Survey of Primary Care Physicians & Patients on Substance Abuse

Addiction is not often treated within the scope of routine medical practice. CASAColumbia’s national substance use survey is the most comprehensive nationally representative survey of how primary care physicians — family doctors, pediatricians, general practitioners, internists, obstetricians and gynecologists — deal with patients who have substance use problems and the experiences of such patients with their primary care physicians.

Key Takeaways

The vast majority (94%) of primary care physicians, excluding pediatricians, failed to diagnose substance use disorder when presented with early symptoms related to alcohol use in an adult patient. Additional findings included the following:

41% of pediatricians failed to diagnose illegal substance use when presented with a classic description of a teenage patient, failing to include substance use among the 5 diagnoses they were asked to suggest.

Most patients said their primary care physician did nothing about their addiction.

43% said their physician never diagnosed their addiction.

11% said the physician knew about their addiction but did nothing about it.

Less than one-third of primary care physicians carefully screened for substance use disorder.

Recommendations

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.