General practice involvement in the management of alcohol misuse: dynamics and resistances

While there is a growing body of empirical evidence to suggest that the types of interventions which General Practitioners (GPs) could offer patients with potential or established alcohol problems are effective, there are still, in practice, many barriers to the treatment of alcohol problems in the primary care setting. These barriers are both practical and attitudinal in nature and stem from GPs, patients, the operational practices, and the ethos of the primary healthcare system itself. GPs, for example, may have difficulty arriving at a diagnosis of alcohol problems. Many believe that they have neither the skills nor the expertise required to deal with such problems. Patients are often reluctant to seek help for alcohol problems and may question the appropriateness of GP treatment. Situational barriers include the already heavy workload of the GP. Barriers such as these are reviewed and recommendations about the ways in which they might be overcome are outlined.