Excessive drinking is frequently and in many settings overlooked. Only about a quarter of ‘high-risk’ or ‘excessive’ drinkers are correctly identified by primary care physicians (Wallace and Haines, 1985; Reid et al., 1986). Even in the hospital setting, where one might imagine more time was available for enquiry and investigation, the problem often goes unrecognized (Farrell and David, 1988; Canning et al., 1999). The detection rate in the social work setting has not been adequately investigated, but there can be little doubt that the contribution made by drinking to all manner of social presentations is passed by. Every therapist needs to cultivate a more alert eye, and aim at earlier and more complete diagnosis. If the element of drinking is allowed to remain hidden, it will defeat our plans to help that patient or client. The ‘depression’ will not respond to the prescribed antidepressant, a stomach ulcer will fail to heal, a family's situation will deteriorate, and we will be left puzzled and frustrated. Treatment which is blind to the drinking problem may indeed do actual harm rather than simply fail in its goal, whereas early diagnosis which can lead to help before dependence is advanced, or irreversible damage established, is very much in the patient's best interests.

This chapter looks at the barriers to the detection and diagnosis of drinking problems and considers ways in which rates of detection may be enhanced. Special consideration is also given to the use of laboratory tests and questionnaires in screening and diagnosis.