RECOGNIZING DRUG AND ALCOHOL-PROBLEMS IN PATIENTS REFERRED TO CONSULTATION-LIAISON PSYCHIATRY

Objective: To study the extent of recognition by referring doctors of drug and alcohol problems in patients referred to consultation-liaison psychiatry for any reason, and the factors associated with non-recogn ition. Design: Comparison of referring doctors' reasons for referral a nd psychiatrists' DSM-III-R diagnoses in 2347 inpatients referred cons ecutively over three years, by means of the prospective MICRO-CARES cl inical database used by the consultation-liaison psychiatry service of each hospital involved. Setting: Four general teaching hospitals of M onash University. Results: Psychiatrists considered a psychoactive sub stance use disorder diagnosis likely in 336 (14%) of the referred pati ents; referring doctors missed 188 (56%) of these, referring instead f or ''depression'', ''anxiety'' and ''suicide attempt evaluation''. The factors correlating with this discordance included younger age, male sex, having a personality disorder diagnosed, and having attempted sel f-harm. Conclusions: The extent of the failure to identify drug and al cohol problems in patients in whom some psychological problem worthy o f referral to psychiatry had been detected is symptomatic of the exten t of this failure in medicine generally. Education and the use of scre ening procedures may lead to development of coherent drug and alcohol protocols in individual institutions.