What are the experiences of healthcare professionals working with individuals with Alcohol Use Disorder (AUD)? : a systematic review and qualitative synthesis : clinician implicit and explicit attitudes regarding Alcohol Use Disorder (AUD) : exploring the relationship between “blame” and clinical decision-making

Abstract

Systematic Review: What are the experiences of healthcare professionals working with individuals with Alcohol Use Disorder (AUD)? A systematic review and qualitative synthesis.

Background: Healthcare Professionals (HCPs) are often required to support people with an Alcohol Use Disorder (pwAUD). The umbrella term Alcohol Use Disorder (AUD) encompasses a complex and vulnerable client group, requiring integrated and joined up care between services. The HCP role is often challenging, however little is known from the HCP perspective about improving service structure and quality for both HCPs and pwAUD. This systematic review sought to synthesise a substantial body of qualitative literature examining HCP experiences of supporting pwAUD. Methods: Three electronic databases were searched, employing ENTREQ and PRISMA guidelines. The quality of studies was reviewed by two researchers via the CASP checklist. Through employment of a thematic synthesis approach, extracted data from 18 papers (17 primary studies) were synthesised, providing three analytical themes (navigating complex systems, the layered role of the HCP and the complexity of the AUD client group), consisting of 11 descriptive themes. Results: Synthesis findings provide insights into the experiences of HCPs supporting pwAUD, emphasising the intricacies of the professional role. Many HCPs remain reactive or avoidant to the needs of AUD due to system pressures, lack of clear guidance (navigating complex systems), confidence in professional abilities (the layered role of the HCP) and clients’ complex needs (the complexity of the AUD client group). Conclusions: Further considerations may be required to ensure supportive and accessible working environments including effective leadership, enhanced training and overall cultural shifts in AUD conceptualisations.

Empirical Project: Clinician implicit and explicit attitudes regarding Alcohol Use Disorder (AUD): exploring the relationship between “blame” and clinical decision-making.

Background: Alcohol Use Disorder (AUD) is one of the most common mental health conditions globally, however, treatment access and engagement remains poor. Stigmatising attitudes of blame are common towards AUD, with similar attitudes appearing in Healthcare Professionals (HCPs). Treatment decisions are impacted by clinician factors and attitudes, alongside service and organisational considerations. Evidence suggests both implicit and explicit attitudes impact clinical decision-making, yet implicit attitudes remain under researched in HCPs. The study aims were therefore to investigate (i) if clinicians hold implicit and/or explicit attitudes of blame towards those with AUD and (ii) if implicit and/or explicit attitudes are related to clinical decision-making in terms of treatment referrals. Methods: Forty-one HCPs completed a series of implicit measures including the Implicit Association Test (IAT), and the Implicit Relational Assessment Procedure (IRAP), explicit self-report measures regarding the blameworthiness of AUD, and a clinical decision-making task requiring review of four vignettes (AUD cases and common mental health cases). Results: HCPs showed a moderate implicit Alcohol Dependence-Blameworthy/ Depression-Blameless bias (via the IAT), however scores on the four IRAP trials were not significant. Explicitly, HCPs strongly disagreed that Alcohol Dependence is Blameworthy. However, the results for explicit attitudes of Alcohol Dependence-Blameless were not significant. Correlation analyses showed that as an Alcohol Dependence-Blameless/Depression-Blameworthy bias increased (via the IAT), for the AUD vignettes, HCPs were more likely to recommend talking therapies for intervention. For treatment referrals, referral decisions for AUD often remained close to the neutral point. Conclusions: Implicit attitudes of Alcohol Dependence being a blameworthy condition may be a factor that influences referral decisions for HCPs, specifically for talking therapies. There was also an uncertainty around onward AUD referrals. HCPs’ attitudes may therefore be a factor in clinical decision-making for AUD. Future research may explore the potential lack of clarity among HCPs around appropriate AUD support.

Thesis embargoed until 31st December 2026.

Date of Award	Dec 2025
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	David Curran (Supervisor) & Donncha Hanna (Supervisor)