Doctors Still Don’t Understand Addiction

Med schools ignore major health problem.

If there is one thing most workers in the field of addiction treatment can agree upon, it is that doctors are inadequately trained to deal with addicted patients.

Researchers at the Boston Medical Center recently reported that “education on addiction is inadequate during medical training, resulting in suboptimal medical care for those at risk.” In a study published in the Journal of General Internal Medicine, the Boston researchers found that a “Chief Resident Immersion Training” program yielded significant benefits. This “train the trainers” approach “effectively transferred evidence-based addiction knowledge and practice to 64 chief residents in generalist disciplines and more importantly, enhanced the addiction curriculum in 47 residency programs,” according to Daniel P. Alford, associate professor of medicine at Boston University School of Medicine.

The problem is not a new one. In 2003, Howard Markel of the New York Times wrote that the failure of primary care physicians to diagnose substance abuse was due to “insufficient training in the treatment of addiction, doctor’s frustration with afflicted patients, the common perception among doctors that treatment for substance abuse does not work, and a poor rate of insurance reimbursement for such services.” Dr. June E. Osborn of the Josiah Macy Jr. Foundation put it bluntly: “In clinical situations where they don’t know exactly what they are doing, doctors tend to walk away and adopt an attitude of blaming the patient.”

The Times article concluded that “scant formal training on addiction and substance abuse is available in American medical schools. Now, most of them offer only a few hours on these complex subjects and even less is offered during most residency or postgraduate programs.”

Moreover, in actual practice, insurance benefits for substance abuse problems present a difficult reimbursement problem in many cases. Hence doctors may be more reluctant to offer a formal diagnosis of addictive disorder.

Joseph Califano Jr. of Columbia University’s National Center on Addiction and Substance Abuse told a conference in October: “Although doctors and nurses have the best opportunity to intervene with alcoholics and substance abusers, our research indicates they are woefully inadequate at even diagnosing someone with this disease." Surveys conducted by the center showed that 90% of primary care doctors fail to offer a diagnosis of addiction even in patients clearly displaying classic hallmarks of the condition.

To redress the current state of affairs, the center recommends formal substance abuse training for med students, residents, and doctors, expanding drug dependency coverage under Medicare, Medicaid and private insurers, and “adding legal accountability” for doctors who fail to diagnose addiction when warranted.

To be fair, however, the plight of doctors in this regard is not to be underestimated. Dr. Catherine D. DeAngelis, editor-in-chief of the Journal of the American Medical Association, told the New York Times that “caring for patients with substance abuse is one of the most difficult things I have ever had to deal with as a doctor.... when the ailment in question carries a substantial behavioral component, like substance abuse, physicians get frustrated and don’t do as well.”

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