“We’ve learned it’s a medical illness, not a moral choice”: Qualitative study of the effects of a multicomponent addiction intervention on hospital providers’ attitudes and experiences

BACKGROUND: Substance use disorders (SUD) represent a national epidemic with increasing rates of SUD-related hospitalizations. However, most hospitals lack expertise or systems to directly address SUD. Healthcare professionals feel underprepared and commonly hold negative views toward patients with SUD. Little is known about how hospital interventions may affect providers’ attitudes and experiences toward patients with SUD. OBJECTIVE: To explore interprofessional hospital providers’ perspectives on how integrating SUD treatment and care systems affect providers’ attitudes, beliefs, and experiences. DESIGN: In-depth semi-structured interviews and focus groups. The study was part of a formative evaluation of the Improving Addiction Care Team (IMPACT), an interprofessional hospital-based addiction medicine service with rapid-access pathways to post-hospital SUD treatment. SETTING: Single urban academic hospital in Portland, Oregon. PARTICIPANTS: Multidisciplinary hospital providers. MEASUREMENTS: We conducted a thematic analysis using an inductive approach at a semantic level. RESULTS: Before IMPACT, participants felt that hospitalization did not address addiction, leading to untreated withdrawal, patients leaving against medical advice, chaotic care, and staff “moral distress.” Participants felt that IMPACT “completely reframes” addiction as a treatable chronic disease, improving patient engagement and communication, and humanizing care. Participants valued post-hospital SUD treatment pathways and felt having systems to address SUD reduced burnout and provided relief. Providers noted that IMPACT had limited ability to address poverty or engage highly ambivalent patients. CONCLUSIONS: Providers’ distress of caring for patients with SUD is not inevitable. Hospital-based SUD interventions can reframe providers’ views of addiction and may have significant implications for clinical care and providers’ well-being. Journal of Hospital Medicine 2018;13:XXX-XXX.