The rate of drug addiction in America has skyrocketed, with opiate drugs making up the bulk of new cases. Given this increased incidence, and given the vastly improved chance of opioid recovery when intervention happens early, primary care physicians should make addiction screening for all patients a priority starting yesterday.
A study from the National Center on Addiction and Substance Abuse found that 41% of doctors failed to include substance abuse among five suggested diagnoses for a patient presenting classic symptoms of drug addiction. The study identified several reasons for the failure, including inadequate training, expectations of patient resistance or evasion, and even embarrassment.
Extend the study’s findings to doctor’s offices around the country. How many times have people who needed addiction treatment referral received some medicine or therapy to treat one of their symptoms, rather than the underlying cause? How many people have made repeated doctor’s visits seeking treatment for the same physical symptom? And, how often do patients present with lethargy, irritation, or heart issues, only to receive treatment consistent with a cause other than addiction?
The primary care physician represents the front line in healthcare. They are the first doctor or medical professional a patient interacts with (except in the case of emergency room visits, who likely see cases of addiction far more often). The family doctor knows the patient better than many and, with the right mindset, could recognize patterns of symptoms or family history which could lead to an increased vulnerability to addiction. What changes, then, need to take place to modify the role of the primary care physician in recognizing addiction?
Problems involved with shortcomings in training can only be addressed through a systemic re-working of medical education, and this in turn will likely only happen through legislative advocacy. We need to influence our lawmakers to make recognizing addiction a doctor’s responsibility.
It’s one thing for doctors to be better trained to recognize addiction, but we should shore up their intuition with a diagnostic toolset made available across the medical community. This could range in scope from questionnaires and formal screening all the way down to simple tools like acronyms about symptoms for doctors to memorize, and in practice a comprehensive approach would involve both.
The issues of embarrassment, both on the part of the patient and the clinician, must change alongside the national attitude toward and understanding of mental health and addiction.
There’s no magic bullet for greater understanding of the struggle of addiction, but we believe the first step is recognizing that addicted people don’t look or behave differently than you or I. They don’t live in another neighborhood or work in a different profession. The truth is that every human is susceptible to addiction, a condition whose causes are broad and still poorly understood. Once we can accept addiction for the disease that it is, both the general public and the medical community can move forward together to recognize and treat both the causes and effects of addiction.