How Often Are Substance Use Disorders Diagnosed in Outpatient Settings?

Providing screening, assessment, and care for substance abuse in general medical settings has the potential to reach many people who might not otherwise have access to treatment. Yet, rates of treatment are low in these settings, despite an estimated substance abuse prevalence of 2%–9% among primary care patients.

Researchers in this study aimed to identify patient characteristics associated with receiving a diagnosis of substance abuse or dependence. They analyzed data from a random selection of office-based physicians who reported on their diagnosing practices as part of a national survey (60,238 surveys analyzed).

• From 1997 to 2004, diagnoses of substance use disorders were recorded at 0.9% of family practice visits, 0.8% of internal medicine visits, and 5.1% of psychiatry visits.
• Women, the elderly, and patients seen for an acute condition were significantly less likely than others to have a substance use disorder diagnosis noted, regardless of physician specialty.

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Comments:

The rate at which generalist physicians record substance abuse diagnoses is substantially lower than the actual prevalence of these conditions as defined by national surveys. Although the actual prevalence of substance abuse in these physicians’ practices is unknown, this study’s findings support the argument that more widespread implementation of substance abuse screening and assessment in primary care settings could identify many more people who could benefit from attention to these conditions.

Marc N. Gourevitch, MD, MPH

Reference:

Banta JE, Montgomery S.  Substance abuse and dependence treatment in outpatient physician offices, 1997–2004.  Am J Drug Alcohol Abuse. 2007;33(4):583–593.