Still a difficult business? Negotiating alcohol-related problems in general practice consultations
Open accessAbstract
This paper describes general practitioners' (GPs) experiences of detecting and managing alcohol and alcohol-related problems in consultations. We undertook qualitative research in two phases in the North-East of England. Initially, qualitative interviews with 29 GPs explored their everyday work with patients with alcohol-related issues. We then undertook group interviews--two with GPs and one with a primary care team--where they discussed and challenged findings of the interviews. The GPs reported routinely discussing alcohol with patients with a range of alcohol-related problems. GPs believed that this work is important, but felt that until patients were willing to accept that their alcohol consumption was problematic they could achieve very little. They tentatively introduced alcohol as a potential problem, re-introduced the topic periodically, and then waited until the patient decided to change their behaviour. They were aware that they could identify and manage more patients. A lack of time and having to work with the multiple problems that patients brought to consultations were the main factors that stopped GPs managing more risky drinkers. Centrally, we compared the results of our study with [Thom, B., & Tellez, C. (1986). A difficult business-Detecting and managing alcohol-problems in general-practice. British Journal of Addiction, 81, 405-418] seminal study that was undertaken 20 years ago. We show how the intellectual, moral, emotional and practical difficulties that GPs currently face are quite similar to those faced by GPs from 20 years ago. As the definition of what could constitute abnormal alcohol consumption has expanded, so the range of consultations that they may have to negotiate these difficulties in has also expanded.
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In 2 qualitative studies from Australia and the UK, GPs acknowledged they were not interested in dealing with alcohol problems.
“In 2 qualitative studies from Australia and the UK, GPs acknowledged they were not interested in dealing with alcohol problems [105, 107].”
Three qualitative studies reported that GPs and nurses would feel incentivized if financial reimbursement for providing alcohol brief interventions was available.
“Three qualitative studies reported that GPs and nurses would feel incentivized if financial reimbursement for providing alcohol brief interventions was available [39, 80, 105];”
Six pieces of data from 3 qualitative, 1 quantitative and 1 mixed methods studies alluded that both GPs' and nurses' screening activities were influenced by patients' characteristics.
“Six pieces of data from 3 qualitative, 1 quantitative and 1 mixed methods studies alluded that both GPs and nurses screening activities were influenced by patients’ characteristics [41, 51, 74, 105, 115].”
Better co-operation with specialized services, involving other professionals in general practice, public health educational campaigns, and more media attention were among the most commonly cited facilitators.
“Better co-operation with specialized services [20, 39, 59, 60, 80], involving other professionals in general practice (e.g. an addiction consultant or a specialized nurse) [39, 71, 105], public health educational campaigns [23, 47, 78, 99, 110] and more media attention [39, 110] were among the most commonly cited facilitators.”
Alcohol was not a goal priority for GPs because they were too busy, which makes them neglect alcohol issues in favour of other presenting problems.
“Alcohol was not a goal priority for GPs because they were too busy, which makes them neglect alcohol issues in favour of other presenting problems [23, 47, 78, 83, 92, 105, 106].”
Both GPs and nurses in 6 qualitative studies expressed concern about negative reactions from patients when discussing alcohol issues.
“Both GPs and nurses in 6 qualitative studies expressed their concern about negative reactions from patients when discussing alcohol issues [49, 84, 86, 89, 92, 105].”
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“At first glance this finding seems to contradict the concern of many GPs generally tending to expect a rejecting response by their patients after giving advice to reduce alcohol consumption (Rapley et al., 2006).”
ResultKarlsson, N. E., Skagerström, J., O'Donnell, A. J., Abidi, L., Thomas, K., Nilsén, P., & Lid, T. G. (2023) · International Journal of Public Health · doi:10.3389/ijph.2023.1605634 · Cited by 6 · see citing works
“At the same time, there is also evidence that primary healthcare providers are more likely to ask patients in a lower SES about their drinking compared to those with a higher SES (7, 29), and may more easily identify signs of high alcohol consumption in patients with a lower SES than those of similar SES to themselves…”
BackgroundHome detox - supporting patients to overcome alcohol addiction
Davis, C. (2018) · Australian Prescriber · doi:10.18773/austprescr.2018.059 · Cited by 6 · see citing works
Wilson, H. H., Norris, R., Tapley, A., Magin, P. J., & Klein, L. (2020) · Education for Primary Care · doi:10.1080/14739879.2020.1830720 · Cited by 7 · see citing works
Nursing interventions for preventing alcohol-related harm
Littlejohn, C., & Holloway, A. S. (2008) · British Journal of Nursing · doi:10.12968/bjon.2008.17.1.28062 · Cited by 6 · see citing works
Minian, N., Ivanova, A., Voci, S. C., Veldhuizen, S., Zawertailo, L. A., Baliunas, D. O., Noormohamed, A., Giesbrecht, N., & Selby, P. L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17031024 · Cited by 4 · see citing works
“This might be due to the research showing that HCP decisions to provide a brief intervention are associated with the social acceptability of alcohol [25,26], and findings pointing out that drinking is seen as an appropriate masculine behavior [27] but which defies feminine stereotypes [28].”
