Failure to Identify Alcohol Problems

Despite their advantageous situation it has been a common theme for many years that doctors often fail to identify alcohol problems. In one series of studies of six hospitals, the false negative rate ranged from 25-91 per cent. 13 There is a failure to anticipate alcohol problems and to ask about alcohol in routine examinations. Where an alcohol problem is identified it does not necessarily follow that any constructive intervention takes place. There is evidence that some doctors may prescribe Drugs of doubtful appropriateness to problem drinking patients, most obviously anti - depressants.14

Even where identification is made, it is often at a late stage. Doctors are most likely to diagnose alcohol dependence in the severely impaired, and less likely to diagnose it in higher income patients, the elderly, and women. 13

As well as late diagnosis, there is also a tendency to treat the symptoms rather than the causes of alcohol problems with the result that treatment may have only transient effects. Indeed, it is not unusual that, in treating the symptoms rather than the causes patients are made fit enough to continue or resume drinking.

There is also a continuing reluctance on the part of many doctors to raise the issue of alcohol consumption in patients whose medical complaints may be related to drinking. Some have referred sardonically to an unspoken `gentleman's agreement', whereby the patient does not volunteer information about his drinking and the doctor does not ask.

References:

13 N. V. Dawson et al:
The effect of patient gender on the prevalence and recognition of alcoholism on a general medical in-patient service. Summary of General Internal Medicine. 7. 38-45. 1992.
14 A. Deehan et al:
How do general practitioners manage alcohol misusing patients ? 1998. Drug and Alcohol Review Vol 17. No 3.