The general healthcare system in the United States offers an ideal opportunity to identify and treat substance abusers and thereby reduce associated adverse health, family, and societal effects. Practitioners from various disciplines, including physicians, nurses, pharmacists, dentists, social workers, psychologists, and other allied health professionals, are essential participants in national efforts to deal with these problems.
12 Physicians are particularly well positioned to play a role in the recognition and treatment of such patients.
13 However, minimal attention has been given to educating primary care physicians and other health professionals to respond to the needs of individuals and their families affected by SUDs. As a result, primary care physicians do not identify and diagnose alcohol and drug problems with the same acuity they bring to other medical disorders. Their role in prevention, early identification, and referral remains largely untapped.
Primary care physicians are in an ideal position to provide preventive guidance, education, and intervention to children, adolescents, adults, and their families. It has been estimated that up to 20% of visits to such physicians are related to substance use problems.
14 Both generalist and specialist physicians have frequent contact with patients who have SUDs.
15-17 Moreover, patients with alcohol and other drug problems are twice as likely to consult a primary care physician as persons without such problems.
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Research also shows that physicians play an important role in the health decisions of their patients. For example, a recent review of brief interventions for alcohol and drug problems concluded that primary care physicians can be effective in changing the course of a patient's harmful drinking.
19,20 Smoking cessation research shows that a physician's recommendation to quit smoking is sufficient to convince many patients to undertake such an effort. Interventions by emergency physicians have been shown to reduce subsequent alcohol use and readmission for traumatic injuries,
21 as well as drinking and driving, traffic violations, alcohol-related injuries, and alcohol-related problems among 18- and 19-year-old persons.
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Strong evidence exists that the public wants such help from their caregivers. In a public opinion survey conducted by Harvard University and The Robert Wood Johnson Foundation,
23 74% of respondents said they believe that addicts can stop using drugs, but that to do so, they need help from professionals or organizations outside their families. By “help,” two thirds of those surveyed said they meant intervention by a healthcare professional.
Unfortunately, though primary care physicians are the professionals most often cited by patients and families as the “most appropriate” source of advice and guidance about issues related to the use of alcohol, tobacco, and other drugs (including prescription drugs), they also are reported to be the “least helpful” in actually addressing these issues. Physicians often miss a diagnosis of drug abuse or addiction, and even when they make the diagnosis, they have a lack of knowledge as to how to do a brief intervention or develop an organized plan for patient referral or treatment.
Osteopathic physicians represent 8.3% of all practicing physicians in the United States, but 62.2% of DOs are in primary care (ie, family medicine, internal medicine, pediatrics, and obstetrics and gynecology).
24 Thus, osteopathic physicians, who by design have a strong educational focus on this aspect of medicine, can assume a more significant role in helping patients currently suffering from a substance use disorder or at future risk for this condition. However, because of the lack of training in osteopathic medical schools and graduate medical education programs, there is often a missed opportunity for appropriate intervention in the physician's office.