RESEARCH: DRUG USE NOT CITED

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.

Texas Tech University medical students receive their first
substance-abuse training in classroom work during their first two
years of medical school in Lubbock, said spokesman Mike Hughes.

When they arrive in Amarillo for the final two years of training,
substance abuse is part of the clinical studies, which are taken in
six-week rotations, he said.

During the psychiatric rotation, students spend one day a week in a
substance-abuse clinic working with patients, Hughes said. They also
receive substance-abuse training during the obstetrics-gynecology
rotation, where substance-abuse detection is key to the health and
well-being of newborns.

"I can't really break it down into hours taught because the training
is integrated into our daily routine," said Dr. John Jennings,
department chairman of obstetrics-gynecology.

During the internal medicine rotation, students also receive substance
abuse training, Hughes said, but the primary focus is on smoking cessation.

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.