Hidden barriers to the diagnosis and treatment of alcoholism and other alcohol misuse.

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Abstract
To assess why physicians and problem drinkers usually do not make constructive therapeutic contact with respect to alcohol misuse, patients and medical personnel in Montreal [Quebec, Canada] were interviewed and completed questionnaires. Over 2/3 of the 473 adults who completed questionnaires while in general practitioners'' waiting rooms viewed problem drinking as an area of medical concern, and 51 (11%) admitted that they were concerned about their drinking habits. Only 2 of the 51 asked their physicians for aid, although another 18 mentioned the drinking problem to their physicians. In 8 of these 20 cases the physician suggested specific treatment, in 3 cases he offered vague advice and in 9 cases he did not pick up the subject. To learn about patient-physician interactions when alcohol misuse was obvious, 17 members of Alcoholics Anonymous, 21 problem drinkers who were patients at a mental hospital or an alcoholism clinic, 11 therapists and 9 industrial medical officers (IMO) were interviewed. Patients were not likely to raise the subject of problem drinking spontaneously, and most though that their physicians should have recognized and broached the subject of their condition before it became critical. The IMOs were more likely than other physicians to confront a possible problem drinker, perhaps because their patients'' supervisors had already identified alcoholism or problem drinking. IMOs rarely undertook treatment themselves, but were more positive about treatment results than were other physicians. Interviews with 23 psychoanalysts revealed that the interaction of some physicians and patients was affected by problem drinkers'' disturbed narcissism and their failure to assume a help-seeking role, thus challenging the physicians'' authority. Apparently the physician''s function in preventing and treating alcohol misuse will not improve until physicans learn how to handle their tendency to demand that patients acknowledge their authority.

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