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John L. Coulehan, MD; Monica Zettler-Segal, MS; Marian Block, MD; Maureen McClelland, MD; Herbert C. Schulberg, PhD

Arch Intern Med. 1987;147(2):349-352.

Abstract
• Alcohol and other substance abuse are frequently seen in primary medical practice but are underdiagnosed. Forty-two (14%) of 294 adult primary care patients suffered from alcohol or other substance abuse, as diagnosed by a structured psychiatric interview. Primary care physicians identified 17 (40%) of these patients, as well as another patient identified during a six-month follow-up period, as having a substance abuse problem at initial clinical evaluation. Clinically identified substance abusers were older, more likely to be married, and more often used multiple drugs. They more frequently had antisocial personality disorders, while patients not clinically recognized were often depressed. Logistic regression analysis indicated that the presence of antisocial personality, the absence of a coexisting depressive disorder, and better social functioning scores were the factors most strongly associated with clinical recognition. The study suggests clinical judgment issues, which may be useful to physicians in training to improve their recognition and treatment of substance abuse disorders.

(Arch Intern Med 1987;147:349-352)

Author Affiliations
From the Departments of Community Medicine (Drs Coulehan and Block) and Psychiatry (Mss Zettler-Segal and McClelland and Dr Schulberg), University of Pittburgh School of Medicine.

Footnotes
Accepted for publication Sept 10, 1986.

Reprint requests to Department of Community Medicine, M-200 Scaife Hall, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 (Dr Coulehan).

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