ALCOHOL ABUSE SYMPTOMS OFTEN MISSED

WASHINGTON (AP) -- 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.