Tuesday, October 7, 2008

Doctors can't treat your drinking problem

The rise in alcohol abuse should be a matter for social policy not the GP's surgery

‘Your GP is the first place to turn if you are concerned about your drinking.’ This was the concluding advice of a recent eight-page Guardian supplement devoted to ‘Britain’s harmful relationship with alcohol’. Once regarded as a manifestation of moral turpitude, excessive drinking is now defined as a medical condition. GPs have taken the place of evangelical ministers at the head of the modern temperance crusade. The fact that these same doctors come second only to publicans in terms of death from alcohol-induced cirrhosis of the liver has not diminished medical authority in this area.

The rise of GPs in dealing with alcohol problems is based on claims for the effectiveness of ‘brief interventions’. This means doctors giving patients a quick, but empathetic, lecture on the adverse health consequences of alcohol before advising them to stop. But close scrutiny of these studies reveals that their high success rates are achieved at a cost. They exclude patients who are alcohol dependent (including only those deemed to have ‘hazardous’ levels of drinking). They follow up for a short period (usually less than 12 months). And they define success in terms of a reduction in total consumption or episodes of binge drinking (rather than achieving abstinence).

If doctors suggest to patients drinking over the odds that they should consider cutting back, they do, for a while, before resuming their old habits. A desperate resort to old-fashioned medical paternalism? – yes. A solution to ‘Britain's harmful relationship with alcohol’? – no.

Prominent doctors and medical organisations instinctively recognise the ineffectiveness of medical intervention – and indeed of medical treatment. They have campaigned for prohibitionist measures to deal with excessive drinking. No newspaper or television feature on alcohol is now complete without a leading liver specialist, psychiatrist or GP demanding more regulations on the sale of alcohol. They call for banning advertising, raising prices and for tougher policing of licensing laws. But if doctors cannot treat alcoholism in their surgeries, why should anybody accept their proposals in the sphere of social policy? After all, they have no expertise there whatsoever.

The notion that doctors can treat the nation’s alcohol problem is a delusion that is convenient for the medical profession and for politicians eager to respond to the latest moral panic. But it marks an evasion of the real issues. Self-destructive patterns of alcohol consumption express personal and social demoralisation. This is not susceptible to medical – or political – quick-fixes.
source: The Times

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