title: Physician unawareness of serious substance abuse.
abstract: OBJECTIVE
  To describe and assess the prevalence of perceived physician unawareness of serious substance abuse.
  
  
  METHODS
  We report an observational study with validation of multivariable results of data collected by interview from persons presenting for addictions treatment in the public system who reported having a physician.
  
  
  RESULTS
  Of 3,253 patients interviewed, 87% (2,843) responded to the question about having a physician. Of 1,440 patients who stated that they had physicians, 45% (651) reported that the physician who cared for them was unaware of their substance abuse. In multivariable logistic regressions adjusting for sociodemographics, health status, and substance abuse histories, the following patient characteristics were found to be independently associated with physician unawareness of substance abuse and were confirmed in a validation analysis (OR = Odds Ratio, CI = 95% Confidence Interval); no prior episodic medical illness (OR = 1.98, CI = 1.35-2.92), no health insurance (OR = 1.89, CI = 1.33-2.70), no prior mental health treatment (OR = 1.75, CI = 1.06-2.88), no chronic medical illness (OR = 1.69, CI = 1.18-2.40), no prior substance abuse treatment (OR 1.64, CI 1.17-2.31), and no prior detoxification (OR = 1.54, CI = 1.14-2.22).
  
  
  CONCLUSIONS
  Forty-five percent of patients with substance abuse serious enough to prompt a presentation for treatment stated that the physician who cared for them was unaware of their substance abuse. Patients without health insurance, a history of medical illness, or prior substance abuse or mental health treatment were more likely to have reported physician unawareness. Even among substance abusing patients requesting addiction treatment, many perceive that their physicians do not recognize their substance abuse.
authors.affiliation: Research and Education Unit, Boston Medical Center, Boston University School of Medicine, Massachusetts 02118, USA.
authors.forename: R
authors.initials: R
authors.lastname: Saitz
authors.forename: K P
authors.initials: KP
authors.lastname: Mulvey
authors.forename: A
authors.initials: A
authors.lastname: Plough
authors.forename: J H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D001364:Awareness; D001900:Boston / Q000453:epidemiology; D003042:Cocaine; D015897:Comorbidity; D003951:Diagnostic Errors; D005260:Female; D006556:Heroin Dependence / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008432:Mathematical Computing; D017057:Medically Uninsured / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D003042:Cocaine