The Extent to Which Psychiatrists Diagnose and Treat Substance Use Disorders

At least 20% of adults with mental health conditions have a co-occurring substance use disorder (1). Among individuals with co-occurring disorders, 80% receive only mental health treatment, with no substance abuse treatment (1). To begin to understand how psychiatrists might help close this treatment gap, we examined the percentage of office visits to psychiatrists involving substance use disorder diagnoses or prescriptions to treat them.

We analyzed data from the 2012–2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey conducted by the National Center for Health Statistics on visits to office-based physicians primarily engaged in direct patient care. The NAMCS sampling frame and weights provide nationally representative data on outpatient visits to psychiatrists. Visits to psychiatrists involving a substance use disorder diagnosis were identified with the NAMCS psychiatrist specialty variable and ICD-9-CM diagnosis codes 303.XX (alcohol dependence syndrome), 304.XX (drug dependence), and 305.XX (nondependent abuse of drugs); up to five diagnosis codes could be listed. Visits involving a prescription to treat an opioid use disorder (OUD) (buprenorphine, naltrexone) or alcohol use disorder (AUD) (naltrexone, disulfiram, acamprosate) were identified with generic drug codes; up to 30 generic drugs could be listed. Visits were weighted to produce national estimates (number of visits per year averaged 38.6 million).

Figure 1 shows that on average, from 2012 to 2015, psychiatrists diagnosed a substance use disorder or prescribed a medication for one during 9% of psychiatrist office visits. More specifically, 8.7% of office visits to psychiatrists involved a substance use disorder diagnosis, 2.2% involved a prescription for OUD, and .5% involved a prescription for AUD. Our findings suggest that psychiatrists may be diagnosing and treating less than half of their patients who have a substance use disorder (that is, if 20% of their patients have a substance use disorder and they are only diagnosing 9%, 9/20=45%). Psychiatrists have great potential to reduce the treatment gap for substance-related disorders. More efforts may be needed to encourage and train psychiatrists to screen for substance use disorders and ensure that their patients are receiving addiction treatment.