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Undiagnosed - Ignoring the Symptoms

Most Doctors Fail to Diagnose Alcohol Abuse


Updated November 22, 2003

Nine out of ten primary care physicians in the United States fail to correctly diagnose alcohol abuse even when their adult patients present classic early symptoms, according to a survey by the Center on Addiction and Drug Abuse (CASA) at Columbia University.

Even more startling perhaps, 41 percent of pediatricians fail to diagnose illegal drug abuse when presented with a classic description of a drug abusing teenage patient.

The doctors responding to the survey cited lack of adequate training in medical school, residency or continuing medical education courses; skepticism about treatment effectiveness; discomfort discussing substance abuse, time constraints and patient resistance.

Lack of Confidence

The most comprehensive nationally representative survey of how primary care physicians deal with substance-abusing patients, Missed Opportunity: The CASA National Survey of Primary Care Physicians and Patients, indicates physicians feel unprepared to diagnose substance abuse and lack confidence in the effectiveness of treatment, according to a CASA news release.

Only a small percentage of physicians consider themselves "very prepared" to diagnose alcoholism (19.9 percent), illegal drug use (16.9 percent) and prescription drug abuse (30.2 percent). In sharp contrast, 82.8 percent feel "very prepared" to identify hypertension; 82.3 percent, diabetes; 44.1 percent, depression.

Most physicians feel treatment is "very effective" for hypertension (85.7 percent) and diabetes (69 percent), and nearly half for depression (42.5 percent), but only a few feel treatment is "very effective" for smoking (8.2 percent), alcoholism (3.6 percent) and illegal drug abuse (2.1 percent).

Holding Them Liable

The CASA report makes a number of recommendations including increasing substance abuse training in medical schools, residency programs and continuing medical education, expanding coverage by Medicare, Medicaid, private insurers and managed care for substance abuse treatment services, and holding primary care physicians liable for negligent failure to diagnose substance abuse and addiction and encouraging their patients to seek help.

Barry R. McCaffrey, Director of the White House Office of National Drug Control Policy in 1999, agreed with CASA's call for additional training of physicians in substance abuse and addiction.

"Families have always relied on their doctors for health care advice. Drug abuse rips families apart. Giving the right advice on drug prevention and treatment can keep a family together. It is critical that physicians have the training needed to confront this health crisis so prevalent in our society." McCaffrey said, "A frank discussion with a doctor about the risks posed by substance abuse is a powerful prevention tool."

Under Trained Physicians

Donald R. Vereen, MD, MPH, Deputy Director of ONDCP in 1999, said, "Most medical students receive little education in identifying the symptoms of substance abuse. If health care professionals were more attuned to drug-related problems, substance abuse could be addressed before it becomes addiction.

"Fortunately, we have a number of scientifically evaluated screening tools available to primary care doctors. We just have to get them into the hands of the health care providers."

According to the CASA study, physicians have only the most rudimentary understanding of substance abuse - how to recognize it, and how to treat it. When asked to diagnose a hypothetical patient, only six percent of the doctors surveyed recognized the primary problem as alcoholism.

Public Health Challenge

"ONDCP supports efforts by the Department of Health and Human Services to develop faculty mentoring programs and training of health care professionals," Vereen said. "We have been working with physicians nationally in supplying drug education materials for patients in doctors' offices. In addition, new pending regulations on drug treatment medications including methadone will make it easier for physicians to treat patients in their offices."

According to Drug Czar McCaffrey, "One of our public health challenges is to reduce the stigma associated with drug prevention and treatment. A major step in this direction is to have screening for substance abuse become a part of regular check ups. Another important action is to treat addiction as we do other chronic illnesses.

"Accordingly, the Federal government has directed that all Federal employees will be provided the same health coverage for addiction treatment as mental health problems. We must work to achieve a similar result in the private sector."

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