Tackling negative healthcare bias in addiction treatment

Researchers at the Monash Addiction Research Centre and Turning Point have uncovered multiple examples of stigma within Australia’s health system, as well as processes and procedures that act as barriers when people seek help as a result of harm from alcohol and other drugs (AOD).

The findings also suggest health professionals may not be aware that the everyday processes and language they use could perpetuate stigma and negatively affect the people they are treating.

“I remember the worst time when I presented to hospital,” explained a patient with substance use problems that developed after suffering a back injury from their time in the defence force.

“I asked if I could get a bottle to urinate in, and one of the nurses just sort of scoffed at me and said she’s got real patients to treat. Wouldn’t get me one.”

Read more: A mental disorder, not a personal failure: Why now is the time for Australia to rethink addiction

As a result of the research, a series of resources have been developed to help service providers and policymakers improve processes and competencies among health professionals.

“We know that one bad interaction with a healthcare provider can put people off asking for help, often for many years. By identifying opportunities to make healthcare more welcoming, we hope that people will be able to get help with their substance use earlier,” says Professor Suzanne Nielsen, lead researcher of the study.

Welcoming and inclusive processes

According to Professor Nielsen, hospital and primary care settings were chosen as the focus of their research because they’re well-placed to initiate effective care pathways for people experiencing alcohol and other drug harms.

“Our findings have shown multiple opportunities to improve existing processes in hospital and primary care settings so that people seeking help for substance dependence receive person-centred care,” Professor Nielsen says.

For example, more could be done to ensure primary care funding doesn’t create a barrier to the patient receiving ongoing treatment.

“We have a system that pays us to write scripts and do referrals, rather than sit down and talk and listen, which is what our patients really need,” a healthcare staff participant explained as part of the research.

The researchers recommend implementing and strengthening AOD screening and brief intervention capabilities across all service settings attended by people experiencing harm from AOD, including emergency departments, mental health providers, and family violence sectors.

“Integrating peer navigation support, where trained professionals with lived experience in AOD support new clients, would also improve experiences and mean that people who have begun treatment are more likely to continue,” Professor Nielsen says.

AOD support integrated within health services

Another key theme identified during interviews was that treatment for AOD use was seen as being outside the “medical model”, and separate from the role of health services.

For example, healthcare staff had experienced colleagues treating patients with AOD-related problems being perceived as not sick or deserving of care.

“This person with the heart attack, [this] is our sick patient,” a staff participant said. “[T]his [AOD patient] is just wasting our time.”

The researchers also found healthcare workers were sometimes reluctant when treating patients with substance dependence due to comments other staff had made in their clinical records.

“Oh my god, [after I read the notes I thought] I don’t want to see this patient. They sound like a nightmare, they sound really agitated.”

In this case, the healthcare worker observed that the patient was not how they’d been portrayed in the notes, but the language used by colleagues in the notes had created fear and negative expectations.

Since people who use alcohol and other drugs often have complex presentations, the researchers recommend training so healthcare staff learn to respond compassionately, using trauma-informed approaches.

Policies were also identified as barriers, with some patients being told they could not access housing or mental health services until they had been treated for their drug use.

“We also recommend implementing policies to ensure that people actively using AODs aren’t excluded from accessing other services,” says Professor Nielsen.

Increased workforce capabilities

The issues with existing procedures in healthcare settings may also affect health professionals’ attitudes, leading to biased beliefs and stigmatised language.

The researchers identified three themes where language communicated stigma.

Rather than focusing on the patient’s experiences, the use of language maintained a focus on the patient, and:

• positioned a patient as undeserving
• separated them from other patients
• blamed a patient for being unwell.

For example: “… he’s just a scumbag.”

“ … a nightmare. They sound like such a nasty person.”

“We argue that the issues identified in our study, such as organisational expectations about how to treat AOD patients, or processes that position treatment of AOD patients as separate to mainstream healthcare, may contribute to staff being unaware of their own biases, which in turn could perpetuate stigma,” says Professor Nielsen.

Crucially, stigmatising language among healthcare staff can lead to patients not continuing with their treatment, and may even perpetuate risky or dependent use of alcohol or other drugs.

“It’s vital we build non-AOD workforce competency in treating people experiencing harms from AOD and better-understanding the challenges faced by people with a substance dependence,” says Professor Nielsen.

Read more: Your Language Matters: A clinician’s guide

A future with equitable access to healthcare

Overall, ensuring that people with experience of AOD harms are empowered to tell their stories, engaged as peer researchers and involved in the co-design of support services will be important steps towards resolving the multiple issues relating to stigma and service delivery processes within Australia’s health system.

However, due to the research team’s finding that the existing healthcare service processes may be contributing to staff’s stigma communication, they’re also calling for improvements at policy and system levels that remove the stigma and barriers faced every day by people experiencing harms from alcohol or other drugs.

“Everyone deserves access to equitable healthcare,” says Professor Nielsen.