Survey of Primary Care Physicians & Patients on Substance Abuse | CASAColumbia

Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse

Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse

Published: May 2000

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Addiction is not often treated within the scope of routine medical practice. CASAColumbia’s national substance abuse 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 abuse problems and the experiences of such patients with their primary care physicians.


CASAColumbia surveyed a nationally representative sample of 648 primary care physicians and a patient sample of 510 adults currently receiving treatment for substance abuse in 10 facilities in California, Illinois, New York and Minnesota. The surveys were conducted in the spring and summer of 1999. To inform the survey, focus groups were conducted with primary care physicians, patients receiving substance abuse treatment and primary care support staff in the Chicago area. Key informant interviews were also conducted with physicians who had expertise in substance abuse.


  • The vast majority (94%) of primary care physicians (excluding pediatricians) failed to diagnose substance abuse when presented with early symptoms of alcohol abuse in an adult patient
  • 41% of pediatricians failed to diagnose illegal drug abuse when presented with a classic description of a drug-abusing teenage patient; these physicians and pediatricians failed to include substance abuse 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 it
    • 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 abuse

Physicians were missing or misdiagnosing patients’ substance abuse for several reasons:

  • Lack of adequate training in medical school, residency and continuing medical education courses
  • Skepticism about treatment effectiveness
  • Discomfort discussing substance abuse
  • Time constraints
  • Perceived patient resistance
  • 58% of physicians said they don’t discuss substance abuse with their patients because they believe their patients lie about it; nearly 85% of patients admitted to lying to their physicians
  • More than one-third of physicians cited time constraints, and nearly 11% were concerned that they wouldn’t be reimbursed for the time necessary to screen and treat a patient with addiction


The report includes the following recommendations:

  • Medical schools, residency programs and continuing medical education programs should increase training in substance abuse
  • Licensing boards and residency review committees of primary care specialties should mandate strong requirements regarding knowledge of substance abuse and addiction
  • Medicare, Medicaid, private insurers and managed care organizations should expand coverage for substance abuse treatment services and pay physicians to talk to patients about substance abuse
  • Primary care physicians should screen their patients for substance abuse and be responsive to clusters of symptoms that may signal abuse of tobacco, alcohol and other drugs
  • Primary care physicians should be held liable for negligent failure to diagnose substance abuse and addiction and should encourage their patients to seek treatment

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