Addicted women: when your patient can't stop drinking, smoking, shopping, eating

While they do not necessarily present the same health risk, such other problems as compulsive shopping and eating have similarly serious implications for both physical and emotional health. All of these behaviors share a common theme reflecting difficulty with impulse control. In some cases, identifying patients with impulse control problems is straightforward; the pack of cigarettes or nicotine stains are easily visible, or the patient's weight can be measured in the office. Other problems, such as alcohol abuse or compulsive shopping, are less observable. To further compound the difficulty with identification is the fact that physicians may not ask routinely about the existence of such problems. Whether a practitioner inquires about the existence of these or other impulse control problems may be related to the difficulty one faces when the problem is finally identified. Addictive behaviors and impulse control disorders are notoriously difficult to treat. High relapse rates and the frustration of both patient and health care provider when efforts to change fail are a testimonial to the tenacity of these behaviors. Recent research highlighting how to meet patients at their level of readiness to change a risk-related behavior offers a perspective on what clinicians can do to assist their patients in approaching and ultimately changing these behaviors. The stages of change model will be described as a method for conceptualizing how behavior change can be facilitated in patients with these various problems. In addition, issues relevant to making a referral will be discussed.