Exposure and response of private practice psychiatrists in Greece to illicit substance use-related treatment requests: A cross-sectional survey

The use of illicit substances is a major public health problem. While individuals with substance use problems primarily seek treatment in specialized treatment programs, the role, exposure, and response of private practice psychiatrists to requests for substance use-related problems remain unclear. This study aims to assess private practice psychiatrists' exposure to and response to treatment requests for substance use-related problems, along with examining the requests' characteristics. A cross-sectional online anonymous survey was administered involving private practice psychiatrists in Greece between January and February 2024. A total of 100 private practice psychiatrists responded to the survey (response rate ~10%; 53.0% male, aged 49.5 (SD=9.3) years, with 13.7 (SD=9.9) years of professional experience, and 59.0% with a private office in the Attica/Athens region. Most participants (84.0%) reported exposure to requests for substance use treatment during the last 12 months, with 69.0% of them (58% of the total) accepting to offer of treatment. The most frequently reported categories of substances included cannabis and cocaine/crack. High rates of comorbidity with problematic alcohol use, multiple substance use, and other mental disorders were also reported. Pharmacotherapy and cognitive behavioral therapy were the treatments most commonly used. Factors associated with accepting to offer treatment included past specialized training in addiction (p<0.001), past or current employment in treatment facilities (p=0.002), self-reported expertise in addictions (p=0.017), previous training during specialty in substance use departments (p=0.001), and use of motivational interviewing (p=0.011). Around 70% of participants who did not accept cases believed patients would be better treated in specialized substance use treatment programs. Among all participants, 63.6% were willing to accept future treatment requests⎯significantly higher percentage (93.1%) among those who had accepted similar requests before, compared to those who had not (19.2%, p<0.001). In conclusion, apart from specialized addiction services, a substantial number of private practice psychiatrists in Greece were also exposed to and accepted treatment requests for illicit substance use-related problems, with most frequently encountering requests related to cannabis and cocaine use. Future research should investigate the characteristics of patients treated for illicit substance use-related issues in private settings and the services provided to them.