Within a total and balanced approach to drinking problems, the physical element must be seen as often very important. Helping services must be so organized as to cope effectively with diagnosis and treatment in the physical domain and, whatever the particular professional affiliation of the person who is working with the problem drinker, there is need for an alertness towards possible physical pathologies. For instance, voluntary workers in a lay counselling centres are, of course, practising their own special types of skill, and no-one would suggest that they should also cultivate a highly specialized knowledge of liver pathology. It is, though, a reasonable expectation that they should know enough about the liver to understand the significance to their client of a diagnosis of cirrhosis, rather than themselves being mystified by this term and consequently deflecting that client from talking about something of vital importance. A polite conspiracy can be set up which pretends that the body does not exist.

Why physical complications matter

Alcohol consumption is a significant cause of physical morbidity and poses a substantial burden on hospital services (Royal College of Physicians, 2001). In Great Britain, approximately 15–30% of male and 8–15% of female admissions to general hospitals in urban areas have alcohol-related problems (Chick, 1994; Canning et al., 1999). The equivalent figure in the USA is 20–40% for both men and women (Lieber, 1995). Alcohol consumption is also responsible for considerable mortality from natural causes and contributes to deaths from accidents, suicide and violence (Edwards et al.