Attitudes towards alcoholism

Medical education in substance use disorders

This paper outlines recent developments in drug and alcohol medical education, and highlights improved prospects for prevention and appropriate management of substance use disorders. The paper also presents a model of effective drug and alcohol medical education designed to induce both clinical competence and effective practice behaviour. Of particular note is the trend towards greater emphasis on skills development, especially clinical interaction skills. This emphasis is underpinned by an increasingly behavioural orientation, whereby concern is focused on fostering clinical competence in specific skills, e.g. identification, history taking and interventions. Practical examples of the application of such approaches are noted. In addition, relevance of concepts, such as self-efficacy and role legitimacy, to the area of drug and alcohol medical education is highlighted. Together with recent data on early intervention, and the widespread recognition and support for medical practitioners' involvement in drug and alcohol problems, future prospects are viewed as very encouraging.

Is alcoholism a self-induced disease? A survey among doctors in Aarhus, Denmark and in Mainz, Germany

The intent of this study was to explore differences in views concerning the statements "alcoholism is a disease" and "alcoholism is a self-induced disease" among doctors in two cities from two contrasting countries, relating to different official definitions of alcoholism, namely Denmark, where alcoholism is related to ways of lifestyle and Germany, where alcoholism is related to preliminary diseases. The data come from a postal anonymous survey, carried out between January and February 2000 in Aarhus and Mainz, sent to general practitioners and hospital doctors from surgery, internal medicine and psychiatry. The identified sample was n = 572, and the response rate = 66% (n = 374). As opposed to doctors in Aarhus (73.7%), significantly more doctors in Mainz (92.4%) described alcoholism as a disease, but independent of nationality, about half of the samples (no gender, age and healthcare settings differences) also agreed that "alcoholism is a self-induced disease". The governmental position on alcoholism seems to have an influence on doctors' evaluation: in Denmark, where alcoholism is defined as a disease of lifestyle, doctors in Aarhus were less likely to describe alcoholism as a disease than in Mainz, where alcoholism is seen as a preliminary disease. The ideological background for these differences is connected to the different influence of the temperance groups on the alcohol field -- less in Denmark and more in Germany. However, half of the doctors in Aarhus and Mainz viewed alcoholism as a self-induced disease and so indirectly assumed that alcoholics are responsible for their self-afflicted disease.

Treatment received by alcohol-dependent suicide attempters

The purpose of this study was to examine the clinical features of alcohol-dependent suicide attempters and the treatment they received before and after the index attempt. A total of 47 subjects with current DSM-III-R alcohol dependence were identified from a systematic sample of 114 suicide attempters in Helsinki. All of them were comprehensively interviewed after the attempt, and the treatment they had received was established from psychiatric and other health-care records and follow-up interviews. Most had a history of psychiatric (83%) or substance abuse (83%) treatment. During the final month before the attempt, half of the subjects (51%) had been treated by health care services; 11% had received disulfiram-treatment and 6% had received psychotherapy. Subjects complied with recommended aftercare more often when they had been actively referred. After 1 month, 64% were being treated by health care services. However, only 14% were receiving disulfiram-treatment and 9% were receiving psychotherapy. These findings suggest that the quality and activity of treatment offered to suicide attempters with alcohol dependence should be improved.

Assessing bias in community-based prevalence estimates: towards an unduplicated count of problem drinkers and drug users

General population survey estimates of the overall prevalence of problem drinking and drug use in a community are biased by the exclusion of non-household populations. Estimates based on compiling prevalences in community institutions may also be biased due to over-counting of users of more than one institution. This paper examines prevalence estimates derived from probability samples of problem drinkers in the general population and within alcohol treatment, drug treatment, mental health, criminal justice and welfare agencies in a single US county. Data sets are merged and weighted to reflect a community sample of institutions, and a 17% subset of cases is identified within the institutional samples that are not living in housing units typically included in general population sampling frames. The difference in prevalences of problem drinking in the household and non-household populations is found to be large: 11% and 48%, respectively. Even greater differences are found between estimates of unprescribed weekly drug use (6% and 47%, respectively) and combined problem drinking and weekly drug use (2% and 27%, respectively). This suggests that confining samples to the household population can systematically under-represent the prevalence of problem drinking and drug use. A second source of bias in prevalence is characteristic of studies using records from multiple institutions. When duplication of service use in the five agency samples is considered, it becomes apparent that prevalence may be biased upward due to over-counting of multiple service users.

