When it comes to drug and alcohol abuse, if physicians don't ask, patients don't tell.

The National Institute on Drug Abuse, noting that inquisitive, caring doctors can help steer substance abusers to sobriety or keep minor problems from becoming severe, is trying to change that sad truth.

Through its new NIDAMED program, the organization hopes to encourage all doctors, from emergency room physicians to family practitioners, to inquire about substance use and abuse, and gauge a patient's susceptibility to addiction. The institute provides a computerized program that enables doctors to ask a series of question, assess the extent of a patient's problem and recommend an appropriate course of action.

And in the process, NIDA hopes to change some sad statistics.

According to the American Medical Association, 23 million Americans could benefit from substance abuse treatment. But only about 2 million are getting the help they need, and the costs, to the health-care system, and in terms of human suffering, are incalculable.

Physicians often come into contact with this at-risk community, studies suggest. People on the verge of addiction, due to a propensity for injury and overall poor health, typically seek medical care more often than those who abstain from drugs and alcohol. But too often, according to NIDA, those visits turn into opportunities lost.

Doctors need to be patient. It may take several visits before a patient admits to having a problem, or agrees to seek help.

And patients need to be honest when responding to inquiries, volunteer information if their physician fails to ask, and follow their doctor's orders to prevent minor problems from spiraling out of control.

Remember, medical records and doctor/patient discussions are confidential. And being truthful about substance abuse can save your life by reducing the risk of deadly drug interactions from prescribed medications and insuring that doctors treat your conditions correctly.

So doctors, do ask. Be the first line of defense in the fight against substance abuse. And patients, do tell. There's nothing to risk by opening up, but a lot to lose by trying to hide your problem.

Drug and alcohol abuse is not a weakness or a character flaw or cause to be ashamed; it's a medical problem, one that can be treated successfully. But only if doctors and patients are willing to break the silence.