Handling Alcoholic Patients Essay Sample

DIFFICULTIES INVOLVED IN
DEALING WITH ALCOHOLIC
PATIENTS IN PRIMARY CARE
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This essay is prepared with an aim to investigate into the difficulties arises while dealing
with alcoholic patients in primary care in Europe. In this context, the researcher will evaluate the
issues concerned with doctors in tackling the psychological character of alcoholic patients.
Moreover, the discussion will provide how doctors motivate such patient to recover from their
lethal conditions. In spite of declining in the wine-producing nations, Europe remains the
province on the globe with largest production as well as consumption of alcoholic beverages
along with commensurately more levels of harm related to alcohol. In the survey of North
America it was found that over 4.5% of women and 23% of men are involved in the alcohol use
or dependence throughout their lifetime. The country is about the middle of the worldwide
league of intoxicating consumption. Thus, in all European Union’s member states the alcoholic
harms are considered as a major public health problem. The use of alcohol and its harm are
increasing sharply in the some recently independent regions of Eastern Europe (Taylor and
Oberman, 2006).
There can be both social and health problems related to alcohol. Some dangers linked
with alcohol obtain from long-term heavy consumption and some from acute intoxication. There
are lots of psychological, social and medical issues connected with alcohol dependence. All
kinds of issues subsist in unstable degrees of relentlessness. Overall, 9% of total diseases are due
to alcohol products in the WHO European Region as well as 40-60% of deaths from
unintentional and intentional injury is attributable to alcohol. Potentially doctors are not just
providers of care for patients concerned with alcoholic problems; rather they are also regarded as
“gatekeepers” into the services of treatment and usually the leaders of involved multidisciplinary
teams (Baum, 2007). Moreover, doctors worked as advocates for alcoholic issues treatment and
prevention within the health services. Alcohol invades on a series of medical specialists, such as
emergency and accident, general surgery, general medicine, dermatology, cardiology, obstetrics,
neurology, gynaecology, geriatrics, paediatrics, biochemistry, hematology, toxicology,
psychiatry, pathology, etc. About 42 millions of adults in the European Union are dependence
through some period of their lives and experience alcohol abuse. If the hypothesis will make that
every drinker negatively affect only one other person then 94 millions of Europeans will
experience severe problems from either another’s or their own drinking (Thompson, 2007).

In clinical settings, individuals with alcohol related problems appear in huge number.
Problem drinkers make consultation with family doctors just about twice as regular as matched
controls, particularly due to acute injuries and psychological problems. The children as well as
partners of problem drinkers are also excessively important clients of social or health services.
Globally, in primary care settings about 10-20% of patients are seen with alcohol issues. Further,
there is also more existence of alcohol dilemmas in secondary health care. In several European
countries, high prevalence rates of alcoholic patients are reported and thus, doctors are well
positioned to find out alcoholic addicted patients. Not only frequent family members and
children of problem drinkers consult with a doctor, however, they also expect doctors to ask
them for their alcohol consumption (Pratten, 2009).
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In a seminal study of society agents, together with doctors, three factors are identified by
the researchers that are influencing their emotional and intellectual attentiveness to work with

problem drinkers. This attentiveness was referred as Therapeutic Commitment as well as its
absence or presence was determined through: role adequacy, role support and role legitimacy.
Role legitimacy is the belief that patients received their right to ask questions regarding drinking
when necessary. Role adequacy is the belief that agents possessed enough knowledge to perform
the supporting role while working with problem drinkers. Role support is the confidence that
they can attain expert assistance and advice when required (Hewitt, 2012).
Low therapeutic commitment was described by an exact avoidance pattern of problem
drinkers. It can take the form of refusing their survival in the caseload or of failing to identify
patients with problems of alcohol, at least until the issues had arrived at such an advanced stage
as to be undeniable and unmistakable. Several other avoidance tactics comprised getting rid of
drinkers, for instance through referring them to another agency, in relation to their drinking
dilemmas as irreversible and blaming drinkers for missing the motivation to change their
behaviour. The leading aspect of this negative response was a marked hopeless and therapeutic
pessimism, which is the belief that there was little point in trying to recognize individual with
alcohol issues, due to the reason they did not actually want and would not benefit from the
support or assistance provided (Griffiths, 2006).
On the contrary agents with more of degree of therapeutic commitment did not keep
away from handling problem drinkers or they even don't fail to identify the symptoms and signs
of alcohol issues. They did not consider problem drinkers as ominous to their self-esteem or
professional competence. They were organized to ask germane questions and believed to their
intervention was valuable that advantageous change was possible. Those individual’s with more
degree of therapeutic dedication shared a range of characteristics, such as they had role support
available to them and they were proficient in working with drinkers (Jethwa, 2009). In addition
to this, these doctors had attained training in counselling, in which the more hours they received
the training, the less nervousness in relation to their role legitimacy and role adequacy.
Moreover, such professionals have clinical knowledge of alcohol and alcohol problems. The key
parts of their clinical knowledge are the alcohol effects on the individual drinker, for instance,
how to identify symptoms of acute withdrawal, the social or physical outcomes of excessive
drinking and patterns of behavioural characteristic of more tolerance (Panagaria, Varma,
Nijhawan and Rai, 2010).

