Increasing Primary Care Providers’ Willingness to Intervene in Alcohol- and Drug-Related Problems: A Review1

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Abstract
Over the past decade increased attention has focused on the role of primary care physicians in the treatment of drug and alcohol problems. Compelling arguments have been proffered in their support including high prevalence levels within community populations and frequency of presentation in primary care settings. In addition, ready access, the nonstigmatizing setting, and proven efficacy of physician-delivered early intervention add further weight to primary care provider involvement. However, a complex relationship exists between treatment providers and potential recipients-and greater involvement is hampered by numerous factors. For instance, substantial evidence suggests that primary care providers are less than enthusiastic, are inadequately informed, and perform poorly with regard to identification and treatment of drug and alcohol problems. These deficits are examined from several perspectives. Doctors’ willingness to intervene (WTI) is discussed in relation to a recently developed model which encompasses four key components: the doctor factor, the patient factor, the context factor, and the doctor-patient interaction factor. Some components of this model are discussed in relation to barriers to wider involvement by primary care physicians. The extent to which poor knowledge levels may impact upon provision of treatment is examined and discussed in light of recent Australian and Canadian surveys of primary care physicians’ knowledge and attitudes. Finally, consideration is given to a novel application of Skog's (1) social contagion theory, to the effect that when patients are successfidly counseled to reduce their alcohol consumption, they influence their social contacts to do likewise. Such an effect would multiply the benefits to the community arising from the provider's successful detection and management of an individual patient's alcohol or other drug-related problems. An experimental protocol to test this theory is described.