Clark W D
Am J Med. 1981 Aug;71(2):275-86. doi: 10.1016/0002-9343(81)90129-7.
Physicians fail to recognize alcoholism if patients do not attribute their suffering to drinking problems. Underutilization of logical diagnostic strategies reflects lack of knowledge of the multitude of presentations of alcoholism, as well as lack of supervised experience with patients who are unable to be forthright about problems because of psychologic and cognitive impairments due to the illness process and to toxic effects of alcohol. Negative attitudes of both physician and patient inhibit the establishment of a partnership and the setting of treatment goals. Difficulties arise from unspoken agreement to not accept or confront the diagnosis, to ignore the need for assistance, and to downplay abstinence from alcohol and tranquilizers. We present herein a rational framework for understanding typical diagnostic problems. We discuss accepted counselling principles and their usefulness in the approach to alcoholic patients. Diagnostic acumen and patient management are easily improved, and physicians need not feel hopeless and helpless when faced by alcoholism problems.
如果患者不将自己的痛苦归因于饮酒问题，医生就无法识别酒精中毒。逻辑诊断策略未得到充分利用，这反映出对酒精中毒多种表现形式缺乏了解，以及缺乏对因疾病进程和酒精毒性作用导致心理和认知障碍而无法坦诚面对问题的患者的监督经验。医生和患者的消极态度都抑制了伙伴关系的建立和治疗目标的设定。困难源于双方默契地不接受或面对诊断、忽视寻求帮助的必要性以及淡化戒酒和停用镇静剂的重要性。我们在此提出一个理解典型诊断问题的合理框架。我们讨论公认的咨询原则及其在治疗酒精中毒患者中的作用。诊断敏锐度和患者管理很容易得到改善，医生在面对酒精中毒问题时不必感到绝望和无助。
