Thursday, March 18, 2010

Teaching about Addiction in Primary Care

Earlier this month I had the pleasure of speaking at the Virginia Nurse Practitioners Annual conference up in Reston Va. It was a very well attended conference with over 450 participants. I chose to speak on “Addiction in the Primary Care Setting”.

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There is a lot of evidence that primary care practitioners, whether Physicians or Nurse Practitioners, are not very skilled at detecting alcohol or other drug addictions when they see patients in a primary care setting. Not only do they not detect the illness, but they frequently don’t know what to do when they do come across it. This is especially a pity because alcohol and other addictions are major factors in a large percentage of primary care visits. Frequently patients come in with anxiety, depression, stress, accidents, hypertension, GERD, or other problems that are directly caused by their use of addictive substances. You can add to this all the problems that the family members suffer with –depression and anxiety in the spouses, school problems for the children, etc. It is also important to add in all the diseases that are made worse by the patients’ substance abuse – their diabetes that is not well managed, their lack of exercise and poor nutrition, forgetting to take their regular medicines, and so on. When you add it all up substance abuse has a huge impact on our national health.

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And yet Primary Care Practitioners almost never look for the disease, unless the patient comes in and actually asks for help – which is a small minority. When patients come in and ask for help it is usually only in the later stages of the illness, when a lot of damage has already been done and success rates are lower. It is so important then, that doctors look for the disease and diagnose it in the early stages when treatment can be most helpful.

There are many reasons for this. Many docs don’t fully accept that alcoholism and other drug addictions are illnesses. They often feel that alcohol and drug problems are not any of their business. They may feel they are being judgmental. They may be afraid that the patient will get mad and may leave the practice. It has also been shown that doctors often hesitate to investigate a problem or make a diagnosis if they don’t feel comfortable dealing with it. So if a doctor doesn’t know what to do if the patient does admit to a problem then the doctor often won’t bring it up. Often times Doctors and Nurse Practitioners just don’t have the knowledge base about addiction – they don’t have the information about what substance abuse really is. They frequently don’t know how to screen for the disease or how to diagnose the disease if the screen is positive. They often don’t know where to get help if the patient does acknowledge there is a problem.

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So there was a lot to cover in my talk up in Reston. Fortunately the group of Nurse Practitioners who came to the talk were very eager to learn and participate. They asked very insightful questions and had very helpful feedback. We were all able to share our experiences and learn from each other. Hopefully they will have a little better idea of when to suspect there may be a substance abuse problem and they will be a little more willing to ask those difficult questions.

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Now it is on to Physicians. Later this month we are starting a Webinar series for Primary Care Doctors to help teach them the same kind of material. If you know a physician who may like to participate please call Mike at our office to get more information.

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Peter Coleman MD

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