A national panel reports

Physician failure to diagnose dependency costs nation $240B per year

A panel of national experts led by Dr. David Lewis, director of Brown's Center for Alcohol and Addiction Studies, has concluded that only a small fraction of the millions of people who are dependent on drugs and alcohol get help from their doctors, costing the nation billions in health care costs and lost worker productivity.

PROVIDENCE, R.I. -- Many physicians are unable to diagnose a large percentage of their patients who are dependent on alcohol and drugs because they lack the training and desire to diagnose addictions. This costs the nation billions of dollars annually in lost worker productivity and health care costs, according to a panel of national experts.

With those findings in hand, the panel, which consists of 45 doctors, insurance company representatives, public officials, business leaders and leaders of medical education, is calling on physicians to learn as much about alcohol and drug abuse as they know about typical medical problems.

"Substance abuse costs the nation almost $240 billion a year, including a $100 billion in lost productivity and $13.7 billion in health care," said Dr. David Lewis, chairman of the panel and director of Brown University's Center for Alcohol and Addiction Studies. "In a climate where cost-effectiveness is of prime concern, early intervention by physicians in diagnosis, referral and treatment for patients with substance abuse problems can save enormous amounts of money and suffering. We need to prevent and treat substance abuse rather than wait to address the enormous social and medical complications of the disease."

The panelists said that post-medical school residency programs are the best way to train future physicians to recognize and address substance abuse problems. "Some medical students are getting a good education," about alcohol and drug dependency, Lewis said. But once the students begin their residencies, competing information often overshadows dependency problems. "Dependency education and diagnosis has to become more of a priority for our medical schools and residency programs," Lewis said.

Complicating matters is the stigma surrounding alcohol and drug dependency, which often prevents doctors from asking simple questions that could lead to diagnosis. "Often people are just waiting to be asked," Lewis said. When a doctor does discover a patient's dependency problem, he or she too often is unable to address it properly, he added.

In the United States, according to Lewis, one quarter of all deaths each year stem from alcohol and drug dependency or health complications resulting from addictions. "This is a big wake-up call," said Lewis. "This puts the medical leadership up at the plate."

Editors: Dr. Lewis will be in New York City March 12 to present the panels finding at a American Medical Association briefing on alcoholism. For further information call 401/863-2476.

The panel cited specific measures that physicians and educators can take:

• require more training to give residents experience with substance-abuse patients;
• require training programs to have faculty members who have been trained specifically to manage substance abuse;
• require training programs to include substance-abuse treatment centers as training sites and assign rotations in these centers;
• fight professional stigmas attached to physicians and other providers who care for substance abuse patients;
• recognize that substance abuse is a disease and reimburse for its treatment comparable to other diseases.