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Brief Interventions for Problem Drinking: Another Piece of the Puzzle

Patrick G. O'Connor, MD, MPH
[+] Article, Author, and Disclosure Information

From Yale University School of Medicine, New Haven, Connecticut.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Patrick G. O'Connor, MD, MPH, Section of General Internal Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520; e-mail, patrick.oconnor@yale.edu.

Ann Intern Med. 2007;146(3):223-225. doi:10.7326/0003-4819-146-3-200702060-00012
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Problem drinking has been associated with a wide variety of serious health and social problems (1), along with more than 100 000 deaths per year and an annual economic cost of more than $180 billion in the United States alone (2). The impact of these problems has motivated leaders in government and science to support research on screening and treatment strategies for patients with problem drinking (3). On the basis of this research, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published recommendations for identifying patients with problem drinking and treating them individually according to their pattern of alcohol use (4). “At-risk” or “hazardous” drinkers are men who drink 5 or more drinks per day or 15 or more drinks per week and women who drink 4 or more drinks per day or 8 or more drinks per week. According to the NIAAA, about 3 in 10 U.S. adults drink at these risky levels and approximately 1 in 4 of these heavy drinkers meet DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for alcohol abuse or alcohol dependence (4).

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Brief Intervention in Alcoholism as a Paradigm for Where We Went Wrong
Posted on March 5, 2007
Mark Antony LaPorta
Independent Professor of Medicine, North Miami, FL
Conflict of Interest: None Declared

A long time ago, Dr. Osler told us to listen to the patient. He meant "sensitively." Sometimes we do, and we elicit issues that might have gone undetected with limitless technology or process. Other times, we don't listen or we can't hear.

While I must agree with Dr. O'Connor that the accompanying lead article was brilliantly conceived and precisely executed, however, the whole idea missed the main point: ask the happiest survivors of alcoholism and its consequences how they found a way to health and freedom. They will almost all tell you the same thing: someone told them about Alcoholics Anonymous and the Twelve Steps.

Essentially, my patients -- and members of many communities -- tell me that no matter how process-driven, thoughtful, well-intentioned, or even forceful a healthcare team member was, the professional intervener didn't have a chance until they simply made the referral to someone who'd already been through it and came out the other side. Active alcoholics -- connoted by the consequences of their own actions, and therefore scalable to many other addictive, behavioral, emotional and mental maladies -- cannot be made to "snap" into understanding because denial causes blindness, but may be able to agree to make one single visit to someone who has recovered. That is where their hope lies, one day at a time. Not in pills, despite a recent spate of attempts, and not in money,grants, formats, lectures, or our trained proxies. "Institutionalization" is a multidimensional and multifaceted hazard, especially to an idea.

In addition, any medical professional who puts that s/he has "no financial incentive" or conflicting issues, is, to put it politely, delusional.

Conflict of Interest:

None declared

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