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A nationwide survey of primary care doctors that appears in the current issue of The Archives of Internal Medicine suggests that many are doing little to help their drug-addicted patients conquer addiction. Nearly one-third of the 1,080 doctors surveyed said that they did not routinely ask new patients if they used illicit drugs, and 15% stated that they did not routinely offer any intervention to those patients who said they used drugs. Family physicians, internists, obstetricians, gynecologists, and psychiatrists were questioned. The survey results indicate that the psychiatrists and obstetricians were the most likely to ask their patients about drug abuse, however the obstetricians were the least likely to intervene.

Dr. Peter Friedmann, the lead author of the survey and an assistant professor of medicine and community health at Brown University, said that of the doctors who do offer intervention, 61% routinely recommend 12-step programs (which some research suggests may be less successful than formal addiction therapy, such as methadone treatment or treatment in residential care centers). According to Dr. Friedmann and his team of researchers, this finding suggests that many doctors do not yet consider drug abuse a medical problem akin to other chronic diseases like diabetes, asthma, or high blood pressure.

The national data from 1999 estimated that as many as 14.8 million Americans were users of illegal drugs. Many drug abusers seek treatment for common disorders that can often be linked to drugs. However, as Dr. H. Westley Clark, the director of the Center For Abuse Treatment at the U.S. Department of Health and Human Services, points out, if doctors neglect to ask their patients about drug usage, they are neglecting to treat the problem.

“Primary care is supposed to embrace preventative medicine,” said Dr. Terry Norton, medical director for Phoenix House, a national drug treatment program. “If you don’t identify the people, there’s not a chance you can get them toward help.”

Dr. Friedmann offered suggested reasons for doctors failing to address their patients’ drug abuse, including pessimism about being able to do anything to help and skepticism about the efficacy of drug treatment programs. Some doctors, he added, could also think that it’s taboo to discuss drug abuse with patients, or they may feel it is outside their role as primary care physician. All of which, said Dr. Friedmann, indicate the need for better drug-abuse training in medical schools. “The problem,” he said, “is pervasive enough in medical settings that all doctors should be trained and ready to identify patients with these problems and intervene.”

Responding to the findings of the survey, the Director of The National Institute on Drug Abuse, Dr. Alan I. Leshner, said, that despite common misconceptions, “addiction is imminently treatable if the treatment is well delivered and tailored” to the patient’s own needs. Primary care physicians, emphasized Dr. Leshner, are in a key position to help diagnose drug addiction and get abusers proper treatment.