Primary Health Care Providers Usually Don't Recognize Symptoms

Alcohol Abuse Goes Undiagnosed
In Most Primary Care Settings

By BuddyT

Nine out of ten primary care physicians in the United States fail to correctly diagnose alcohol abuse even when their adult patients present classic early symptoms, according to a survey by the Center on Addiction and Drug Abuse (CASA) at Columbia University.

Even more startling perhaps, 41 percent of pediatricians fail to diagnose illegal drug abuse when presented with a classic description of a drug abusing teenage patient.

The doctors responding to the survey cited lack of adequate training in medical school, residency or continuing medical education courses; skepticism about treatment effectiveness; discomfort discussing substance abuse, time constraints and patient resistance.

Unprepared to Diagnose

The most comprehensive nationally representative survey of how primary care physicians deal with substance-abusing patients, Missed Opportunity: The CASA National Survey of Primary Care Physicians and Patients, indicates physicians feel unprepared to diagnose substance abuse and lack confidence in the effectiveness of treatment, according to CASA.

Only a small percentage of physicians consider themselves "very prepared" to diagnose alcoholism (19.9 percent), illegal drug use (16.9 percent) and prescription drug abuse (30.2 percent). In sharp contrast, 82.8 percent feel "very prepared" to identify hypertension; 82.3 percent, diabetes; 44.1 percent, depression.

Lack of Confidence in Treatment

Most physicians feel treatment is "very effective" for:

• Hypertension (85.7 percent)
• Diabetes (69 percent)
• Depression (42.5 percent)

But only a few doctors feel treatment is "very effective" for:

• Smoking (8.2 percent)
• Alcohol Use Disorder(3.6 percent)
• Illegal drug abuse (2.1 percent)

CASA Recommendations

The CASA report made a number of recommendations including:

• Medical schools, residency programs and continuing medical education programs should increase training in substance use.


• Licensing boards and residency review committees of primary care specialties should mandate strong requirements regarding knowledge of substance use and addiction.


• Medicare, Medicaid, private insurers and managed care organizations should expand coverage for addiction treatment services and pay physicians to talk to patients about substance use.


• Primary care physicians should screen their patients for substance use disorder and be responsive to clusters of symptoms that may signal SUD.


• Primary care physicians should be held liable for negligent failure to diagnose substance use disorder and addiction and should encourage their patients to seek treatment.

Learn more about Alcoholism Symptoms.