Willingness to treat drug dependence and depression: comparisons of future health professionals

Brian K Ahmedani^1,2, Sheryl Pimlott Kubiak², Carlos F Rios-Bedoya³, Maureen Mickus⁴, James C Anthony^5
1Center for Health Services Research, Henry Ford Health System, Detroit, MI, USA; ²School of Social Work, Michigan State University, East Lansing, MI, USA; ³Department of Family Medicine, Michigan State University, East Lansing, MI, USA; ⁴Occupational Therapy, Western Michigan University, Kalamazoo, MI, USA; ⁵Department of Epidemiology, Michigan State University, East Lansing, MI, USA

Purpose: Stigma-related feelings, including degree of enthusiasm and willingness to work with alcohol, drug, and mental disorder (ADM) patients, as well as anticipated success in such work, will be required for the United States to be successful in its new initiatives for ADM screening, brief intervention, and effective referral to treatment and rehabilitation services (SBIRT). This study investigates students of medicine and social work with respect to their stigma-related feelings and degree of enthusiasm or willingness to treat patients affected by alcohol dependence, nicotine dependence, or major depression. Inference is strengthened by an anonymous online survey approach, with use of randomized reinforcers to gain at least partial experimental control of nonparticipation biases that otherwise are present in student survey data.
Material and methods: All students on required course rosters were asked to participate in a two-part in-class and online assessment; 222 participated, with a gradient of participation induced via randomly drawn reinforcers for online survey participation. Between-group comparisons were made with a multivariate generalized linear model and generalized estimating equations approach that adjusts for covariates.
Results: Medical and social work students did not differ from each other with respect to their willingness to treat patients affected by major depression, alcohol dependence, or nicotine dependence, but together were less willing to treat nicotine and alcohol dependence-affected patients as compared to depression-affected patients. Personal history was not associated with the students' willingness to treat, but men were less willing to treat. Drawing strength from the randomized reinforcer experimental design nested within this survey approach, the study evidence suggests potential nonparticipation bias in standard surveys on this topic.
Conclusion: These results indicate that future health professionals may prefer to treat depression as opposed to drug dependence conditions. For SBIRT success, curriculum change with educational interventions may be needed to increase willingness to treat patients with neuropsychiatric conditions such as drug dependence. Future research requires attention to a possible problem of nonparticipation bias in surveys of this type.

Keywords: alcohol dependence, nicotine dependence, depression, health professionals, stigma