Is it possible there is a big hole in the addiction treatment safety net?
Recent research has spotted a significant gap in the treatment of substance use disorders in the psychiatric practice. What do the statistics indicate regarding the current lack of treatment? How can this issue be addressed?
Addiction Treatment and Psychiatric Diagnoses
calls them “missed opportunities,” but for the person with substance use disorders, they can be potentially life-threatening. They are talking about a recent study published in Psychiatry Online
that found that psychiatrists are diagnosing less than half of the patients that likely present in their practice with substance use disorders.
The math behind the study is fairly simple. A National Survey on Drug Use and Health
study found that of the 43.5 million people with mental illness, 20 percent have co-occurring substance use disorders. Study authors Dr. Tami L. Mark and Dr. Angelica Meinhofer looked at this data and analyzed it against the volume of psychiatric visits found in the National Ambulatory Medical Care Survey
from 2012 to 2015.
In reviewing the diagnoses and treatments during these visits, the authors discovered that psychiatrists diagnosed substance abuse as an ailment just nine percent of the time. When measured against the national stats that show that 20 percent of all psychiatric patients have substance use co-morbidities, it is clear that these clinical professionals potentially missed the opportunity to provide addiction treatment in addition to psychiatry for these vulnerable populations.
So, psychiatrists—who receive instruction in diagnosing and treating substance use disorders as part of general psychiatry training but not as extensively as those who complete addiction medicine fellowships—can improve the treatment of co-occurring conditions by looking more carefully for substance use disorders among their patients.
Reasons for Missing Addiction Treatment
It is important to note that is is not just the psychiatry practice that struggles to provide addiction treatment in these cases. Primary care physicians and ER clinicians are increasingly pressed for time; visits are shorter, so the camaraderie needed to facilitate an honest discussion about substance use frequently is not present.
Delving into the reasons behind simply missing these diagnoses offers some complexities that could also include:
- Placing substance use disorders behind other mental health disorders, and therefore simply failing to recognize the co-morbidity.
- The reluctance of patients to discuss their substance use.
- Underdiagnosis and treatment even when the substance use disorder is recognized, such as when the doctor simply downplays the issue in favor of other clinical signs.
The complexity in diagnosing mental health and substance use disorders as simultaneous chronic illnesses is widely documented. For example, alcohol is legal and widely accepted in our culture. A high-functioning alcoholic many not even recognize the disorder within, and the stigma associated with any type of substance use disorder may prevent candid discussion within the psychiatric office visit. Developing the kind of relationship where these illnesses are discussed is time-consuming.
However, these issues do not remedy the fact that psychiatrists and other clinicians should continue to screen carefully for substance co-morbidities that present with mental illness. Failing to do so, especially in light of the current opioid crisis, is a disservice to the populations we are trying to help.
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