U.S.

MDs Miss Signs of Alcoholism

By CBSNews.com staff CBSNews.com staff

May 11, 2000 / 4:30 PM EDT / CBS

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 has found.

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

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.

"Part of that relates to the fact that doctors aren't paid to talk to patients," Califano said. "It's a terrible problem. We pay doctors to stick us; we pay doctors to gives pills. Managed care has got to start reimbursing doctors to talk to patients."

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.

Calling substance abuse the country's number one disease, Califano said 60 million Americans are hooked on cigarettes, 20 million have alcohol problems and 4-6 million have illegal drug problems.

"Doctors have got to start looking at it and facing up to it," he said

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 dug 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.