Alcohol Addiction | Approaching the problem drinker : Part Two

Asking about alcohol consumptions is a simple, import and frequently neglected activity. Screening questionnaires can be useful, and the CAGE Questionnaire is short and can be a conversation starter. One of the factors affecting treatment can be that taking a history can raise issues for the health professional. Addictions are but one area of sensitivity – is it something to do with yourself or do you fear antagonism from the patient? The skilled clinician has learnt the art of history taking and understands a little of their own counter-transference’s – feeling and personal issues that they bring to the consultation. For example, if one of your parents died of alcoholism it will have an impact  on the way you practice and your relationship with alcoholic patients. The therapeutic relationship is highlighted as warranting particular attention with such patients.

There are many layers of treatment – support, practical advice and guidance as well as the development of an inner understanding. Simply discussing the subject can have a considerable impact. “We are not about curing people, we are about helping people change. Let’s try and achieve a little and for some patients that is a lot”. Thus stage one (precontemplation), getting them to think about their drinking, would constitute a successful conclusion to a consultation. Stages of change is a useful model to frame your treatment plan.

The severely dependent and those with additional psychological, social or physical problems benefit from an initial stay in hospital. The impact of simply providing asylum should not be neglected. In-patient programmes are usually based on educational material and identification with other group members. Planning for after-care is a critical part of the treatment. Self help groups can be a considerable source of help, the best being non-judgmental, non-authoritarian and organised by the real experts – other patients.