"Although doctors and nurses have the best opportunity to intervene with alcoholics and substance abusers, our research indicates they are woefully inadequate in even diagnosing someone with this disease," said Joseph Califano Jr., chairman and president of Columbia University's National Center on Addiction and Substance Abuse (CASA).

According to research conducted by CASA, nine out of 10 primary-care physicians fail to diagnose addiction in patients who display typical symptoms of the problem.

"Caring for patients with substance abuse is one of the most difficult things I have ever had to deal with as a doctor," said Dr. Catherine D. DeAngelis, editor in chief of The Journal of the American Medical Association and a pediatrician. "But I am hardly alone. Doctors are trained to figure out a specific pathology and effective treatments for diseases. But when the ailment in question carries a substantial behavioral component, like substance abuse, physicians get frustrated and don't do as well."

Contributing to the problem, researchers said, are insufficient training in the treatment of addiction, frustration on the part of doctors with addicted patients, physicians' misconception that treatment does not work, and a low rate of insurance reimbursement for such services.

To address the problem, CASA recommended enhancing formal addiction training for medical students, residents and doctors; expanding Medicare, Medicaid, private insurance and managed-care coverage for treatment; and introducing legal accountability for primary-care doctors who fail to diagnose addiction.

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