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Few patients being treated for depression in primary care are counseled about substance abuse problems

Substance abuse complicates the diagnosis and treatment of depression, and patients suffering from depression are less likely than other patients to have their alcohol and/or drug problems diagnosed. A new study found that more than 30 percent of depressed women and men visiting primary care doctors had drug or alcohol problems. Yet only 8 percent of these patients, mostly men, had been counseled about drug or alcohol use during their most recent primary care visit.

Substance abuse continues to carry more stigma for women than for men, and this may discourage some women from seeking help from a health care provider. This may make detection of substance abuse problems in women more difficult, explains Kenneth B. Wells, M.D., M.P.H., of the University of California, Los Angeles.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS08349), the researchers analyzed data from a large survey of 46 managed care clinics in 5 States that were participating in a study to improve quality of care for depression. The researchers calculated the frequency of problematic alcohol and drug use among male and female patients who had symptoms of depression and determined whether they had received substance abuse counseling at their last primary care visit. Of 1,187 depressed patients surveyed, 30 percent of women and 39 percent of men reported problematic substance use. A total of 8 percent of women and 19 percent of men reported hazardous drinking, and 26 percent of women and 29 percent of men reported problematic drug use, including use of illicit drugs and misuse of prescription drugs.

Only 8 percent of the patients who reported hazardous drinking or problematic drug use were counseled about drug or alcohol use during their last primary care visit. Men were more than three times as likely to have been counseled as women about these problems (15.6 vs. 4.5 percent). Although depressed women were less likely than men to have problems with alcohol or marijuana, they were more likely than men to misuse sedatives. The combination of problematic alcohol and drug use was more common among depressed men, but as many women as men had problematic use of more than one drug.

More details are in "Problematic substance use, depressive symptoms, and gender in primary care," by Carol A. Roeloffs, M.D., Arlene Fink, Ph.D., Jurgen Unutzer, M.D., M.P.H., and others, in the September 2001 Psychiatric Services 52, pp. 1251-1253.

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