Why Physicians Are Unprepared to Treat Patients Who Have Alcohol- and Drug-related Disorders

Abstract

Most primary care physicians do not feel competent to treat alcohol- and drug-related disorders. Physicians generally do not like to work with patients with these disorders and do not find treating them rewarding. Despite large numbers of such patients, the diagnosis and treatment of alcohol- and drug-related disorders are generally considered peripheral to or outside medical matters and ultimately outside medical education. There is substantial evidence that physicians fail even to identify a large percentage of patients with these disorders. Essential role models are lacking for future physicians to develop the attitudes and training they need to adequately approach addiction as a treatable medical illness. Faculty development programs in addictive disorders are needed to overcome the stigma, poor attitudes, and deficient skills among physicians who provide education and leadership for medical students and residents. The lack of parity with other medical disorders gives reimbursement and education for addiction disorders low priority. Medical students and physicians can also be consumers and patients with addiction problems. Their attitudes and abilities to learn about alcohol- and drug-related disorders are impaired without interventions. Curricula lack sufficient instruction and experiences in addiction medicine throughout all years of medical education. Programs that have successfully changed students' attitudes and skills for treatment of addicted patients continue to be exceptional and limited in focus rather than the general practice in U.S. medical schools. The authors review the findings of the literature on these problems, discuss the barriers to educational reform, and propose recommendations for developing an effective medical school curriculum about alcohol- and drug-related disorders.

Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study

“…Several physicians reported that they were uninterested in providing treatment for their patients' addictive disorders. This lack of interest was linked with a negative characterization of addicted patients and supports previous research on physicians' and clinic directors' attitudes on treating addicted patients [19][20][21] . Some of these attitudes seem to result from physicians feeling unprepared to treat addiction.…”

“…This finding reinforces previous research on physicians' attitudes regarding their training in substancerelated disorders 22,23 , highlights the need for improved training in addiction at the medical school and post-graduate levels, and suggests potential issues and areas of concern that might be more fully explored in the 8-h training program designed to prepare physicians who are interested in providing buprenorphine treatment. Our data suggest that the following topics might be important to address: (1) the research and practice evidence that supports the appropriateness of officebased addiction treatment [19][20][21]24 , (some respondents viewed addiction treatment as outside their realm of medicine); (2) when and how to seek guidance on patient care (some physicians expressed concerned about treating addiction without access to specialists). Our experience indicates that having support from buprenorphine providers (on-site, by phone or email) is often sufficient 25 ; (3) strategies for working with "difficult-to-treat" patients-(the majority of the difficulties reported by physicians related to discomfort in setting appropriate boundaries); (4) treatment of co-existing disorders (many physicians expressed concern about their competence in treating medical and psychiatric problems associated with opioid dependence).…”

They Don’t Know What They Don’t Know: Internal Medicine Residents’ Knowledge and Confidence in Urine Drug Test Interpretation for Patients with Chronic Pain

“…Third, training in substance abuse and pain management is lacking in medical school and residency, and the subtleties of UDT interpretation are omitted from standard curricula. [35][36][37][38][39][40] Physician overconfidence can lead to diagnostic errors, 32 in this case leading to either under-diagnosis or over-diagnosis of abuse or diversion, with potentially negative consequences for patients. 18 One way overconfidence can cause diagnostic error is through premature closure, for example, concluding without further investigation that an opiate-positive urine drug screen reflects a patient's prescribed oxycodone use.…”

Medical students' knowledge, attitudes and behaviours related to substance use in Lebanon: a cross-sectional study

“…Studies have shown lack of knowledge among medical students and attitudes that could interfere with their care for patients with abuse problems as well as their own wellbeing (16,17). Factors found to contribute to the students' knowledge and attitudes include previous experience with substance use, family history, social and cultural context and exposure to drug education programmes (18). Researchers have highlighted the role of medical education in ensuring that doctors become competent in managing patients with substance abuse.…”