(146) Provider-Reported Barriers to Screening and Treating Alcohol Use Disorder

Background & Introduction: The prevalence of alcohol use disorder (AUD) in the USA is ~29.5 million yet only 7.6% receive treatment(1). For comparison, the treatment rate for Major Depressive Disorder is 61%(2). Additionally, per the World Health Organization, alcohol use is the third leading cause of preventable death worldwide(3). Investigation into factors that contribute to low treatment rates of AUD is the first step towards increasing treatment rates and therefore improving patient outcomes. In a systematic review looking at inpatient and emergency room settings, commonly cited barriers to screening and treating for AUD included lack of time, provider discomfort, and lack of knowledge(6). In another study looking at rural primary care offices, commonly cited barriers to screening for AUD included lack of time, lack of training, and provider discomfort(7).

The purpose of this study is only to gather information, specifically the most common provider-reported barriers to screening for, diagnosing and treating AUD. No intervention will be proposed for this study, however, the information gathered will be used in a future quality improvement project which will implement policy changes, address knowledge gaps, and assess the change in rates of diagnosis and treatment of alcohol use disorder in the Carle Health patient population.

Methods: The Carle health system serves the central Illinois region including mid-size cities and surrounding suburban and rural areas. This population is insured via a mix between Medicaid/Medicare and private insurance. Qualitative information was gathered anonymously from Carle-employed providers (including physicians, physician assistants, nurse practitioners, and clinical psychologists) specializing in internal medicine, family medicine, and psychiatry.

Google Forms was used to create an online survey that collects information regarding AUD screening and treating. Survey questions were created based on previous research on this topic, personal anecdotal evidence and clinical gestalt. Sample characteristics such as provider title, specialty, and practice setting were obtained. Respondents were asked whether/how they routinely screen for or treat AUD, and if they do not, what reasons they do not. Additionally, respondents are asked to identify what resources they know exist within their own hospital system that are available for the treatment of AUD. The survey was distributed via e-mail to all health system providers that met the aforementioned criteria, resulting in a simple random sample. Qualitative data was analyzed to obtain response rates as well as the target data in the form of a ranked list of most common reported barriers to screening and treating for AUD.

Results: The survey was distributed to 246 Carle Health providers. 66 providers responded which is a response rate of 26.8%. 30.3% of respondents practice in the inpatient setting and 78.8% practice in the outpatient setting (some providers practiced in both settings). 30.3% of respondents specialized in psychiatry, 47.0% in family medicine, 18.2% in internal medicine, and 4.5% in other specialties such as pediatrics or obstetrics/gynecology. 39.4% of respondents do NOT routinely screen for AUD with the three most common reasons being; they do not have enough time (44.4%), they only screen in certain scenarios (e.g. at initial visit or if presenting problem is related to alcohol use) (33.3%), and they do not know how to screen OR would not know what to do after a positive screen (25.9%). 60.6% of respondents do screen for AUD with the three most common methods including the CAGE questionnaire (37.5%), single item alcohol screening questionnaire (35%), and clinical interview (25%). 16.7% of respondents do NOT routinely attempt to treat AUD with the three most common reasons being; they do not have enough time (33.3%), they do not know how to treat AUD (33.3%) and they only treat young children/babies (22.2%). 83.3% of respondents do routinely attempt to treat for AUD, with the three most common methods including referral to Addiction Medicine (79.7%), prescribing medication for addiction treatment (MAT) (66.1%), and referral to peer support groups such as Alcoholics Anonymous (42.4%). Of the respondents who do not routinely screen for or treat AUD, 86.2% said they would start to screen/treat if the aforementioned barriers were addressed. 44.6% of providers refer to peer support groups despite 75.8% being aware of the service. This discrepancy is seen for all services that were discussed in the survey, including detox (14.3% refer vs. 39.4% are aware), residential rehabilitation (14.3% vs. 42.4%), partial hospitalization programs (12.5% vs 36.4%), therapy (33.9% vs. 69.7%), and social worker/case management (32.1% vs. 72.7%).

Conclusion & Discussion: This study highlights the reasons that many providers do not screen for or treat alcohol use disorder (AUD). Many of these reasons reflect what is seen in similar studies, such as lack of time or knowledge with how to screen or treat AUD. For those that do routinely treat AUD, almost all providers refer patients to Addiction Medicine. However, this is not a sustainable solution given the ubiquitous shortage of addiction specialists in America, highlighting the need to educate non-addictionologists on how to screen and treat AUD. Most interestingly is the lack of utilization of certain resources such as therapy or peer support groups despite knowledge of their existence. Overall response rate was adequate. Limitations identified include minor survey design or technical issues, and lack of generalizability due to the study being conducted within a single health system. The subsequent quality improvement project will be designed to directly target barriers and discrepancies identified here to increase screening and treatment rates of AUD, therefore expecting to improve overall patient outcomes. Policy changes should be efficient, easy to understand and require minimal time to implement.

References: 1. Nehring SM, Chen RJ, Freeman AM. Alcohol Use Disorder: Screening, Evaluation, and Management. https://www.ncbi.nlm.nih.gov/books/NBK436003/. Accessed July 21, 2025.

2. Substance Abuse and Mental Health Services Administration. (2022). Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report . Accessed from https://www.nimh.nih.gov/health/statistics/major-depression#:~:text=In%202021%2C%20an%20estimated%2061.0,treatment%20in%20the%20past%20year. Accessed on July 21, 2025.

3 - GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1151-1210.

6. Gargaritano KL, Murphy C, Auyeung AB, Doyle F. Systematic Review of Clinician-Reported Barriers to Provision of Brief Advice for Alcohol Intake in Hospital Inpatient and Emergency Settings. Alcohol Clin Exp Res. 2020 Dec;44(12):2386-2400.

7. Saunders EC, Moore SK, Gardner T, Farkas S, Marsch LA, McLeman B, Meier A, Nesin N, Rotrosen J, Walsh O, McNeely J. Screening for Substance Use in Rural Primary Care: a Qualitative Study of Providers and Patients. J Gen Intern Med. 2019 Dec;34(12):2824-2832.