STUDY SAYS PHYSICIANS OFTEN MISS SYMPTOMS OF ALCOHOL ABUSE

WASHINGTON - More than nine out of 10 physicians asked to diagnose
patients with symptoms typical of early alcohol abuse failed to
recognize that problem, a study by a leading substance-abuse center
found.

That failure is a "lost opportunity" to reduce substance abuse and cut
its eventual costs to society, Joseph A. Califano, head of the
National Center on Addiction and Substance Abuse at Columbia
University, said Wednesday.

His center's survey of physicians nationwide found nearly 94 percent
failed to include substance abuse among five possible diagnoses they
were asked to make based on the following symptoms typical of early
stage alcohol abuse: A 38-year-old married patient has recurrent
abdominal pain, intermittently elevated blood pressure, gastritis,
waking up frequently at night and irritability.

"These findings add up to a monumental lost opportunity," said
Califano, a former secretary of Health, Education and Welfare.

He called on doctors to focus more closely on alcohol and drug abuse,
urged medical schools to emphasize it in their teaching and suggested
that state licensing boards stress the importance of this problem.

Dr. Richard Corlin, a gastroenterologist in Santa Monica, Calif., said
the symptoms "are vague and common symptoms that can be related to a
whole variety of conditions" besides alcohol abuse. Other
possibilities include ulcers, depression, recurrent gastritis and
anxiety, he said.

But, he added, they clearly could indicate alcohol abuse and doctors
need to be made more aware of this possibility.

Unfortunately, people with alcohol and drug problems may lie out of
embarrassment or fear, doctors say.

"It's a tremendously courageous act by a patient with drug or alcohol
problems to lay that out before their physician," said Dr. Macaran
Baird, a family physician at the Mayo Clinic in Rochester, Minn. "We
need for them to help the physician."

The symptoms listed in the survey present an "interesting scenario,"
Baird added. "I would be happy if a higher percentage of physicians
listed alcohol abuse as a possibility.... We all want to do a better
job."

Califano said primary care physicians have a unique opportunity to
identify and help treat substance abuse in its early stages when the
potential for success is high.

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

In addition to the failure to identify adult alcohol abuse, the survey
found 41 percent of pediatricians didn't diagnose illegal drug abuse
when presented with a classic description of a drug abusing teen-age
patient.

The survey found 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.

Of the physicians responding to the survey that presented the typical
symptoms in the 38-year-old married patient, just 6.2 percent
mentioned substance abuse. Female doctors did a little better, with
9.0 percent diagnosing abuse compared with 5.5 percent of male physicians.

Some 9.4 percent of doctors who graduated from medical school in the
last 10 years listed substance abuse as a possibility, a share that
dropped the longer a doctor was out of school.

Doctors in family practice were the most likely to recognize the
symptoms, 11.5 percent. Substance abuse was recognized by 6.8 percent
of those in internal medicine, 4.3 percent of gynecologists and 2.5
percent of general practitioners.

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