The Adequacy of Screening, Documenting, and Treating the Diseases of Substance Abuse

Abstract

In a large inner-city teaching hospital, only 28 percent of over 1000 consecutive hospital admissions received proper screening for diseases of substance abuse. Although the CAGE questions are currently considered the best screening test for quickly assessing an alcohol abuse history, not a single CAGE question was documented during our 23 day study. Of the 1010 patients in the study, 160 or 16% were found to be substance abusers. Of these, 57 (37%) were properly screened by the physician team and 8 (5%) received adequate follow-up treatment for their substance abuse by way of social service or psychiatric consultation, or documented counselling by their physician. Physicians are not adequately screening for the diseases of substance abuse, and are not appropriately evaluating and referring patients who are known to be substance abusers. Meaningful training of medical students and physicians is necessary to increase awareness and produce positive behavior change.

Social Work Practice with the Elderly Substance Abuser

“…Unfortunately, the research suggests that these gatekeepers do not fare well in detecting and responding to patients with substance abuse and mental health problems (Bartels, Horn, Sharkey, Levine, 1997;Caine, Lyness, & Conwell, 1996;Callahan, Hendrie, & Tierney, 1995;Chappel, 1991;Higgins, 1994;Hopkins, Zarro, & McCarter, 1994;Michels, Johnson, Hornung, & Updike, 1993;O'Connor, 1994;Saitz, Mulvey, Plough, & Samet, 1997;Siegal, Cole, Li, & Eddy, 2000). The purpose of this article is to update social workers on advances in geriatric addictionology by reviewing current epidemiological studies and extracting practice principles.…”

Mental Health Nursing in the 21st Century

“…Nationally, the United States experiences a 13.5% lifetime prevalence of alcohol abuse or dependence, affecting more than 15 million Americans (U.S. Public Health Service, 1998). The costs of alcohol problems recently were estimated as exceeding $128 billion per year and the health care costs as exceeding $16.5 billion per year (Hopkins, Zarro, & McCarter, 1994). An additional $60 billion cost was attributed to drug problems, with most of the cost related to reduced productivity, decreased health status, and restricted activity days (Keer et al, 1994).…”

“…Anxiety disorders and substance abuse are common. Screening for substance abuse and recognition of it in primary care settings have been found to be inadequate (Crum & Ford, 1994;Hopkins et al, 1994). Alcohol abuse and drug abuse together with depression constitute the greatest burden of serious mental disorders in community populations and are seen frequently in primary care and occupational settings (Roberts & Lee, 1993).…”

A Substance Abuse Consultation Service

“…Among general hospital inpatients, substance use problems are commonly underidentified or misidentified 7,14 . A chart review by Hopkins et al 15 found that only 28% of the patients had adequate substance use histories on the chart. Moore et al's study 9 documents low physician detection rates of screen‐positive alcoholism.…”

“…Other reports highlight the inadequacy of using discharge diagnoses to document the presence of alcoholism among the patients' problems 5,16 . Even when substance abuse is identified and discussed with the patient, studies suggest that little is done to refer them for appropriate treatment 5,15,17–19 …”