BackgroundAddressing alcohol in routine healthcare in Sweden—population-based surveys in 2010 and 2017
Karlsson, N. E., O'Donnell, A. J., Abidi, L., Skagerström, J., & Nilsén, P. (2019) · European Journal of Public Health · doi:10.1093/eurpub/ckz057 · Cited by 5 · see citing works
Proposing a New Term for Organizational Behavior Literature
Arar, T., Öneren, M., & Yurdakul, G. (2022) · Journal of information and organizational sciences · doi:10.31341/jios.46.1.5 · Cited by 3 · see citing works
“In a study, it is stated that alcohol and drug addiction are among the reasons that reduce job satisfaction and productivity in businesses [75].”
BackgroundChan, P. S.-F., Fang, Y., Xie, Y. J., Wong, M. C. S., Nilsén, P., Leung, S. F., Cheung, K., Wang, Z. J., & Yeoh, E. (2024) · Implementation Science Communications · doi:10.1186/s43058-024-00590-z · Cited by 3 · see citing works
“…to address these determinants [26, 43], some strategies In line with the findings in the United Kingdom, Slo-venia, the United States, New Zealand, and Germany, common barriers applied to four sub-groups included the perceptions that SBI implementation was complicated and of high cost [45–49].”
ResultBrief Intervention Experiences of Young High-Frequency Cannabis Users in a Canadian Setting
Rudzinski, K., McGuire, F., Dawe, M., Shuper, P. A., Bilsker, D., Capler, R., Rehm, J. T., & Fischer, B. (2012) · Contemporary Drug Problems · doi:10.1177/009145091203900104 · Cited by 3 · see citing works
The Perception of Various Physician Specialists on Addiction Treatment Methods in Latvia
Sudraba, V. (2014) · Cited by 2 · see citing works
Fankhänel, T., Rascher, A., Thiel, C., Schulz, K., & Klement, A. (2016) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2016.03.013 · Cited by 2 · see citing works
Colom, J., & Segura, L. (2020) · PubMed Central · Cited by 2 · see citing works
Leong, L. H.-L., & Tam, C. W. M. (2014) · doi:10.7287/peerj.preprints.439v1 · Cited by 2 · see citing works
“drinking detection [23, 25, 31].”
Brief interventions 2.0: a new agenda for alcohol policy, practice and research
Stewart, D., Madden, M., & McCambridge, J. (2024) · Globalization and Health · doi:10.1186/s12992-024-01031-1 · Cited by 1 · see citing works
“Too often, conversations in health and care settings about alcohol are too brief, too crude, heavily moralised, paternalistic and all too easy to ignore, when they are not avoided altogether [43, 44].”
BackgroundPotthoff, S., Brendryen, H., Bosnic, H., Bhardwaj-Gosling, R., Iden, K. R., Njå, A. L. M., O'Donnell, A. J., & Lid, T. G. (2025) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2025.2598835 · Cited by 2 · see citing works
“…a potentially sensitive topic in routine consultations, even though they see addressing alcohol-related health problems as their responsibility [10,11]. so far, large-scale implementation studies on sBi have not been successful, and while brief alcohol interventions (Bais) are effective,…”
Fankhänel, T., Schulz, K., Petersen, L., Klement, A., & Frese, T. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01231-9 · Cited by 1 · see citing works
“identify barriers against implementation, several studies have been conducted [8] [9] [10] [11] [12] [13] [14] [15]”
BackgroundTreating Excessive Consumers With Brief Intervention to Reduce Their Alcohol Consumption
Fankhänel, T., Panic, B. J., Schwarz, M. A., Schulz, K., & Frese, T. (2021) · European Journal of Health Psychology · doi:10.1027/2512-8442/a000079 · Cited by 1 · see citing works
Wysokińska, M., & Kołota, A. (2022) · Alcoholism and Drug Addiction · doi:10.5114/ain.2022.126947 · Cited by 1 · see citing works
“The data available in the literature shows that doctors are often concerned about the frequency of alcohol consumption during follow-up visits due to the risk of a negative patient reaction [121, 122].”