These aspects are interconnected. Specifically, one of the most essential results of this
study was that in those with only narrow experience of working with drinkers problems, the
ownership of even quite considerable alcohol knowledge and alcohol issues did not lessen
anxieties regarding their role adequacy
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In some nations, during years of clinical training, the total time devoted to alcohol
problems study amounts to a few hours. The type as well as the amount of education given tends
to vary from one medical institution to another, on the basis of interests and commitments of
individual teachers. Presently, only some nations have been taken appropriate steps to integrate
education with regards to alcohol issues into the main curriculum. In general, though, it remains
optional and without the actual requirement to attain approved standards. Thus, across the
European Union, it is still feasible for individuals to qualify as well as practice as health
professionals without having attained or being required to demonstrate an adequate competence
level in relation to substance abuse (Hinshelwood, 2012).

In view of earlier neglect, alcohol problems and substance misuse should now be taken as
priority in clinical education and be provided a higher profile in the basic curriculum at every
level, such as postgraduate, undergraduate and continuing medical education. There is a need to
embrace corresponding, multi-disciplinary approaches that address lifelong learning. In order to
advance this agenda, options are presently available in several European nations by two
interconnected developments. The first one is health reforms, i.e. various countries are increasing
the orientation of primary care along with their health system's input (Lowe, 2001). It is
generally associated with an enhanced importance of health promotion, early detection of alcohol
problems and encouraging activities related to the prevention. Such activities often consist of
multi-disciplinary team-working. The second is a medical education reform, which means that
undergraduate curricula in several nations are becoming more community oriented as well as
comprise higher primary care together with common practice input. Continuing medical
education and postgraduate are identifying the significance of practice-based education, multi-disciplinary
learning and lifelong learning (Ormrod, 2009).
There is an obvious case for incorporating alcohol in a wider syllabus in relation with
substance abuse, especially as alcohol issues are often connected with illegal drug abuse or
prescribed drugs and tobacco, particularly in younger patients. On the alcohol dilemmas,
education is facilitated by the development of and assistance for academic units of Addiction
Behaviour, specifically those with a Chair of Habit. These have been made known to be coupled
with the most wide-ranging services of alcohol treatment, the most training opportunities of
postgraduates and average or above average medical school training (Goroll and Mulley, 2012).
On the other hand, while courses and approaches concerned with the substance misuse and
addictions in general have much to suggest them, it is suggested that in nations, such as Italy it
might be imprudent to combine issues of alcohol entirely into a substance misuse framework. It
is due to alcohol being seen as an integral element of the diet and thus alcohol consumption
having a particular cultural meaning, which is very distinct from that connecting to other types of
substance misuse. There is abundant evidence that although comparatively it is simple to design
educational programs to enhance knowledge and inspire or change attitudes, it is more critical to
affect real behaviour. Therefore, it is significant for evaluation to be an inherent feature of

training and education programs (Health Care Needs Assessment: The Epidemiologically Based
Needs Assessment Reviews, 2004).
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The last is the capability to interpret accurately laboratory tests and the knowledge to
choose a perfect management plan along with the direction or management of the patient’s
detoxification at home (Robinson, Gould and Strosahi, 2011).
It is suggested that required competencies also comprise counselling skills. The proposal
of WHO also acknowledges but provides inappropriate weight to the family factors of alcohol
dilemmas. In the settings of primary care, it might well be the child or partner of the problem
drinkers who is the patient. Furthermore, children and partner could be severely harmed by the
problem drinkers and require support in their own right. The “Audit” questionnaire has been
created as a cross national test instrument for the early diagnosing of the harmful drinking that
also identifies alcohol dependence with a more degree of accuracy. Audit is constant with ICD-
10 disorders definitions because of psychoactive substance misuse. One more factor that needs
specific concentration is the capability of doctor’s to tailor his/her approach to the patient’s
willingness to act in response. The renowned “cycle of change” model gives a basis for deciding

