Recognition of Alcoholism and Substance Abuse in Primary Care Patients

\s=b\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 analy-sis 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 judg-ment issues, which may be useful to physicians in training t