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Alcohol Abuse Symptoms Often Missed

Updated:
WASHINGTON (AP) — A leading substance-abuse center today urged the nation's doctors to focus more closely on alcohol and drug use by their patients after finding that more than nine out of 10 physicians didn't diagnose alcohol abuse when presented with its early symptoms.

A survey by the National Center on Addiction and Substance Abuse at Columbia University found that physicians felt unprepared to diagnose substance abuse and lacked confidence in the effectiveness of treatment.

When presented with an adult showing early signs of alcoholism, some 94 percent of primary care physicians failed to diagnose substance abuse, the center reported.

And 41 percent of pediatricians didn't diagnose illegal drug abuse when presented with a classic description of a drug abusing teen-age patient.

The center said that when the doctors were asked to suggest five possible diagnoses for the symptoms, they failed to include substance abuse.

The findings were reported in a study, ``Missed Opportunity: The CASA National Survey of Primary Care Physicians and Patients,'' released today in Washington.

``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,'' Joseph A. Califano Jr., CASA president, said in a statement.

Barry R. McCaffrey, director of the White House office of national drug control policy, said he supports 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,'' he said.

The survey found that only about 20 percent of doctors felt very prepared to diagnose alcoholism and 17 percent felt prepared to diagnose illegal drug use. In contrast, nearly 83 percent felt very prepared to identify high blood pressure, 82 percent to diagnose diabetes and 44 percent to identify depression.

Some 86 percent felt treatment for high blood pressure is very effective, and 69 percent felt diabetes treatment is very effective.

But only 8 percent felt treatment is very effective for smoking, close to 4 percent believed it is effective for alcoholism and 2 percent for illegal drug abuse.

The center said 58 percent of doctors don't discuss substance abuse with their patients because they believe their patients lie about it. Some 35 percent listed time constraints for not discussing it and 11 percent were concerned they won't be reimbursed for the time necessary to screen and treat a substance-abusing patient.

The report recommended increased education programs for doctors in diagnosing and treating substance abuse, urged state licensing boards to require such training and called on Medicare, Medicaid, private insurers and managed care to expand coverage for substance abuse treatment.

The survey of 648 physicians across the country has a margin of error of plus or minus 4 percentage points, the center said. It also conducted a survey of 510 patients but noted that was done at only selected centers and was not statistically representative.

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On the net:

National Center for Addiction and Substance Abuse: http://www.casacolumbia.org

National Institute on Drug Abuse: http://www.nida.nih.gov
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