People affected by substance use disorders commonly receive treatment from healthcare professionals trained as general physicians (GPs), psychiatrists or addiction services specialists. Whatever the details of their training, these professionals contribute a critical element to successful treatment by committing themselves to their work as fully as possible. However, not all professionals involved in the field hold the same level of regard for their patients/clients. In a study published in January 2014 in the journal Drug and Alcohol Dependence, researchers from three Dutch institutions compared the general patient- or client-related attitudes among GPs, psychiatrists and addiction services specialists.
Substance Use Disorders
Substance use disorders are defined in the U.S. by the American Psychiatric Association and get their name because they involve certain serious problems related to drug, alcohol or medication intake. Some people diagnosed with these disorders are affected by chemical dependence and addiction, while others establish a damaging substance-based lifestyle without developing dependence- and addiction-related issues. Specifically designated subtypes of substance use disorder include stimulant use disorder, cannabis use disorder, alcohol use disorder, opioid use disorder, tobacco use disorder, sedative use disorder and phencyclidine (PCP) use disorder. When diagnosing any given individual, a doctor typically identifies the substance(s) that individual uses, as well as the number of relevant symptoms he or she is experiencing. (A minimum number of 11 possible symptoms indicates a fairly mild disorder, while a substantially higher number of symptoms indicates a relatively severe disorder.)
General physicians, also called general practitioners, are doctors who treat a wide range of short-term and chronic health problems rather than specializing exclusively in the treatment of a narrow range of problems. These physicians commonly encounter individuals affected by substance use disorder only occasionally as part of a much larger patient base. Psychiatrists are medical doctors who specialize in diagnosing and treating people affected by some sort of mental health disorder. Since substance use disorders qualify as mental health concerns, these doctors may encounter substance-affected patients with some regularity. Addiction services specialists, also simply called addiction specialists, are individuals who receive special training in dealing with substance addiction-related issues and other forms of addiction. Depending on specific circumstances, these individuals may have primary training as psychiatrists, general practitioners, psychologists, nurses, social workers or drug or alcohol counselors. Because of their field of choice, they frequently encounter people affected by substance use disorder.
Previous research has shown that healthcare professionals who hold negative attitudes toward their substance-using patients or clients can interfere with the chances that those patients/clients will receive any form of treatment or receive treatment that meets minimum standards for effectiveness. In the study published in Drug and Alcohol Dependence, the Dutch research team assessed how professional status impacts the attitudes of the three main groups responsible for diagnosing and/or treating substance use disorders. They carried out this assessment by issuing questionnaires to 180 general physicians, 89 psychiatrists and 78 addiction specialists. These questionnaires were specifically designed to capture characteristic attitudes toward working with substance use disorder-affected individuals.
The researchers concluded that the lowest level of regard for people with substance use disorders typically appears among doctors trained as general physicians. Psychiatrists not trained as addiction specialists have an intermediate level of regard for substance use disorder-affected individuals, while the highest level of regard appears among professionals specifically trained to deal with substance-related matters. The thoughts and emotions most likely to instill a negative attitude among the study participants included fear toward substance users, anger toward substance users and a belief that substance users are “to blame” for their problems. Conversely, the factors most strongly associated with a positive attitude among the study participants included a high level of belief in the effectiveness of substance treatment, regular involvement with people affected by substance use disorder and a thorough understanding of substance use-related issues. Both positive and negative attitudes were also affected by the social importance the surveyed healthcare professionals attached to their substance use disorder work.
Significance and Considerations
In reporting their findings, the authors of the study published in Drug and Alcohol Dependence specifically note the potential for poor treatment enrollment and poor treatment outcomes when healthcare professionals hold negative attitudes toward substance use disorder-related issues. They believe that these negative attitudes can be diminished or eliminated through improved training and improved understanding of the factors that go into successfully addressing substance use disorders.