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A lack of institutional support topped the list of reasons why clinicians may be reluctant to intervene in addiction, according to a systematic review of 283 studies.

Overall, 81.2% of articles stated the institutional environment was the most common reason for not intervening in addiction, Wilson Compton, MD, MPE, deputy director of the National Institute on Drug Abuse (NIDA), and colleagues reported in .

Other common reasons for not intervening included a lack of knowledge (71.9%), a lack of skill (73.9%), and a lack of cognitive capacity (73.5%), they reported.

"We see a number of reasons for the difficulty in implementing addiction services and the lack of institutional support really stood out as our main finding," Compton told MedPage Today. "Ultimately, it means that there isn't necessarily leadership or institutional funding to provide the addiction services that were highlighted, whether that's screening and intervention, whether that's full access to referral to treatment, whether that's access to medications or long-term follow up of patients."

Marlene Martin, MD, an addiction specialist at the University of California San Francisco and San Francisco General Hospital, told MedPage Today the results aren't surprising, but that some healthcare systems have started to increase institutional support and physician education around addiction.

However, these efforts often require a culture change within healthcare institutions, she said.

"With the large treatment gap for patients with substance use disorders and the continued overdose and addiction crisis, we need policies, incentives, and training to broadly address the institutional, knowledge, skill, and cognitive barriers leading to physician reluctance to address addiction across all healthcare settings," Martin said.

Indeed, while effective treatments for substance use disorders are available, only about a quarter of the nearly 49 million people with substance use disorder in the U.S. in 2022 received treatment, according to (SAMHSA).

Compton and colleagues found that other reasons for physician reluctance to intervene in addiction included negative social influences (65.8%), or beliefs about public acceptance of addiction care, as well as their expectations around the benefit of treatment (61.4%).

Challenges in the institutional environment included a lack of trained staff, resources to train staff, as well as the cost to the patient or the lack of insurance coverage. Lack of knowledge focused on a lack of understanding of treatment, particularly for drug use. Lack of cognitive capacity involved being too busy with other clinical tasks and the perception that treating addiction was too time-consuming.

For their systematic review, Compton and colleagues assessed 283 studies involving 66,732 physicians, published between January 1, 1960, and October 5, 2021, based on a literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network.

Of those studies, 97.3% were published in 2000 or later, and most of the studies reported survey-based research results. The authors also noted that most physicians in the review practiced either general medicine, internal medicine, or family medicine in office-based settings in the U.S.

The most studied substances were alcohol (124 studies), opioids (120 studies), and nicotine (43 studies), while the most studied interventions were treatment (235 studies) and screening (153 studies). A total of 213 studies included the institutional environment as a barrier to care; 242 included lack of knowledge; 230 included lack of skill; and 185 included lack of cognitive capacity.

The review was limited by several factors, including inconsistent use of terms across the included studies, inconsistent survey data, and changes in practices and available medications throughout the years covered in the review.

Compton said future research should focus on how to improve physician adoption of evidence-based practices for intervening and treating addiction.

"We know that addressing substance use disorders is a major priority for the public, and when you look at what various institutions are highlighting as their priorities, this is one of them," Compton said. "I hope this will give them a tool that [physicians] could use to bring to the leadership within their organizations to garner the resources to address these major public health concerns."

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