Asking about drinking
Bringing Up the Touchy Subject of a Patient’s Drinking
Broaching the subject of alcohol with a patient or client who shows signs of a drinking problem can be awkward. Drinkers often feel ashamed of their problem, at the same time that they downplay its seriousness. Directly confronting them may do no more than provoke a flat denial. For these reasons professionals very often steer clear of the matter. But to wait for that patient or client to bring up the subject amounts to giving up on the issue, according to some with first-hand experience in the matter.
“In 30 years of practice it almost never happens that someone comes in and announces that they have a problem with alcohol,” says Carvel Taylor-Valentine, a licensed clinical social worker.
“Patients would rather that their problems are about anything other than alcohol or drugs. They would rather admit to some kind of mental illness, even schizophrenia, than to call themselves an alcoholic.”
The reason for this, says Ms. Taylor-Valentine, who is a certified addictions counselor, is simple: “They don’t want to stop drinking. Alcohol is a feel-good substance, and they are afraid of giving it up.”
Marsha Epstein, M.D., medical director, Tucker Health Center, a unit of the Los Angeles Department of Public Health, agrees.
“No one is quick to admit to current problems with alcohol or drugs. When I was in private practice years ago, I saw about 2,000 patients over four and a half years and none ever admitted current heavy drinking.”
Dr. Epstein, who also has a master’s degree in public health, remembers a phone call from the daughter of a woman patient disclosing that the mother drank alcoholically. “I believed the daughter, but I never brought up any problem with alcohol to her mother. I did not know how.”
Both Dr. Epstein and Ms. Taylor-Valentine have found that the information forms filled out by new patients are the best place to introduce questions about drinking problems, especially if the questions are about alcohol abuse in a patient’s family.
“It was at a medical conference that I was introduced to a woman who was a member of Al-Anon and who told me about that program,” says Dr. Epstein. [Al-Anon is a Twelve Step program for those who have problem drinkers in their lives.] “When I returned from that conference, I added a question about drinking problems among family members to the medical history forms filled out by patients.”
Happy to Discuss Anyone Else’s Drinking
Whereas practically no patient would talk about their drinking problem, “lots admitted that they had family members who drank too much,” says Dr. Epstein. Nowadays, when the conversations get to a patient’s drinking, Dr. Epstein says, “instead of asking if someone has a problem with alcohol, I ask when was the last time they overdid it. Not asking specific questions is a mistake.”
When a patient opens up about their alcohol abuse, Dr. Epstein steers them to Alcoholics Anonymous. “Here’s the number for A.A. meetings - just go. You don’t have to say anything, and you can sit in the back.”
Back in her time in private practice, Dr. Epstein also made use of Al-Anon. “If they checked ‘yes’ on that question about a family drinking history, I would suggest they go to an Al-Anon meeting and come back and tell me how it was.”
What Dr. Epstein discovered was that some of her patients found their way to Alcoholics Anonymous through Al-Anon.
“Over the course of a few years, five patients who had gone to Al-Anon returned to tell me that they discovered in that program that they had a problem with alcohol. I suspect there were many others who got to A.A. through Al-Anon. It never occurred to me that it would work this way.”
From; About AA; A newsletter for professionals, Spring 2007. www.AA.org
Dilemma of the Alcoholic Marriage
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