Healthcare Worker’s Feelings About People With Substance Use Disorders

To have a health condition that is stigmatized can be extremely upsetting for the individual who bears it. At the same time, there are many legitimate challenges to working with individuals who have active substance use disorder. It is important to understand health professionals’ attitudes toward those in or seeking recovery.

Depending on the tone of these attitudes, professionals can have important roles in exacerbating or alleviating the stigma of substance use disorder. What does the science say about health professionals’ attitudes toward those with substance use disorder?

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Substance use disorders are among the most stigmatized conditions in the Western world. Stigma is defined as “an attribute, behavior, or condition that is socially discrediting”. This stigmatized condition “sets the bearer apart from the rest of society, bringing with it shame and isolation.”

Even well meaning professionals are not immune to attitudes which can make the stigma of substance use disorder worse.

Feeling stigmatized in professional settings is a barrier to individuals seeking treatment and recovery support services.

In this review, van Boekel summarized the existing science on health professionals’ attitudes toward individuals with substance use disorder, and the impact of any negative attitudes on healthcare delivery and outcomes.

HOW WAS THIS STUDY CONDUCTED?

This study reviewed articles that were published between 2000 and 2011 and focused on attitudes of health personnel working in Europe, North America, and Australia toward individuals with substance use disorder.

READ MORE ON STUDY DESIGN

Studies focused on nicotine use disorder, a specific group of individuals with substance use disorder (e.g., youth), or specific types of interventions (e.g., medication-assisted treatment) were not included in the review.

After an extensive vetting process, 28 studies met the parameters to be included. Of the 28, 12 were conducted in Australia, 7 in the United Kingdom (UK), 5 in the United States (US), 1 in Canada, 1 in Ireland, 1 that spanned eight European countries, and 1 across both the UK and the US.

Study samples included nurses and physicians, as well as specialty substance use disorder and other mental health care professionals. The providers’ attitudes were measured primarily with the Substance Abuse Attitude Survey (SAAS) and Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ).

WHAT DID THIS STUDY FIND?

In general, the health professionals in these studies had negative attitudes toward substance use disorder patients. Also, attitudes toward those with substance use disorder were more negative than toward patients with mental or less stigmatized medical illnesses, such as depression and diabetes.

Of note, authors stated attitudes toward illicit drug users, in particular, were “strongly negative”.

Factors contributing to their overall negative attitudes were beliefs that patients with substance use disorder can be “manipulative,” “irresponsible,” & “poorly motivated.”

Furthermore, perceiving substance use disorder as within an individual’s control was related to more negative attitudes.

Although health professionals’ negative attitudes may be related to difficulties empathizing with individuals who have substance use disorder, personal and/or professional experience with these individuals is related to more favorable attitudes.

Targeted training may help improve attitudes and increase knowledge related to substance use disorder. Results on the actual impact of these attitudes on health care delivery are mixed. In one noteworthy study of residential substance use disorder treatment patients, perceived discrimination from providers was related to drop-out.

WHY IS THIS STUDY IMPORTANT?

This study showed health provider attitudes are important factors in addressing the stigma related to substance use disorder. There are several related studies that are important to help contextualize this review:

Another study led by this research team suggests not all professionals have equally negative attitudes. They found substance use disorder specialists had more positive attitudes than psychiatrists who had more positive attitudes than primary care physicians. Most importantly, greater belief that the individual was personally responsible for the substance use disorder was related to lower regard for the individual.

More direct experience with individuals with substance use disorder, and greater belief that treatment can be successful, was related to higher regard.

Language can be critically important to the perpetuation of stigma

Research has shown that calling someone an “individual with a substance use disorder” rather than “substance abuser” can evoke more positive attitudes about this group of people (e.g., more likely to benefit from treatment).

LIMITATIONS

This review was comprehensive, but like all literature reviews, the findings were subject to the authors’ interpretations and synthesis of 28 different studies.

BOTTOM LINE

For individuals & families seeking recovery: You or your loved one could encounter negative attitudes from health professionals, particularly outside of substance use disorder specialty settings. While this may certainly be upsetting, you are encouraged to bring up your feelings openly with these professionals. You may not only be giving yourself a chance to get the help you need, but you might help reduce their negative attitudes as well.
For Scientists: This review highlights a critical need for future intervention development and evaluation: strategies to enhance health professionals’ attitudes regarding individuals with substance use disorder.
For Policy makers: This review highlighted health professionals’ general negative attitudes toward individuals with substance use disorder. More research is needed to determine the effect of these attitudes on patient outcomes and to develop strategies to alleviate this problem. Consider policies and funding to support these initiatives.
For Treatment professionals and treatment systems: This review highlighted health professionals’ general negative attitudes toward individuals with substance use disorder. Because health professionals – even those outside specialty settings – are likely to encounter such individuals, it is important to provide adequate substance use training and ongoing support to your staff. More research needs to be done to develop evidence-based training interventions to enhance health professionals’ attitudes.

CITATIONS

Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence, 131(1), 23-35.