Dilemmas in implementing alcohol-related secondary prevention in primary care using a behavioural method

This is a report on experiences from a trial study, based on normal daily routines, in which the aim was to study the feasibility of a simple method, grounded in behavioural science, of alcohol counselling in primary care, directed towards excessive drinkers. Physicians and nurses were educated in the method in 1-day courses, followed by some tutorial sessions. The evaluation showed that the method in itself seemed to be suitable, functional and effective. At return visits, several patients reported that they had reduced their alcohol consumption, and most patients with initially high liver function test values showed a consistent decrease when new tests were made. However, only few potential patients were identified. The question is why the method was not used to a greater extent. One reason may be that the prevalence of excessive drinkers in primary care is lower than has been reported in previous studies. Another explanation might be the difficulty of identifying possible excessive drinkers, in any significant numbers, in the clinical situation at the health centre. One further reason might be the reluctance on the part of physicians and nurses to broach the subject of alcohol.