PHYSICIAN UNAWARENESS OF SERIOUS SUBSTANCE-ABUSE

Purpose: To describe and assess the prevalence of perceived physician unawareness of serious substance abuse. Patients and methods: We repor t an observational study with validation of multivariable results of d ata collected by interview from persons presenting for addictions trea tment in the public system who reported having a physician. Results: O f 3,253 patients interviewed, 87% (2,843) responded to the question ab out having a physician. Of 1,440 patients who stated that they had phy sicians, 45% (651) reported that the physician who cared for them was unaware of their substance abuse. In multivariable logistic regression s adjusting for sociodemographics, health status, and substance abuse histories, the following patient characteristics were found to be inde pendently associated with physician unawareness of substance abuse and were confirmed in a validation analysis (OR = Odds Ratio, CI = 95% Co nfidence Interval): no prior episodic medical illness (OR = 1.98, CI = 1.35-2.92), no health insurance (OR = 1.89, CI = 1.33-2.70), no prior mental health treatment (OR = 1.75, CI = 1.06-2.88), no chronic medic al illness (OR = 1.69, Ci = 1.18-2.40), no prior substance abuse treat ment (OR 1.64, CI 1.17-2.31), and no prior detoxification (OR = 1.54, CI = 1.14-2.22). Conclusions. Forty-five percent of patients with subs tance abuse serious enough to prompt a presentation for treatment stat ed that the physician who cared for them was unaware of their substanc e abuse. Patients without health insurance, a history of medical illne ss, or prior substance abuse or mental health treatment were more like ly to have reported physician unawareness. Even among substance abusin g patients requesting addiction treatment, many perceive that their ph ysicians do not recognize their substance abuse.