DILEMMAS IN IMPLEMENTING ALCOHOL-RELATED SECONDARY PREVENTION IN PRIMARY-CARE USING A BEHAVIORAL-METHOD

This is a report on experiences from a trial study, based on normal da ily routines, in which the aim was to study the feasibility of a simpl e method, grounded in behavioural science, of alcohol counselling in p rimary care, directed towards excessive drinkers. Physicians and nurse s were educated in the method in 1-day courses, followed by some tutor ial sessions. The evaluation showed that the method in itself seemed t o be suitable, functional and effective. At return visits, several pat ients reported that they had reduced their alcohol consumption, and mo st patients with initially high liver function test values showed a co nsistent decrease when new tests were made. However, only few potentia l patients were identified. The question is why the method was not use d to a greater extent. One reason may be that the prevalence of excess ive drinkers in primary care is lower than has been reported in previo us studies. Another explanation might be the difficulty of identifying possible excessive drinkers, in any significant numbers, in the clini cal situation at the health centre. One further reason might be the re luctance on the part of physicians and nurses to broach the subject of alcohol.