The Betty Ford Institute's CEO on why the "most dangerous place" for an alcoholic to seek help can sometimes be your doctor's office

The Macleans.ca Interview: Dr. Garrett O’Connor
Kate Lunau

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Alcoholism is under-diagnosed. Why? It’s a hard subject to raise.

An expert on alcoholism and addiction, Dr. Garrett O'Connor struggled for years with an alcohol problem of his own. He saw several doctors during that period but "the only person who ever said I might have a problem," he notes, "was my dentist." During some routine dental work "all my teeth fell out. I was going to sue [the dentist], until he pointed out my liver was deficient, not his skills." O'Connor claims his experience is far from unusual; many family doctors are still unequipped, he claims, to help patients with addiction. O'Connor, the CEO of the Betty Ford Center, a world-renowned addiction treatment centre in Rancho Mirage, CA, recently spoke to Macleans.ca.

Q: The family doctor is probably the one health practitioner that most people see on a regular basis. And yet you say that for an addict, a family doctor's office can be a dangerous place. Why?

A: There was a study done at Columbia University where they surveyed primary care physicians and found that 94 per cent were unable to diagnose addiction. They were diagnosing high blood pressure or depression. They were seeing only the symptoms of addiction, and not the disease itself. Sometimes, the most dangerous place for an addict or alcoholic to be looking for treatment is in a doctor’s office. It’s a terrible tragedy.

Q: Those numbers are astonishing. Is that something you’ve witnessed for yourself?

A: Yeah, it’s commonly seen. Most physicians—myself included, until I got into the specialty of addiction 35 years ago—to this day, do not get anything even remotely resembling adequate training in the recognition and management of addictive disease. A couple of months ago in Palo Alto, the local medical association had their annual meeting and I was the guest speaker. There were about 150 doctors in that audience, all well-trained, upscale physicians. I asked them how many felt they had adequate education and training in how to recognize and manage addiction. Only three people put their hands up, and one put her hand down pretty quickly.

Q: Is addiction not adequately covered in medical training?

A: It isn’t. Alcoholism and addiction are not pleasant diseases to confront. [In the Columbia study,] four out of five doctors who didn’t recognize addiction didn’t think that addiction was a disease. And they didn’t think it was treatable.

Q: When a patient does go to a family doctor, how does the doctor determine if there’s a problem with alcoholism? My own family doctor just asks me how many drinks I’ve had in a week, that’s it.

A: That’s the standard. There’s no talk about patterns, no talk about negative consequences. I mean, 15 to 20 per cent of people going into a doctor’s office have a problem with alcohol—maybe even higher, but certainly that much. A famous psychiatrist once said that syphilis was the great imitator of all diseases, because it was in every system in the body. Now, alcohol is the great imitator of all diseases, because it goes to every cell in the body and can be present as a neurological disorder, a gastrointestinal one, a cardiac disorder, high blood pressure, a skin disorder, an eating disorder and as the whole raft of psychiatric disorders, including depression and bipolar disorder.

Q: Is alcoholism on the rise?

A: It’s really hard to say. It’s so [widespread] that you couldn’t really say if it’s going up or down. The U.S. government, pretty accurately, thinks there’s 25 million people in the country with a significant alcohol or other drug problem, the vast majority of them alcoholics. Of that group, only about two million get treated every year. So, you have 23 million people walking around with an active addictive disease. And of that 23 million who don’t get treatment, 97 per cent think that they don’t need treatment. So, even if you provide treatment on demand, a very significant percentage of those who need it wouldn’t take it.