Expectations and needs of people with illicit substance use disorders in general practice: a qualitative study in Belgium

Abstract

Background: People who use illicit drugs cumulate medical and psychosocial vulnerabilities which justify a rounded health approach. Both caregivers and patients can form barriers to accessing care which can lead to inadequate care. We tried with this study to identify the needs and expectations of these patients in general practice. Methods: Qualitative research using semi-structured interviews was conducted on 23 people with illicit substance use disorder in Brussels in 2020. A multicentric recruitment was performed to obtain a heterogeneous mix of socio-demographic profiles and care trajectories. A thematic analysis was performed using RQDA package software. Results: Several vulnerabilities were highlighted by the participants. These include the presence of significant self-stigmatization and guilt, sometimes to the extent of self-dehumanization even after years of care; overdoses masking suicide attempts and early memory disorders. Multiple substance use, smoking in almost all participants and significant misuse of benzodiazepines were also noted. The majority of participants expressed the need for an open-minded, non-stigmatizing and empathic GP with a holistic approach who could guide them throughout their life course. The competences of GPs in the field of addiction seemed secondary for the participants. Knowledge and good collaboration with the mental health network was an asset. Conclusion: The participants expressed the need for GPs with good interpersonal skills including a non-stigmatizing attitude. The care coordinator role of the GP was highlighted as a key element, as was a holistic approach focusing on global health (including the social determinants of health) and not only on the substance use disorder.