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. 1998 Nov;48(436):1779–1782.

Tackling alcohol misuse: opportunities and obstacles in primary care.

A Deehan 1, E J Marshall 1, J Strang 1
PMCID: PMC1313273  PMID: 10198489

Abstract

Alcohol misuse is a major public health issue. Primary care has been recognized as an ideal setting for the health promotional activity needed to reduce the general population's alcohol consumption. This paper explores the background to the current belief that primary care is suitable for this work by examining the evidence of the potentially successful interventions the general practitioner (GP) can undertake with alcohol misusing patients, GPs' attitudes towards this work, and the impediments that exist. Computer searches of the MEDLINE database up to 1997 and a manual literature search of the bibliographies of published papers that were identified as relevant were carried out. Research points to GP interventions being effective, but it also provides evidence of their negative attitudes. It concludes that more training and support from local services are needed if primary care is to meet its rich potential.

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Selected References

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  1. Anderson P. Effectiveness of general practice interventions for patients with harmful alcohol consumption. Br J Gen Pract. 1993 Sep;43(374):386–389. [PMC free article] [PubMed] [Google Scholar]
  2. Anderson P. Managing alcohol problems in general practice. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1873–1875. doi: 10.1136/bmj.290.6485.1873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Anderson P. Primary care physicians and alcohol. J R Soc Med. 1992 Aug;85(8):478–482. doi: 10.1177/014107689208500818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Anderson P., Scott E. The effect of general practitioners' advice to heavy drinking men. Br J Addict. 1992 Jun;87(6):891–900. doi: 10.1111/j.1360-0443.1992.tb01984.x. [DOI] [PubMed] [Google Scholar]
  5. Backett K., Davison C., Mullen K. Lay evaluation of health and healthy lifestyles: evidence from three studies. Br J Gen Pract. 1994 Jun;44(383):277–280. [PMC free article] [PubMed] [Google Scholar]
  6. Bauman A., Mant A., Middleton L., Mackertich M., Jane E. Do general practitioners promote health? A needs assessment. Med J Aust. 1989 Sep 4;151(5):262, 265-9. [PubMed] [Google Scholar]
  7. Boulton M. G., Williams A. Health education in the general practice consultation: doctors' advice on diet, alcohol and smoking. Health Educ J. 1983;42(2):57–63. doi: 10.1177/001789698304200211. [DOI] [PubMed] [Google Scholar]
  8. Buchan I. C., Buckley E. G., Deacon G. L., Irvine R., Ryan M. P. Problem drinkers and their problems. J R Coll Gen Pract. 1981 Mar;31(224):151–153. [PMC free article] [PubMed] [Google Scholar]
  9. Cooper C. L., Rout U., Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989 Feb 11;298(6670):366–370. doi: 10.1136/bmj.298.6670.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Coulter A., Schofield T. Prevention in general practice: the views of doctors in the Oxford region. Br J Gen Pract. 1991 Apr;41(345):140–143. [PMC free article] [PubMed] [Google Scholar]
  11. Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. doi: 10.1001/jama.274.9.700. [DOI] [PubMed] [Google Scholar]
  12. Deehan A., Taylor C., Strang J. The general practitioner, the drug misuser, and the alcohol misuser: major differences in general practitioner activity, therapeutic commitment, and 'shared care' proposals. Br J Gen Pract. 1997 Nov;47(424):705–709. [PMC free article] [PubMed] [Google Scholar]
  13. Durand M. A. General practice involvement in the management of alcohol misuse: dynamics and resistances. Drug Alcohol Depend. 1994 Jun;35(3):181–189. doi: 10.1016/0376-8716(94)90072-8. [DOI] [PubMed] [Google Scholar]
