Off target

Alcohol targets set by the previous government are not being met, is the message being sent out by researchers from the National Addiction Centre and St George's Hospital.* The aims set out in the Conservative government's "Health of the Nation", which have not been formally abandoned by Labour, state that the intention is to "reduce the proportion of men drinking more than 21 units of alcohol per week from 28 per cent in 1990 to 18 per cent by 2005, and the proportion of women drinking more than 14 units of alcohol per week from 11 per cent in 1990 to 7 per cent by 2005."

The researchers sent a questionnaire to a random sample of 20 per cent of all GPs in England and Wales. What emerges is not an "unwilling profession, but a profession lacking confidence. The provision of support and basic training are major factors in how GPs perceive alcohol misusers and their own role in this work." Despite the lack of adequate training for GPs in this field, it is generally accepted by the medical profession and the government that general practice is a suitable place for health promotional work.

The survey shows that there is currently a low rate of identification of patients drinking beyond the "sensible" limits. It appears that one reason for this is that GPs are recognising the more obvious cases - the chronic alcoholic or the self-presenting patient - but missing those with less visible symptoms or whose ostensible reasons for appearing in the surgery were unconnected with drinking. Another reason is the doctors' own attitude to the business of identifying actual or potential alcohol problems. The authors of the research say: "One of the main themes running through research is the negative perception GPs have of alcohol misusers and the efficacy of their work with them." The GPs' view of the adequacy of their local alcohol services influenced this perception. This was certainly the experience of one alcohol and drug counsellor when he opened a day rehabilitation programme in a market town where there had previously been no such service. He told Alert that local GPs had initially been sceptical but later showed themselves willing to listen and to observe. The result was that most of them not only referred patients whom they had diagnosed as needing treatment for dependency but also that their own skills at identifying problems were enhanced.

These patients, however, were severe drinkers. The researchers point out that "more effective strategies to promote greater GP attention to the detection of less severe drinkers must be identified if real progress towards the...targets is to be achieved."

It is twenty years since the last important piece of work in this field was done and the authors of this one find it "disappointing that, for a profession which recognises its potential to do this work, lack of training and lack of support are still so central to their continued low level of therapeutic commitment."

*Low detection rates, negative attitudes and failure to meet the "Health of the Nation" alcohol targets: findings from a national survey of GPs in England and Wales, Deeham et al., Drug and Alcohol Review, September, 1998.