In this chapter, what is meant by social complications of drinking is explored (Klingemann and Gmel, 2001) and specific types of complication are then considered. Complications which occur within the family – an important type of social problem – are discussed in Chapter 5.

Convenient though it is to think in terms of three classical problem dimensions – physical, mental and social – this must not be allowed to obscure the fact that in the real lives of patients the dimensions are not separate at all. Problems in any one area lead to, and are exacerbated by, problems in the other areas. By and large, the more severe the dependence, the greater the likelihood of alcohol-related problems of all three kinds (Caetano, 1993). The clinical skill lies not only in making the detailed, one-dimensional assessment, but also in putting the dimensions together.

Even as the person from a helping profession other than medicine may be tempted, by training or habit of mind, to neglect the importance of the physical considerations in the equation, so may the physician be guilty of too narrow a concern with the patient's physical well-being at the cost of a proper awareness of the other issues. This chapter seeks to provide a checklist of what should be borne in mind in the social sphere, whatever one's professional affiliation.

The concept of ‘social complication’

The idea of social complication often implies a failure adequately to fulfil an expected social role.