Exploring Scottish addiction services: provider-based stigma, addiction aetiology beliefs, treatment bias, and burnout among addiction treatment providers

TL;DR

This study explores how stigma, beliefs about addiction causes, and burnout among Scottish addiction providers affect treatment approaches and client relationships.

Contribution

The study identifies specific stigma variants and beliefs among addiction providers that influence treatment preferences and burnout in Scotland.

Findings

Over 30% of providers showed high stigma scores linked to preferring abstinence-based treatments and lower harm reduction acceptance.

Belief in the disease model correlates with higher dangerousness and fatalism stigma, while psychosocial beliefs correlate with harm reduction acceptance.

Stigma and burnout among providers are significant issues that could affect treatment quality and client-provider relationships.

Abstract

Drug related deaths continue to increase in Scotland. Many barriers to addiction treatment exist and are often related to poor provider-client relationships possibly caused by stigma, burnout and differentiating beliefs and attitudes among addiction treatment providers. This study investigated the prevalence of provider-based stigma (PBS) including four stigma variants (dangerousness, blame, social distance, fatalism) and its relationship to burnout, job satisfaction, attitudes towards addiction treatment approaches, and beliefs regarding addiction aetiology in a sample of addiction treatment providers.

Cross-sectional online survey was completed by 64 addiction treatment providers currently working in Scotland. Online survey was comprised of validated and adapted measures, extensive statistical analysis was conducted, including ANOVAs and Regressions to examine the outcomes of interest.

Over 30% of participants had elevated scores on PBS variants dangerousness and blame and these were found to predict higher acceptance of abstinence-based treatments, and lower endorsement of harm reduction approaches (dangerousness: b = 0.41, p < 0.001; blame: b = 0.23, p = 0.010). Burnout was high in this sample, and PBS variant blame predicted higher client-related burnout (b = 7.35, p = 0.009). Moreover, the belief in the disease model predicted higher acceptance of abstinence-based treatments (b = 0.30, p < 0.001), whereas belief in the psychosocial model predicted higher acceptance of harm reduction-based treatments (b = -0.25, p = 0.008). Lastly belief in the disease model predicted higher scores on dangerousness (b = 0.19, p = 0.016) and fatalism (b = 0.29, p = 0.002) PBS variants.

The findings from this study provide insights for policy and addiction treatment improvements. Efforts to alleviate addiction treatment providers stigmatising attitudes, especially perceptions of people who use drugs as dangerous, blameworthy, and incapable of recovery are needed. Interventions and policy improvements need to include stigma reduction workshops and consider addiction treatment providers attitudes and beliefs to limit treatment bias, stigma and burnout to foster better relationships between clients and the workers who support them.

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