Introduction

Although the misuse of alcohol and of other substances have many features in common and often coexist in the same patient, for the convenience of the reader this chapter is divided into separate sections on alcohol and drug misuse respectively.

Alcohol related problems

Opportunities for prevention in primary health care

A report by the Royal College of General Practitioners (1986) suggested that any general practitioner will have on his list about 55 patients who are drinking at levels exposing them to a high risk of harm and a further 200 at levels with an intermediate risk of harm. General practitioners and other primary health care professionals are well placed to identify patterns of hazardous drinking early and to intervene in order to arrest progression and minimise damage.

In Britain, 70% of the practice population consult their general practitioner in any one year, offering obvious possibilities for opportunistic screening (Pollak, 1989). Other advantages of the primary care setting are the ease of accessibility, the long-term relationship which often exists between general practitioner and patient, the lack of labelling and stigma which may be associated with specialist alcohol services, and the opportunity for involvement of other members of the patient's family (Babor, Ritson & Hodgson, 1986).

Despite these advantages, many at-risk drinkers go unnoticed and research suggests that many general practitioners are reluctant to become involved with alcohol problems (Thom & Tellez, 1986).