Last week, the White House announced a new, get-tough policy on prescription painkiller abuse, including new training procedures for the more than one million doctors in America who are a bit too promiscuous with their prescription pads (See our earlier coverage). Meanwhile, experts at the recent annual meeting of the American Society for Addiction Medicine (A.S.A.M.) argued for the key role physicians must play in detecting and treating America’s other rampant drug problem: alcohol.

When the F.D.A. offers prescriber training under the new opioid Risk Evaluation and Mitigation Strategy (R.E.M.S.)—even though the training isn’t mandatory—those prescribers who want to hold on to their license are likely to pay attention. And it won’t cost them a dime. Drug companies are being told by the Feds to cover the cost of the training plans, Allison Gandey of Medscape reports. This might seem heavy-handed, were it not for the fact that drug companies are making vast amounts of profits thanks to soaring opiate sales at a time when prescription overdose deaths in the United States are at an all-time high. “I’m glad the F.D.A. acted,” said pain expert Dr. Charles Argoff of the Albany Medical Center in New York. “Unfortunately, I don’t think this goes far enough to get at the root of the problem.” Dr. Argoff worries that the new training procedures will not stop “allowing physicians with insufficient training to prescribe medications that kill people.”

On the other hand, the importance of primary care providers in early detection of alcoholism has been known for some time—but is still not widely and effectively put into practice. “Do not stop at taking a history,” said Dr. Keith A. Nichols, a family practice physician in Oswego, NY. “Delve into and find out if there’s a problem,” he urged the assembled group of addiction health providers in Washington, D.C. “Don’t take the person’s snap response. People in general aren’t offended if you ask them if (they are in trouble.) In fact, a lot of people are grateful if you help them.” What comes next is a matter of some dispute. Many doctors feel it’s not worth identifying alcohol abuse without integrated access to specialty care—a practice that's notably lacking in most clinical settings.

According to Internal Medicine News, there is another good reason for doctors to consider drug and alcohol problems in their overall diagnosis: If alcohol and other drugs are involved, treatment and prescribing procedures may have to be altered for a successful medical outcome.  When nobody asks, everybody loses.