  14. Edwards G., Orford J., Egert S., Guthrie S., Hawker A., Hensman C., Mitcheson M., Oppenheimer E., Taylor C. Alcoholism: a controlled trial of "treatment" and "advice". J Stud Alcohol. 1977 May;38(5):1004–1031. doi: 10.15288/jsa.1977.38.1004. [DOI] [PubMed] [Google Scholar]
  15. Fullard E., Fowler G., Gray M. Facilitating prevention in primary care. Br Med J (Clin Res Ed) 1984 Dec 8;289(6458):1585–1587. doi: 10.1136/bmj.289.6458.1585. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hannay D., Usherwood T., Platts M. Workload of general practitioners before and after the new contract. BMJ. 1992 Mar 7;304(6827):615–618. doi: 10.1136/bmj.304.6827.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Heather N., Campion P. D., Neville R. G., Maccabe D. Evaluation of a controlled drinking minimal intervention for problem drinkers in general practice (the DRAMS scheme). J R Coll Gen Pract. 1987 Aug;37(301):358–363. [PMC free article] [PubMed] [Google Scholar]
  18. Howie J. G., Porter A. M., Forbes J. F. Quality and the use of time in general practice: widening the discussion. BMJ. 1989 Apr 15;298(6679):1008–1010. doi: 10.1136/bmj.298.6679.1008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Jamrozik K., Fowler G. Anti-smoking education in Oxfordshire general practices. J R Coll Gen Pract. 1982 Mar;32(236):179–183. [PMC free article] [PubMed] [Google Scholar]
  20. Kahan M., Wilson L., Becker L. Effectiveness of physician-based interventions with problem drinkers: a review. CMAJ. 1995 Mar 15;152(6):851–859. [PMC free article] [PubMed] [Google Scholar]
  21. Kerwick S., Jones R., Mann A., Goldberg D. Mental health care training priorities in general practice. Br J Gen Pract. 1997 Apr;47(417):225–227. [PMC free article] [PubMed] [Google Scholar]
  22. Killoran A., Calnan M., Cant S., Williams S. Pacemaker. Health Serv J. 1993 Feb 18;103(5340):26–27. [PubMed] [Google Scholar]
  23. Mayfield D., McLeod G., Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974 Oct;131(10):1121–1123. doi: 10.1176/ajp.131.10.1121. [DOI] [PubMed] [Google Scholar]
  24. Meyers D. Letter from Darjeeling: The going is still good. Br Med J. 1979 Aug 4;2(6185):321–322. doi: 10.1136/bmj.2.6185.321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Morrell D. C., Evans M. E., Morris R. W., Roland M. O. The "five minute" consultation: effect of time constraint on clinical content and patient satisfaction. Br Med J (Clin Res Ed) 1986 Mar 29;292(6524):870–873. doi: 10.1136/bmj.292.6524.870. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Mowbray A., Kessel N. Alcoholism and the general practitioner. Br J Psychiatry. 1986 Jun;148:697–700. doi: 10.1192/bjp.148.6.697. [DOI] [PubMed] [Google Scholar]
  27. Myerson S. The doctor's health. Under stress? Practitioner. 1990 Nov;234(1496):973–976. [PubMed] [Google Scholar]
  28. Persson J., Magnusson P. H. Early intervention in patients with excessive consumption of alcohol: a controlled study. Alcohol. 1989 Sep-Oct;6(5):403–408. doi: 10.1016/0741-8329(89)90011-6. [DOI] [PubMed] [Google Scholar]
  29. Pill R. M., Jones-Elwyn G., Stott N. C. Opportunistic health promotion: quantity or quality? J R Coll Gen Pract. 1989 May;39(322):196–200. [PMC free article] [PubMed] [Google Scholar]
  30. Reid A. L., Webb G. R., Hennrikus D., Fahey P. P., Sanson-Fisher R. W. Detection of patients with high alcohol intake by general practitioners. Br Med J (Clin Res Ed) 1986 Sep 20;293(6549):735–737. doi: 10.1136/bmj.293.6549.735. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Robertson C. Alcohol--a public health problem. Is there a role for the general practitioner? J R Soc Med. 1990 Apr;83(4):232–236. doi: 10.1177/014107689008300410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Roche A. M. Drug and alcohol medical education: evaluation of a national programme. Br J Addict. 1992 Jul;87(7):1041–1048. doi: 10.1111/j.1360-0443.1992.tb03122.x. [DOI] [PubMed] [Google Scholar]
