DOCTORS DON'T ALWAYS ADDRESS DRUG ABUSE

CHICAGO, Jan. 22 -- A national survey of primary care doctors suggests that
many are doing little to help drug-addicted patients conquer their addiction.

About one-third of the 1,080 doctors surveyed said they did not routinely
ask new patients if they used illicit drugs, and 15 percent said they did
not routinely offer any intervention to the patients who said they used drugs.

Of the doctors who do offer intervention, 61 percent said they recommended
12-step programs, which some research has suggested may be less successful
than formal addiction therapy, said Dr. Peter Friedmann, the lead author
and an assistant professor of medicine and community health at Brown
University.

Only 55 percent said they routinely recommended that formal addiction
therapy, like methadone treatment or treatment in residential care centers.

Results of the survey, which were mailed to doctors nationwide last year,
appear in the current issue of The Archives of Internal Medicine.

The findings suggest that many doctors do not consider drug abuse a medical
problem akin to other chronic diseases like diabetes, asthma or high blood
pressure, Dr. Friedmann said.

The national data from 1999 estimated that 14.8 million Americans were
users of illegal drugs.

Many of the abusers seek treatment for common disorders that may be linked
to drugs, said Dr. H. Westley Clark, the director of the Center for
Substance Abuse Treatment at the United States Department of Health and
Human Services.

But if doctors neglect to ask about the drug usage, they are not treating
the problem, he said.

Reasons suggested for failing to do so include pessimism about being able
to do anything to help and skepticism about the success of drug treatment
programs, Dr. Friedmann said. Some also think that talking about drug abuse
with patients is taboo, or feel it is outside their role -- findings that
indicate better drug- abuse training is needed in medical schools, he said.

The problem, Dr. Friedmann said, "is pervasive enough in medical settings
that all doctors should be trained and ready to identify patients with
these problems and intervene."

Said Dr. Terry Horton, medical director for Phoenix House, a national drug
treatment program: "Primary care is supposed to embrace preventive
medicine. If you don't identify the people, there's not a chance you can
get them toward help."

Family physicians, internists, obstetricians and gynecologists, and
psychiatrists were questioned. Psychiatrists and obstetricians were the
most likely to ask patients about drug abuse, but the obstetricians were
least likely to intervene.

Dr. Alan I. Leshner, director of the National Institute on Drug Abuse,
which helped fund the study, said primary care physicians were in a prime
position to help diagnose drug addiction and get abusers proper treatment.

And despite common misconceptions, "addiction is imminently treatable if
the treatment is well delivered and tailored" to the patient's own needs,
Dr. Leshner wrote in an 1999 essay in The Journal of the American Medical
Association.