Attitudes, practices, and preparedness to care for patients with substance use disorder: Results from a survey of general internists

ABSTRACT

Background: Previous research demonstrates that most primary care physicians feel unprepared to diagnose and treat substance use disorder (SUD). Confidence in SUD management has been associated with improved clinical practices. Methods: A cross-sectional survey of 290 inpatient and outpatient general internists in an academic medical center evaluating attitudes, preparedness, and clinical practice related to SUD. Results: 149 general internists responded, a response rate of 51%. Forty-six percent frequently cared for patients with SUD. Sixteen percent frequently referred patients to treatment and 6% frequently prescribed a medication to treat SUD. Twenty percent felt very prepared to screen for SUD, 9% to provide a brief intervention, 7% to discuss behavioral treatments, and 9% to discuss medication treatments. Thirty-one percent felt that SUD is different from other chronic diseases because they believe using substances is a choice. Fourteen percent felt treatment with opioid agonists was replacing one addiction with another. Twelve percent of hospitalists and 6% of PCPs believe that someone who uses drugs is committing a crime and deserves punishment. Preparedness was significantly associated with evidence-based clinical practice and favorable attitudes. Frequently caring for patients with SUD was significantly associated with preparedness, clinical practice, and favorable attitudes. Conclusions: SUD is a treatable and prevalent disease, yet a majority of general internists do not feel very prepared to screen, diagnose, provide a brief intervention, refer to treatment, or discuss treatment options with patients. Very few frequently prescribe medications to treat SUD. Some physicians view substance use as a crime and a choice. Physician preparedness and exposure to SUD is associated with improved clinical practice and favorable attitudes towards SUD. Physicians need education and support to provide better care for patients with SUD.

Keywords:

• Addiction
• general internists
• preparedness
• stigma
• substance use disorder

Funding

This work was supported by internal funding through the Massachusetts General Hospital Substance Use Disorder Initiative, who had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This work had no external funding sources. This paper has not been presented.

The authors have no conflicts of interest to report.

Author contributions

All authors contributed substantially to this article. SEW was the principal investigator and contributed to the design and administration of the survey, interpretation of the results, and writing of the manuscript. GP-K was the statistician and completed the analysis, contributed to and edited the manuscript. KD was the co-investigator and contributed to the survey design, interpretation of results, and writing of the manuscript.