General practitioners' management of problem drinkers - attitudes, knowledge and practice

There is evidence that GPs frequently fail to identify problem drinkers and many are ambivalent about treating them. This study investigated GPs' perceptions of the numbers of their patients with alcohol problems; how they diagnose problem drinkers and their knowledge and attitudes; GPs' perceived roles and part in management. Fifty GPs were interviewed. Reported rates of detection and treatment of problem drinkers were lower than expected, and referral was the most popular management strategy. Screening occurred most frequently at registration or was opportunistic. When characterizing and diagnosing alcohol misuse, GPs emphasized social rather than health or psychological problems. They found it easier to broach the subject of alcohol misuse when there was objective evidence of damage to health. Knowledge of the local alcohol services was good. Although most considered general practice an appropriate place to treat problem drinkers and nearly all believed it was legitimate to inquire about patients' drinking, 70% said they would like more training. Most of the GPs found work with problem drinkers unrewarding, and 40% admitted to not liking drinkers. Complaints of lack of time were frequent. These findings indicate little change since the late 1980s. More GPs appear to be screening patients for problem drinking, but few are themselves treating those identified. GPs need more training and support to manage these patients in general practice but a more realistic appraisal may be required of what GPs themselves can provide.