Why are physicians not addressing addiction, substance use in clinical practice?

Physician reluctance to adopt evidence-based treatment practices for addressing addiction and substance use stems from a lack of institutional support, resources, education, training, and policies, according to study results published in JAMA Network Open.

Despite the existence of evidence-based treatment guidelines for addiction and substance use disorders, clinician adoption of these practices remains low. In 2021, only 6.3% of individuals with a substance use disorder in the past year received the necessary treatment.

Therefore, researchers carried out a systematic review of publication databases and a search of relevant government and non-government websites to identify and address barriers reported by physicians in adopting evidence-based practices for addiction within clinical settings. The primary objective of the systematic review was to describe and quantify the factors that contribute to physicians’ hesitance in implementing evidence-based treatment practices for screening, treatment, harm reduction, or recovery support interventions. The researchers included observational studies (ie, surveys, interviews, or qualitative studies) that reported data on physicians at any practice level, types of substance use interventions, and reasons why physicians may be hesitant to take action in cases of addiction.

A total of 283 studies were included in the systematic review, for a pooled sample of 66,732 physicians. The substances most commonly researched were alcohol, nicotine, and opioids, while screening and treatment emerged as the most frequently investigated interventions. Based on the responses across the included studies, the researchers systematized reasons for reluctance in adopting evidence-based treatment practices into 10 distinct categories, based on the Theoretical Domains Framework.

Physicians’ reluctance to embrace evidence-based practices for addiction primarily stemmed from institutional barriers (81.2%) followed by inadequate skills (73.9%), limited cognitive capacity (73.5%), and insufficient knowledge (71.9%). Social influences (65.8%) also play a significant role; however, no notable patterns were identified when reluctance was examined.

The researchers found that the most commonly cited barriers to addressing addiction and substance use included insufficient staff training, lack of resources, acceptance challenges, regulatory issues, and inadequate reimbursement—especially concerning Medicaid, which often failed to cover staff time and training expenses.

The researchers also identified 4 key facilitators to improving physician intervention: 1) the need for quality education and training, 2) the significance of intrapersonal and interpersonal factors, 3) the essential role of supportive institutional infrastructure for interventions, and 4) the necessity for regulatory reforms to streamline processes and enhance coverage is crucial for progress.

“These data suggest that policy, regulatory, or accreditation changes are needed to systematically address institutional barriers, as well as increases to physician reimbursement and opportunities for clinically relevant training that provides both skill development and knowledge gain,” the researchers concluded.

Study limitations include inconsistent terminology across studies, potential repeat participation from the included physicians, and the systematic review was not tailored to intervention facilitators in addiction.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of author disclosures.

By Hibah Khaja, PharmD

References:

Campopiano von Klimo M, Nolan L, Corbin M, et al. Physician reluctance to intervene in addiction: a systematic review. JAMA Netw Open. 2024;7(7):e2420837. doi:10.1001/jamanetworkopen.2024.20837