|WASHINGTON, DC - Nine out of ten--94 percent--of primary care physicians fail to diagnose substance abuse when presented with early symptoms of alcohol abuse in an adult patient, according to a new survey of primary care physicians and patients released by The National Center on Addiction and Substance Abuse at Columbia University (CASA). Forty-one percent of pediatricians fail to diagnose illegal drug abuse when presented with a classic description of a drug abusing teenage patient. These physicians and pediatricians failed to include substance abuse among five diagnoses they were asked to suggest.|
Missed Opportunity: The CASA National Survey of Primary Care Physicians and Patients, the most comprehensive nationally representative survey of how primary care physicians deal with substance-abusing patients, reveals that physicians feel unprepared to diagnose substance abuse and lack confidence in the effectiveness of treatment:
Only a small percentage of physicians consider themselves "very prepared" to diagnose alcoholism (19.9%), illegal drug use (16.9%) and prescription drug abuse (30.2%). In sharp contrast, 82.8% feel "very prepared" to identify hypertension; 82.3%, diabetes; 44.1%, depression.
Most physicians feel treatment is "very effective" for hypertension (85.7%) and diabetes (69%), and nearly half for depression (42.5%), but only a few feel treatment is "very effective" for smoking (8.2%), alcoholism (3.6%) and illegal drug abuse (2.1%).
Most patients (53.7%) say their primary care physician did nothing about their addiction: 43% say the physician never diagnosed it and 10.7% say the physician knew about it but did nothing about it. Less than a third of primary care physicians (32.1%) carefully screen for substance abuse.
"Substance abuse and addiction is the nation's number one disease," said Joseph A. Califano, Jr., CASA President and former U.S. Secretary of Health, Education and Welfare. "Primary care physicians must stop ignoring this elephant in their examining rooms. Medical schools, residency programs and continuing medical education courses have an obligation to provide the training those physicians need to spot and deal with substance abuse."
Among the survey's other key findings:
Nearly 75% of patients say their primary care physician was not involved in their decision to seek treatment.
More than half of patients (54.8%) feel physicians do not know how to detect addictions.
29.5% of patients said their physicians knew about their addiction and prescribed psychoactive drugs such as sedatives or Valium, which could cause additional problems.
35.3% of patients thought their physician was too busy to detect their addiction. .
The typical patient had a substance abuse problem for 10 years before receiving treatment.
LOST OPPORTUNITYPhysicians are missing or misdiagnosing a patient's substance abuse for several reasons: 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.
A majority of physicians (57.7%) say they don't discuss substance abuse with their patients because they believe their patients lie about it, and nearly 85% of patients agree. More than one third (35.1%) of physicians cite time constraints and 10.6% are concerned they won't be reimbursed for the time necessary to screen and treat a substance-abusing patient.
"Americans make 200 million visits each year to general and family practitioners," Califano said. "Whether out of lack of training, time or confidence in treatment effectiveness -- or out of fear of losing patients -- too many primary care physicians are squandering an opportunity, priceless to patients whose lives may be saved and worth billions to society in health care and criminal justice costs."
RECOMMENDATIONSThe CASA report recommends that:
Medical schools, residency programs and continuing medical education increase training in substance abuse.
Licensing boards and residency review committees of the primary care specialties mandate strong requirements regarding knowledge of substance abuse and addiction.
Medicare, Medicaid, private insurers and managed care expand coverage for substance abuse treatment services and pay physicians to talk to patients about substance abuse.
Primary care physicians screen their patients for substance abuse and be responsive to clusters of symptoms that may signal abuse of alcohol and drugs and tobacco use.
Primary care physicians be held liable for negligent failure to diagnose substance abuse and addiction and encourage their patients to seek help.
"This report furthers the important work of the Macy Foundation in working to improve physician education," said Dr. June E. Osborn, President of the Josiah Macy, Jr. Foundation which funded the survey. "The survey's findings sound an alarm and I hope the report will encourage medical schools, residency programs and continuing medical education courses to better prepare physicians to identify substance abuse and know what to do about it."
CASA surveyed a nationally representative sample of 648 physicians in family medicine, general practice, internal medicine, obstetrics and gynecology, and pediatrics, and a convenience sample of 510 patients in treatment for substance abuse. The margin for error for physicians is +/- 3.9 percent.
The CASA survey was conducted by The Survey Research Laboratory, University of Illinois-Chicago. Califano expressed appreciation to The American Medical Association, American Society of Internal Medicine, American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists for their assistance in conducting the survey. "The cooperation of these professional organizations is evidence of their commitment to improve the medical care of individuals suffering substance abuse and addiction," Califano said.
The National Center on Addiction and Substance Abuse at Columbia University is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA's staff of 70 professionals, including 17 Doctorates and 15 Masters in the fields of business, communications, computer engineering, criminology, economics, education, government, history, journalism, linguistics, medicine, psychiatry, psychology, public health, public policy, social work, sociology and statistics; two M.D.'s, and three attorneys. CASA conducts demonstration programs at 38 sites in 25 cities in 16 states, and issues public policy reports on a variety of topics including assessments of the impact of substance abuse and addiction on American populations and systems.