Abstract / Summary
Abstract Background Addressing substance use disorders (SUD) in clinical settings is often complicated by provider stigma potentially impacting the quality and equity of care. Stigma is often shaped by gaps in medical training, contributing to providers being ill-equipped to support patients with SUD. Prior research demonstrates that educational interventions can improve healthcare provider attitudes and intent. The long-term impact of addiction training on stigma or clinical practices remains under-explored. This study sought to examine how addiction training (hours received during medical school and residency; Continuing Medical Education [CME]) and perceived capability to care for individuals with SUD stigma towards patients with SUD and clinical practices. Methods This exploratory secondary analysis used data from a nationally representative cross-sectional survey of U.S. primary care and emergency department physicians conducted from October 2020 to October 2022 (Council of American Survey Research Organizations (CASRO) response rate: 53.6%). Generalized estimating equations assessed relationships of addiction training and perceived capability with SUD stigma and treatment practices. Perceived capability was explored as a mediator between training and stigma. Covariates included sex, race/ethnicity, years since degree, and physician type. Results This analysis included 855 physicians. More training was associated with lower stigma directed towards patients with alcohol use disorders (AUD; β=-2.42, p <.01), stimulant use disorders (StUD; β=-2.78, p <.01), and opioid use disorders (OUD; β=-2.48, p = .02), and higher odds of providing treatment for AUD (PR = 1.19, p <.001), OUD (MOUD PR = 1.09, p <.01; behavioral counseling PR = 1.10, p = .01), and other drugs (PR = 1.14, p <.001). Higher perceived capability was associated with lower stigma toward patients with AUD (β=-0.55, p <.0001), StUD (β=-0.51, p <.0001), and OUD (β=-0.59, p <.0001). When accounting for perceived capability, training no longer had a significant direct effect on stigma; however, its indirect effect via perceived capability remained significant for AUD (β=-0.11, p <.0001), StUD (β=-0.09, p <.0001), and OUD (β=-0.11, p <.0001), indicating full mediation. Conclusions Results suggest that more addiction training was associated with lower provider stigma toward patients with SUD primarily by increasing physicians’ perceived capability to deliver care. Enhancing clinical training in ways that build perceived capability in treating SUDs may improve physician attitudes and the quality of care for individuals with SUD. Clinical trial number Not applicable.