reluctance included external social pressures (65.8%) and doubts about public attitudes toward addiction care. Furthermore, concerns about the outcomes and perceived benefits of treatment (61.4%) played a role.

Challenges within the institutional environment ranged from a shortage of adequately trained staff, and limited resources for staff training, to prohibitive costs faced by patients due to a lack of insurance or unaffordable care. The knowledge gap they observed revolved around a lack of understanding of addiction treatments, particularly concerning drug use. On the other hand, the cognitive capacity issue stemmed from clinicians feeling overwhelmed by other clinical responsibilities and perceiving addiction treatment as too time-intensive.

To conduct their systematic review, Compton and collaborators evaluated 283 studies involving 66,732 physicians, with publications spanning from January 1, 1960, to October 5, 2021. Their literature search was conducted across databases like PubMed, Embase, Scopus, medRxiv, and the SSRN Medical Research Network.

Interestingly, 97.3% of these studies were published post-2000, and the majority were rooted in survey-based methodologies. The physicians included in this review predominantly practiced general, internal, or family medicine within office-based settings in the U.S.

The substances most extensively researched were alcohol (124 studies), opioids (120 studies), and nicotine (43 studies). Of the interventions studied, treatment was the focus of 235 studies, and screening was covered in 153. A total of 213 studies identified the institutional setting as a barrier, 242 cited a lack of knowledge, 230 pointed to a skill deficit, and 185 highlighted cognitive limitations.

The authors acknowledged some limitations in their findings, including varying terminologies across the included studies, inconsistencies with survey data, and evolving practices and medications over the review’s timeline.

Looking forward, Compton stressed the importance of future studies aimed at improving clinicians' adoption of evidence-based strategies for addiction interventions and treatment.

"The public sees addressing substance use disorders as a major priority, and our results show that many institutions also rank it high on their priority list. My hope is that these insights will equip physicians with actionable evidence they can present to their leadership, advocating for more resources to tackle these significant public health issues," Compton concluded.

Disclosures

This study received funding from the National Institute on Drug Abuse.

Compton disclosed stock ownership in companies including General Electric, 3M, and Pfizer, Inc. Co-authors reported institutional support or consulting roles involving research and patient advocacy groups.

Martin reported no conflicts of interest.

Primary Source

JAMA Network Open

Source Reference: Campopiano von Klimo M, et al. "Physician reluctance to intervene in addiction: A systematic review" JAMA Netw Open 2024. DOI: 10.1001/jamanetworkopen.2024.20837