May 5, 2009

New Program Helps Doctors Spot Drug, Alcohol Abuse

A new program, backed by the National Institute on Drug Abuse, aims to guide health workers past the stigma of asking important patient questions about serious substance abuse problems. This ensures that more patients are asked for simple clues to addiction at every doctor's visit.

The program is a step-by-step computerized guide that takes patients' answers to various behavior questions, analyzes their risk for a serious substance use problem, and instructs doctors on what to do next.

Some in the health care industry say it's a huge irony that patients aren't asked about drugs and alcohol use, but go to the emergency room and you'll be asked about a tetanus shot, even though "most of us have never seen a case of tetanus," says Dr. Gail D'Onofrio, emergency medicine chief at Yale-New Haven Hospital.

Up to half of ER visits involve illegal drugs or alcohol, typically "we don't ask it. It makes no sense whatsoever," says D'Onofrio, who teaches new doctors to break that chain of silence.

The new program works like this, if a patient admits to experimenting with heroin then the doctor can ask a few more questions about how often, when, and if he felt cravings. The computerized guide estimates how big his risk is for ongoing drug use and what intervention is needed; it will also remind the doctor to administer an HIV and hepatitis test.

The NIDA says the goal is about getting substance abuse treatment for the 23 million Americans estimated to need it.

Last year, a government study discovered that some simple doctor steps such as brief in-office counseling or referral to a specialty center would help slash drug use by patients coaxed to come clean.

Doctors may have extra opportunities with users since studies suggest people with brewing drug or alcohol problems actually see the doctor more often than their sober counterparts.

"There are all sorts of people who are using alcohol, drugs, who are continuing to work and do their jobs and slowly spiraling down, who are not the hard-core users," says Dr. Brian Jack, a family medicine specialist at Boston University Medical School. "Those are people who are in the clinics every single day for all sorts of different things."

The American College of Obstetricians and Gynecologists in December urged its members to ask every patient about alcohol or drug use.

Top-level trauma centers must screen trauma patients as part of their accreditation, and the government adopted new insurance payment codes last year so doctors could bill for screening time.

The new federal program, called NIDAMED, aims to train doctors who are not familiar with addiction medicine to tell the difference between experimenting and abuse.

New York City officials said they're planning to incorporate NIDAMED into the health department's electronic medical records, enabling more than 1,000 providers in underserved parts of the city to use it.

The key to success, say doctors who routinely screen, is earning patients' trust and explaining they're not being judgmental.

"We're not the police," says D'Onofrio. Medical information is confidential.

"Get to know them as a person and treat them as a person, and care, frankly," adds Jack.


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