BackgroundMadden, M., Stewart, D., & McCambridge, J. (2024) · BMJ Public Health · doi:10.1136/bmjph-2023-000829 · Cited by 1 · see citing works
Stubbe, M. H., Macdonald, L., Tester, R., Gray, L., Hilder, J., Dew, K. P., & Dowell, T. (2020) · Communicating in professions and organizations · doi:10.1007/978-3-030-41668-3_7 · Cited by 1 · see citing works
Fankhänel, T., Mueller, A.-M., & Frese, T. (2020) · Alcohol and Alcoholism · doi:10.1093/alcalc/agaa106 · Cited by 1 · see citing works
Pussig, B., Pas, L., Li, A., Vermandere, M., Aertgeerts, B., & Matheï, C. (2021) · BMC Family Practice · doi:10.1186/s12875-021-01479-9 · Cited by 1 · see citing works
“Interestingly, the highest efficacy occurs when brief advice is delivered to non-treatment-seeking, hazardous drinking patients [8, 9].”
BackgroundPussig, B., Nuland, M. V., Pas, L., Vandelanotte, S., Matheï, C., Aertgeerts, B., & Vermandere, M. (2021) · European Journal of General Practice · doi:10.1080/13814788.2021.1936493 · Cited by 1 · see citing works
“Unfortunately, implementation of EIBI remains low [7,8].”
Alcohol prevention in Swedish primary health care
Geirsson, M. (2011) · Gothenburg University Publications Electronic Archive (Gothenburg University)
Sudraba, V. (2014) · Journal of Alcoholism and Drug Dependence · doi:10.4172/2329-6488.1000149
Rosário, F., Santos, M. I., Angus, K., Pas, L., Ribeiro, C., & Fitzgerald, N. (2021) · Figshare · doi:10.6084/m9.figshare.13545356
Rosário, F., Santos, M. I., Angus, K., Pas, L., Ribeiro, C., & Fitzgerald, N. (2021) · Figshare · doi:10.6084/m9.figshare.13545353
Minian, N., Noormohamed, A., Lingam, M., Zawertailo, L. A., Foll, B. L., Rehm, J. T., Giesbrecht, N., Samokhvalov, A. V., Baliunas, D. O., & Selby, P. (2021) · Figshare · doi:10.6084/m9.figshare.14227990
Fankhaenel, T., Schulz, K., Petersen, L.-E., Klement, A., & Frese, T. (2020) · Figshare · doi:10.6084/m9.figshare.12831954
Fankhaenel, T., Schulz, K., Petersen, L.-E., Klement, A., & Frese, T. (2020) · Figshare · doi:10.6084/m9.figshare.12831957
Madden, M., Stewart, D., Mills, T., & McCambridge, J. (2024) · Figshare · doi:10.6084/m9.figshare.26579417
Chan, P. S.-F., Fang, Y., Xie, Y. J., Wong, M. C.-S., Nilsen, P., Leung, S.-F., Cheung, K., Wang, Z. J., & Yeoh, E.-K. (2024) · Figshare · doi:10.6084/m9.figshare.25762869
Rosário, F., Santos, M. I., Angus, K., Pas, L., Ribeiro, C., & Fitzgerald, N. (2021) · Figshare · doi:10.6084/m9.figshare.13545359
Pussig, B., Pas, L., Li, A., Vermandere, M., Aertgeerts, B., & Matheï, C. (2021) · Figshare · doi:10.6084/m9.figshare.14897441
Rosário, F., Santos, M. I., Angus, K., Pas, L., Ribeiro, C., & Fitzgerald, N. (2021) · Figshare · doi:10.6084/m9.figshare.13545362
- Authors
- Rapley, T., May, C., & Frances Kaner, E.
- Affiliations
- Newcastle University (GB)
- Corresponding author
- Rapley, Tim
- ORCID
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2006-11
- Volume
- 63
- Issue
- 9
- Pages
- 2418-2428
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2069858922
- Cited by
- 95
- References
- 31
- Citations by year
- 2025: 1 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 16 · 2020: 13 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 7 · 2015: 4 · 2014: 5 · 2013: 5 · 2012: 5
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Economic and Social Research Council (RES-000-27-0084)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- alcohol-related problems, general practitioners, alcohol screening, primary care, barriers to intervention, time constraints
- MeSH terms
- Alcoholism, England, Family Practice, Female, Humans, Interviews as Topic, Male, Physician-Patient Relations, Referral and Consultation
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