Systemic barriers in substance use disorder treatment: A prospective qualitative study of professionals in the field

Background: The US is in the midst of one of the largest public health crises in recent history with over 63,000 drug poisoning deaths in 2016 and a projected annual economic cost of over $420 billion. With the rise of deaths and economic burden related to substance use, it is paramount that systemic barriers within the treatment industry be identified and resolved. Methods: Data were collected from US substance use treatment professionals (N = 182) in the fall of 2016. Thematic analysis with axial coding was used on anonymized responses to an online open-ended survey. Additional ad hoc testing for variance (education, generation, regional location, and employment) was completed using Monte Carlo chi-square analyses. Results: 7 major themes emerged: 1) additional training, education, and use of evidence-based practices, 2) expansion of treatment services, 3) increased resources, 4) stigma reduction, 5) increased collaboration and leadership, 6) reductions in regulations, requirements, and incentives, and 7) expansion of recovery support services. Participant response yielded a significant relationship between employment type (p = 0.002) and regional location (p = 0.046). Conclusions: Systemic barriers in the treatment field are prevalent from the perspective of professionals engaged in the field. While previously identified barriers are still present, newly reported barriers include: 1) lack of treatment services (e.g., capacity), 2) lack of technological resources (e.g., technological support tools), 3) lack of recovery support services (e.g., recovery housing), 4) lack of collaboration and leadership (e.g., communication and partnership), and 5) increasing unethical practices in the field (e.g., incentive-based patient brokering).