A Two Year Study of Alcoholics in General Practice

Abstract

This study attempts to evaluate the feasibility of a family doctor diagnosing and treating all the patients with a drinking problem in his London practice. Patients were selected from an ongoing register of suspected pathological drinkers. In a practice population of 9,108 patients, 134 names were on the register in April 1972, and 61 were added to it during the two subsequent years. 133 patients underwent a full assessment for alcoholism with details of personal, social, medical and drinking history and including a physical examination and biochemical profile. 69 patients (51·8%) of the sample were diagnosed as alcoholics on evidence of physical, mental, personal, familial and social harm due to alcohol abuse. 37 of them (53·6%) also had a history of physical dependence on alcohol. 32 (46·4%) had no history of dependence. They all shared a wide spectrum of physical, social and psychiatric pathology. Treatment was offered by the same family doctor and a research worker. Patients were seen in a series of short therapeutic sessions with more lengthy re-assessment at six-monthly intervals. Relatives were involved. Attendance rates were unsatisfactory in 23·2% of cases. During the two year period of the study (1972–1974), patients were visited at home at regular intervals by the research worker. Based on information and impressions of the general practitioner, his partners, his research assistant and relatives, treatment was evaluated at the end of the study. 11 patients (19·3%) remained sober for two years, 26 (45·6%) had improved, 20 (35·1%) were left unchanged. Only 3 patients had sought help or found help from any treatment agency outside general practice and none were known to them. It is concluded that the majority of alcoholics can be identified and treated by the family doctor, who has a vital role in the prevention and treatment of alcoholics in the community.