these practices.^6 These include primary care
medical offices, dental offices, pharmacies,
school-based health clinics, mental health
centers and clinics, emergency departments and
trauma centers, hospitals or encounters with the
justice system due to substance-involved
crimes.^7
Yet, there is no evidence to suggest that medical
and other health professionals routinely avail
themselves of these opportunities.^8 To the
contrary, a 2000 CASA Columbia survey found
that only 32.1 percent of physicians regularly do
even one of the following: administer a health
history form to patients at least annually with
one or more substance use questions; administer
a screening instrument to detect the risky use of
one or more substances; discuss substance use
with pregnant patients; or “almost always” ask
patients about their substance use when they
suspect a patient has a problem.^9
The consequences of failure to identify risky use
or detect signs of addiction can be life
threatening. Mistaking symptoms of risky
substance use for signs of other conditions may
lead to a misdiagnosis or to prescribing
medications that are unnecessary, produce
dangerous drug interactions, compound an
existing addiction problem* or create additional
health risks.^11
- Thirty percent of patient respondents in CASA
Columbia’s 2000 survey of physicians and patients
said their physician knew about their addiction and
still prescribed psychoactive drugs such as sedatives
or Valium.
This gap between evidence and practice is
particularly acute for adolescents because of the
critical importance of prevention and early
intervention in this population. Screening and
intervention services by health professionals for
adolescents rarely is part of routine practice
despite the abundance of guidelines and
recommendations for screening this population;
the knowledge that nearly three out of four high
school students have used tobacco, alcohol or
other drugs; and the availability of effective
interventions.^12Current Practices Related to Tobacco. The
majority (68.8 percent) of adults who are current
smokers report that they want to quit smoking,†
yet less than half (48.3 percent) of smokers who
saw a health professional in the past year
reported receiving advice to quit.‡ 13 A survey
of 6th- through 12th-grade students found that
64.5 percent reported that in the past year no
medical doctor, dentist or nurse asked them
whether they smoked cigarettes,§ 14 even though
screening and interventions by health
professionals can have a substantial impact on
young smokers.^15A large-scale analysis of national data** of
clinical preventive services delivered to
asymptomatic patients in clinical settings
estimates that only 35 percent of the population
receives tobacco screening and brief
interventions in accordance with the† 52.4 percent of current and former smokers (those
who quit smoking in the past year for six months or
longer) had made a quit attempt that lasted longer
than one day in the past year; however, only 6.2
percent report that they have quit successfully.
‡ Medicare beneficiaries were the most likely to
receive smoking cessation advice (59.0 percent) and
those without health insurance were the least likely to
receive smoking cessation advice (35.3 percent).
§ CASA Columbia’s analysis of data from that survey
found that, of those who smoked, only 21.4 percent
said that these health professionals told them to stop
smoking.
** Including the National Health Interview Survey
(NHIS), the Behavioral Risk Factor Surveillance
System (BRFSS) and the Healthcare Effectiveness
Data and Information Set (HEDIS) performance data....Primary care physicians do not routinely
provide any comprehensive screening for
substance use disorders... [When they do provide
treatment referrals, however, some encounter]
addiction treatment services as a “black hole”...
They are not informed of patient progress,
treatment completion or non-completion or
recommendations for continuing care. This
contrasts significantly with referrals to other
specialists wherein the treatment is regularly
communicated and a collaborative relationship is
maintained.^10