  33. Rohman M. E., Cleary P. D., Warburg M., Delbanco T. L., Aronson M. D. The response of primary care physicians to problem drinkers. Am J Drug Alcohol Abuse. 1987;13(1-2):199–209. doi: 10.3109/00952998709001509. [DOI] [PubMed] [Google Scholar]
  34. Romelsjö A., Andersson L., Barrner H., Borg S., Granstrand C., Hultman O., Hässler A., Källqvist A., Magnusson P., Morgell R. A randomized study of secondary prevention of early stage problem drinkers in primary health care. Br J Addict. 1989 Nov;84(11):1319–1327. doi: 10.1111/j.1360-0443.1989.tb00733.x. [DOI] [PubMed] [Google Scholar]
  35. Saunders J. B., Foulds K. Brief and early intervention: experience from studies of harmful drinking. Aust N Z J Med. 1992 Apr;22(2):224–230. doi: 10.1111/j.1445-5994.1992.tb02818.x. [DOI] [PubMed] [Google Scholar]
  36. Scott E., Anderson P. Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug Alcohol Rev. 1991;10(4):313–321. doi: 10.1080/09595239100185371. [DOI] [PubMed] [Google Scholar]
  37. Selzer M. L. The Michigan alcoholism screening test: the quest for a new diagnostic instrument. Am J Psychiatry. 1971 Jun;127(12):1653–1658. doi: 10.1176/ajp.127.12.1653. [DOI] [PubMed] [Google Scholar]
  38. Shute P. A. Patients' alcohol drinking habits in general practice: prevention and education. J R Soc Med. 1988 Aug;81(8):450–451. doi: 10.1177/014107688808100810. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Stanley I., al-Shehri A., Thomas P. Continuing education for general practice. 1. Experience, competence and the media of self-directed learning for established general practitioners. Br J Gen Pract. 1993 May;43(370):210–214. [PMC free article] [PubMed] [Google Scholar]
  40. Strong P. M. Doctors and dirty work--the case of alcoholism. Sociol Health Illn. 1980 Mar;2(1):24–47. doi: 10.1111/1467-9566.ep11340296. [DOI] [PubMed] [Google Scholar]
  41. Sullivan D. Opportunistic health promotion: do patients like it? J R Coll Gen Pract. 1988 Jan;38(306):24–25. [PMC free article] [PubMed] [Google Scholar]
  42. Sutherland V. J., Cooper C. L. Job stress, satisfaction, and mental health among general practitioners before and after introduction of new contract. BMJ. 1992 Jun 13;304(6841):1545–1548. doi: 10.1136/bmj.304.6841.1545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Thom B., Téllez C. A difficult business: detecting and managing alcohol problems in general practice. Br J Addict. 1986 Jun;81(3):405–418. doi: 10.1111/j.1360-0443.1986.tb00347.x. [DOI] [PubMed] [Google Scholar]
  44. Wallace P. G., Brennan P. J., Haines A. P. Are general practitioners doing enough to promote healthy lifestyle? Findings of the Medical Research Council's general practice research framework study on lifestyle and health. Br Med J (Clin Res Ed) 1987 Apr 11;294(6577):940–942. doi: 10.1136/bmj.294.6577.940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Wallace P. G., Haines A. P. General practitioner and health promotion: what patients think. Br Med J (Clin Res Ed) 1984 Sep 1;289(6444):534–536. doi: 10.1136/bmj.289.6444.534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Wallace P., Cremona A., Anderson P. Safe limits of drinking: general practitioners' views. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1875–1876. doi: 10.1136/bmj.290.6485.1875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Wallace P., Cutler S., Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ. 1988 Sep 10;297(6649):663–668. doi: 10.1136/bmj.297.6649.663. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Weinberg A., Andrus P. L. Continuing medical education: does it address prevention? J Community Health. 1982 Spring;7(3):211–214. doi: 10.1007/BF01325516. [DOI] [PubMed] [Google Scholar]
  49. Weller D. P., Litt J. C., Pols R. G., Ali R. L., Southgate D. O., Harris R. D. Drug and alcohol related health problems in primary care--what do GPs think? Med J Aust. 1992 Jan 6;156(1):43–48. [PubMed] [Google Scholar]

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