May 15, 2009
Helping health care workers get past the stigma of asking about alcohol or illegal drug use is the aim of a new program from the National Institute on Drug Abuse (NIDA). The ultimate goal is to boost the proportion of Americans who get the treatment they need, now estimated at only 2 million of 23 million with a substance abuse problem.
Health care providers are in a position to make a difference because so many health care interactions involve substance abuse -- as many as half of ER visits involve illegal drugs or alcohol, for instance.
People with a substance abuse problem are more likely to see a doctor than those without such issues -- whether to address an immediate consequence, such as an injury, or to deal with something more long-term, such as liver disease. "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," said Dr. Brian Jack, a Boston University Medical School family medicine specialist.
The NIDA program offers a detailed guide that, using patients' answers to various questions regarding their behavior, analyzes their risk for substance abuse and advises doctors how to use the information.
For example, a provider whose patient admits to experimenting with heroin can follow up with additional questions that assess the risk for ongoing drug use and whether intervention is needed. It can also prompt the doctor to test for HIV and hepatitis.
For physicians, success rests in part on their ability to discern whether a patient is being truthful and to convince patients that their medical information is confidential, not to be released to law enforcement. "We're not the police," says Dr. Gail D'Onofrio, chief of emergency medicine at Yale-New Haven Hospital.