Primary health care and the addictions: where to start and where to go

The development of community services for problem drinkers is briefly traced over the last 40 years. The numbers of drinkers in need of advice and treatment far exceeds the available resources. Family practice would be an ideal place in which to further primary care and prevention but lack of time, knowledge and motivation for probing into patients' drinking habits detract from the potential. A pilot study of opportunistic screening in general practice is described whereby a yellow label affixed to a patient's medical record card registers the average weekly alcohol intake. In a sample of 400 patients, 16% were high or intermediate risk drinkers. Each high risk drinker presented with a medical condition which could, in either aetiology or management, be related to high consumption. By discussing this, patients were often motivated to drink less or abstain. Various suggestions are made how better medical training and education could improve the diagnosis and treatment of drinking problems.

An initial explanatory model of a medical students' preferences for patient types

Previous studies suggest that medical students and doctors may express a range of positive and negative attitudes and behaviours towards patients. As an initial attempt to understand how attitudes toward patients are formed, first-year medical students were asked to describe their feelings about six categories of patients. These reactions were then correlated with the students' social background, social values and perception of these conditions.

Patient characteristics negatively stereotyped by doctors

A variety of studies demonstrate the existence of prejudice in the manner and content of health care delivery. Alcoholics, attempted suicides, drug addicts, prostitutes, the mentally retarded or mentally ill, the aged and women have been found to receive less adequate health care. Previous studies have identified manifestations of prejudice in health care delivery but have generally failed to determine the prevalence of negative stereotypes in a sample comprising a cross section of medical practitioners. This study reviews the negative patient stereotypes reported by 2421 Victorian (Australia) and Michigan (U.S.A.) doctors. The characteristics of patients so stereotyped are found to be remarkably consistent. The most commonly held negative stereotypes (patients who abuse alcohol, unhygienic patients, abusive patients, substance abusers and those with minor mental disorders) appear to be determined by the social values which prevail in our society. Many negative stereotypes appear to reflect a response to patients who deviate from the sick role. Other stereotypes may involve reactions to patients or to the types of problems which raise important therapeutic dilemmas.

Alcohol: a description and comparison of recent scientific vs. public knowledge

Sought to survey alcohol research since the "rediscovery" of fetal alcohol syndrome (FAS) and to compare recent scientific knowledge with that of the general public. Research was found to concentrate on searching for explanations of alcohol use and/or abuse and on several areas of biological morphogenesis. Significant documentation exists for FAS and validates both physiological and developmental attributes. As an index of public knowledge, an alcohol questionnaire was administered to 190 high-school, college, and graduate students. True-false items represented statements relative to the nature, etiology, effects, variables, and consequences of alcohol use/abuse. The composite mean of less than 60% correct suggested significant misinformation and misconceptions about alcohol. A summary of the most dramatic informational deficits was presented. There was a positive, though minimal, relationship between alcohol knowledge and education, and both sex and race differences were noted.

Attitudes towards criminal and other patients

Staff attitudes towards mentally abnormal offenders were investigated on a forensic psychiatric assessment ward as reflected in a drug trial. The attitude towards drug trials was negative in 79% of the personnel, in contrast to 71% positive in three Swedish mental hospitals. Of the respondents 75% considered that drug treatment did not benefit the patients. Then the attitudes of 21 general physicians towards assessment and drug treatment of mentally abnormal offenders as well as towards 10 illnesses were measured by self-rating scales employing a 10-cm line technique. Both the assessment and drug treatment of mentally abnormal offenders were the least favoured as compared with somatic illnesses. Other neuropsychiatric disorders ranked with them were also very significantly (P less than 0.001) less favoured than pneumonia. They considered that these attitudes were shared in general by medical and nursing staff

Alcoholism. Earlier diagnosis and definition of the problem

There are important measurements of alcoholism that are poorly understood by physicians. Professional attitudes toward alcoholic patients are often counterproductive. Americans spend about $30 billion on alcohol a year and most adults drink alcohol. Even though traditional criteria allow for recognition of the disease, diagnosis is often made late in the natural course, when intervention fails. Alcoholism is a major health problem and accounts for 10 percent of total health care costs. Still, this country's 10 million adult alcoholics come from a pool of heavy drinkers with well defined demographic characteristics. These social, cultural and familial traits, along with subtle signs of addiction, allow for earlier diagnosis. Although these factors alone do not establish a diagnosis of alcoholism, they should alert a physician that significant disease may be imminent. Focus must be directed to these aspects of alcoholism if containment of the problem is expected.