Alcoholism: blocks to diagnosis and treatment.

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.