Doctors and Drinkers: An Exploratory Study of the Therapeutic Commitment of General Practioners in Longford/Westmeath towards working with Problem Drinkers

Alcohol and alcohol related problems are the major public health issues in Ireland and in many other countries in the Western World. In Ireland, and internationally health policy makers have promoted the public health perspective on alcohol problems, incorporating a community response, an emphasis on primary care, and an active role for general practitioners in working with problem drinkers. The rationale for the involvement of general practitioners in this work is underpinned by a range of factors. The most important of these, are the reconceptualization of alcohol problems as a broad spectrum disorder, the evidence that patients with alcohol problems visit thengeneral practitioner more often than other patients, and the evidence for the relative effectiveness of brief interventions, by general practitioners in comparison to intensive specialist services. A number of barriers, both attitudinal and organizational have been identified, that affect the involvement of general practitioners with problem drinkers. Research evidence suggests that general practitioners have what is called low therapeutic commitment towards working with drinkers, because of lack of counselling skills, knowledge, experience and support. The purpose of this exploratory study, was to establish the level of therapeutic commitment of 35 general practitioners, members of the Irish College of General Practitioners in Longford/Westmeath towards working with problem drinkers using the AAPPQ questionnaire (Cartwright 1978). The general practitioners were found to have low therapeutic commitment towards working with problem drinkers. Paradoxically the respondents felt they had the right to engage drinkers (role legitimacy) and that they had the knowledge and skills (role adequacy) to carry out this work. Despite expressed feelings of role adequacy, respondents were found to have limited experience, training, education, and support in relation to alcohol problems. It is suggested that general practitioners need education training and support, in order to increase their therapeutic commitment towards working with problem drinkers. However the structural and situational constraints under which they work, represent major barriers to general practitioners receiving this education and trainin