the suitability of specific intervention on the basis of patient’s stage in the process of recovery
(Oxford Textbook of Primary Medical Care, 2004).
Individuals who are not taking into consideration change in their behaviour of the
problem are defined as pre-contemplators. On the stage of contemplation, people begin to
acknowledge that they an issue and to consider the costs and feasibility of changing their
behaviour. As they grow, they shift on to the stage of determination, where the decision is made
to take change as well as action. Once individuals begin to alter the issue behaviour, they enter
on the stage of action that generally continues for three to six months. After effectively
negotiating the stage of action, they shift to sustain or maintenance change. If such efforts fall
short, a relapse takes place and the individual begins to the other cycle. There is excellent
evidence that numerous heavy drinkers benefit from a simple recommendation from their health
specialist with regards to their behaviour of drinking. In the hospital and primacy care setting
brief intervention has been shown to be effective in lessening harmful drinking, specifically in
men (Ries and et. al. 2009).
However, some patients, especially those showing some level of dependence and not yet
having reached at the stage where they identified that their drinking is problematical or that there
is a great need to alter, might be more resistant to advice. Such patients are at the stage of “pre-contemplative”.
At this level, the primary task is to elicit their attitudes and views as well as to
give information related to the risks connected with their present consumption level. For these
patients and even for others, an essential task is to stress self-responsibility and to make it clear
that the responsibility lies with them to make the essential changes and decisions (Trends in
Alcohol Abuse And Alcoholism Research, 2006). This kind of motivational interviewing
approach might well need special concentration in programs of training, as it represents a
compulsory departure from a traditional concept of the role of doctors. However, this conversion
from curer to the counsellor is justified by the evidence on the intervention's effectiveness with
regards to the addictive behaviours. The significant mechanism of the motivational interviewing
approach have been well summarized with the acronym FRAMES. The acronym stands for
feedback for the impairment and personal harm risk, stress individual responsibility for making
changes, advice to stop drinking or cut down as suitable, provide a menu of altering tactics for
changing patterns of drinking, empathetic interviewing style and self efficacy, i.e. leaving the

patient increased in feeling capable to cope with the objectives, which they have agreed (Florida
Wrongful Death Case: Hit-And-Run, 2010).
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REFERENCES
Online
Florida Wrongful Death Case: Hit-And-Run. 2010. [Online]. Available through:
<http://www.ihlaw.com/press-room/florida-wrongful-death-case-hit-and-run/>.
[Accessed on 29 April 2013].
Freeman, D., 2013. Alcohol Abuse Health Center. [Online]. Available through:
<http://www.webmd.com/mental-health/alcohol-abuse/features/12-health-risks-of-chronic-
heavy-drinking>. [Accessed on 29 April 2013].
Meighan, S. S., 2013. Why primary care physicians avoid treating alcoholics. [Online].
Available through: <http://www.acpinternist.org/archives/1999/04/alcohol.htm>.
[Accessed on 29 April 2013].
Smith, M., Robinson, L. and Segal, J., 2012. Alcoholism and Alcohol Abuse. [Online]. Available
through:
<http://www.helpguide.org/mental/alcohol_abuse_alcoholism_signs_effects_treatment.ht
m>. [Accessed on 29 April 2013].
Books
Baum, M., 2007. D. D. A. D.: (Don't Drink and Drive Or This Could Be You). AuthorHouse.
Goroll, A. H. and Mulley, A. G., 2012. Primary Care Medicine: Office Evaluation and
Management of the Adult Patient. 6th ed. Lippincott Williams & Wilkins.
Health Care Needs Assessment: The Epidemiologically Based Needs Assessment Reviews. 2004.
2nd ed. Radcliffe Publishing.
Oxford Textbook of Primary Medical Care. 2004. Oxford University Press.
Ries, R. K. and et. al. 2009. Principles of addiction medicine. 4th ed. Lippincott Williams &
Wilkins.
Robinson, P. J., Robinson, P. and Reiter, J. T., 2007. Behavioral consultation and primary care.
Springer.
Robinson, P., Gould, D. and Strosahi, K., 2011. Real Behavior Change in Primary Care:
Improving Patient Outcomes and Increasing Job Satisfaction. New Harbinger
Publications.
Taylor, L. and Oberman, S., 2006. Drunk Driving Defense. 6th ed. Aspen Publishers Online.
The guide to mental health for nurses in primary care. 2002. Radcliffe Publishing.
Thompson, T., 2007. Drunk Driving At Issue Series, At issue: Crime. Greenhaven Pr.

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Handling Alcoholic Patients Essay Sample

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