Attitudes toward problem drinkers. A critical factor in treatment recommendations

Attitudes toward problem drinkers, revisited: patient-therapist factors contributing to the differential treatment of patients with alcohol problems

Although there are many treatment alternative open to people with drinking problems, health professionals still exhibit negative attitudes towards alcoholics. In a previous study, the author demonstrated that those patients who were self-labelled alcoholics were treated in a less preferential manner than those who did not identify as such. This study used both overt and unobtrusive measures to determine whether negative attitudes of intake interviewers towards problem drinkers were elicited by the patients' self-label as an alcoholic or by other variables related to perceived treatment outcome. Pre- and postinterview data on patient likability, doctor's eagerness to work with the patient, interview content, treatment disposition, and patient compliance were collected from first-time patients, and from their interviewers, in the walk-in psychiatry and alcohol treatment units of a large, urban teaching hospital. The results elucidate how stereotypes interact with patient characteristics to influence both professional behavior and patient compliance.

Alcoholics' beliefs about abuse: causes, effects and treatment

The beliefs that problem drinkers hold about the causes of abuse, effects of alcohol, and methods of treatment were investigated. The drinkers' beliefs about their own abuse as well as their beliefs about other abusers were both studied. It was found that own abuse was mostly explained by internal factors (drinking to reduce distress or to achieve an elated mood) while external factors (e.g. unemployment) were more often referred to as explanations of the abuse by other persons. Alcohol abuse as an illness was a frequently endorsed concept, while explanations in terms of social or macro level factors were rarely accepted. Females tended to accept more explanations of abuse than males. Many of the problem drinkers tended to see very few explanations for their own abuse and to be quite skeptical about treatment. Factor analysis resulted in three factors: acceptance of reasons for abuse, perceived dependence and experienced control of drinking. Cluster analysis indicated that about 25% of the problem drinkers had a high level of acceptance, perceived dependence and control. These problem drinkers may be a prime target group for treatment.

The response of primary care physicians to problem drinkers

This study examines the extent and characteristics of primary care physicians' response to their patients' drinking problems and several factors which might impede or facilitate their response. The data were collected in an anonymous questionnaire survey of primary care practitioners in the greater Boston area. Although most had been exposed to some type of alcohol education, few physicians were very confident in their patient management skills and few felt professionally responsible for long-term alcohol treatment. The data suggest that physicians may be reluctant to become involved in treatment they are not prepared to carry out or which they feel is not appropriate to their role. If physicians are to be encouraged to take an active role in the diagnosis and treatment of alcoholism, the emphasis of educational programs should go beyond increasing knowledge and changing attitudes, and focus instead on providing the necessary clinical skills.

Hospital staff's perceptions of the alcoholic

Hospital staff's perceptions of the characteristics of alcoholics were investigated by means of a questionnaire containing a set of 23 semantic differential scales on which they rated four types of patient: "the Alcoholic," "the Nondrinker," "the Drug Addict," and "the Heavy Drinker." Factor analysis of the responses showed that types of patients were perceived in terms of three dimensions. Stability, Dangerousness, and Self-Assertiveness. In comparison with heavy drinkers, alcoholics were perceived by hospital staff in general as unstable, harmless, and self-effacing, though clerks tended to see them as more dangerous than did professionals. These perceptions are considered in relation to the respondent's own frequency of drinking. Finally, the explanation of these findings and their implications for clinical education and policy are discussed.

Drinking by alcoholic cirrhotic patients under medical care: a literature survey

In order to gain a broader perspective on the natural course of drinking by alcoholic cirrhotic patients receiving medical care, the medical and surgical literature from 1963 through 1982 was surveyed for prospective studies of patients with alcoholic cirrhosis in which follow-up drinking data were reported. Eleven studies with 1,039 patients were summarized. The patients were mostly urban men, averaging about 50 years old, treated in municipal, Veterans Administration, and university hospitals for either decompensated cirrhosis or for portal hypertension and bleeding varices; follow-up periods ranged from less than 1 to 10 years. The clinical investigators in the studies used various means to assess drinking and to categorize drinking behaviors, and expressed caution regarding validity. Between series, from 20 to 53% of the patients were reported to be abstinent from alcohol during the clinical follow-up periods. In five studies (373 patients) where the extent of drinking was determined, from 21 to 35% of the patients were reported to be drinking in a reduced or moderate manner, and from 17 to 42% to have resumed heavier drinking. The rates of improvement in drinking reported for the cirrhotic patients under medical care compare favorably to those for middle-aged male clients after alcoholism treatment, but the variables that predict course and outcome cannot be fairly compared between "medical" and alcoholism treatment populations. The substantial reduction or cessation of drinking reported in these large series of alcoholic cirrhotic patients over long follow-up periods may simple represent the natural, terminal course of alcoholism in the presence of severe liver disease; concomitantly, improvement may reflect the favorable impact of an alcohol-related disease and continued medical care on changing drinking behaviors.