Barrier to Treatment

Barrier to Treatment: Lack of Education

Discomfort arises in physicians attempting to treat alcoholics due to lack of education, clinical experience and negative perceptions of alcohol abusers. In fact, an American Medical Association poll found that nearly half of the responding physicians did not believe they were competent to treat alcoholism. The main reason cited for this perceived incompetence was a lack of formalized training in the area of alcoholism. Indeed, medical school curriculum has traditionally discussed only the medical complications of alcoholism, not the underlying disease.

The “disease model” of alcoholism was not widely recognized until the very late twentieth century. Within this framework, many primary care physicians envision themselves managing clearly defined, traditional diseases, rather than those which they perceive as mere lifestyle problems. Negative attitudes regarding substance abusers have compounded this lack of understanding and led to fragmented and inferior treatment of alcoholics.

Barrier to Treatment: Reluctance to Intervene

Often physicians are in a good position for intervention efforts. For example, since an obstetrician/gynecologist is the primary care physician for many women, these physicians are in a good position to screen and counsel over half the population in an age group most afflicted with alcoholism. However, despite patient enthusiasm for physician involvement, physicians often are reluctant to become involved in substance abuse treatment. Possible reasons include physicians' discomfort addressing sensitive topics, desire not to interfere in a patient's person life, and misunderstanding of the disease or treatment.

Additional Barriers to Treatment

Many physicians face the following barriers which prevent them from appropriately treating alcohol-dependent patients:

- Physicians typically have little clinical training in the area of substance abuse

- Physicians lack of knowledge concerning risk factors and signs of substance abuse

- Widely, there has been a failure to include physicians in the roundtable of substance abuse treatment

- There is confusion amongst physicians regarding their roles and responsibilities in addressing alcohol and drug problems

- There is some skepticism regarding the efficacy of medical treatment for substance abuse

- Negative stereotypes regarding alcoholics and drug abusers are prevalent

- Little physician contact occurs with patients after age six

- There are economic and third party payment disincentives surrounding substance abuse prevention, intervention, and treatment

Patient Barriers to Treatment

Once a diagnosis of alcoholism is made, the first step is to get the patient to seek treatment. Studies have indicated that the primary reason alcohol abusers do not obtain help is denial, stigma and doubt regarding the efficacy of traditional alcohol treatment.

Barrier to Treatment: Denial

Denial plays a large role in alcoholics' failure to seek treatment and in substance abuse in general. The precursors of denial are minimization and rationalization. Initially, addicts minimize their problem -- “Everyone drinks after work.” Even those who recognize a potential problem may rationalize their behavior -- “If they had my job, they would drink too”. Alcoholics may also develop outright denial, which has been described as an angry and stubborn refusal to recognize the truth about a drinking problem.

Individuals who are in denial are unlikely to see that their life is unraveling right in front of them (marital problems, DUIs, etc.) Getting the alcoholic to seek treatment can be a formidable obstacle and a manifestation of denial. Even after experiencing withdrawal symptoms, alcoholics frequently continue to deny the problem, leaving it upon others to recognize their symptoms and work toward treatment.

Barrier to Treatment: Stigma

Stigma is also a formidable barrier, particularly among older patients who tend to regard alcohol abuse as a character defect or a manifestation of personal weakness. Such patients may have formed opinions of alcoholism in an era before alcohol was recognized as a disease. The patient and those close to him/her should be aware that alcoholism is a disease and that craving, impaired control, and dependence are symptoms of the disease and not character flaws.

Barrier to Treatment: Doubt

Many patients doubt that treatment will work or have personally experienced at least one relapse. However, it is important for the alcoholic to realize that several relapses typically occur before one reaches long term sobriety. Alcohol treatment (like cancer or heart disease) is difficult and frequently wrought with pain. However, as in all serious diseases, treatment is necessary. Barrier to Treatment: Cost

The cost of treatment may be a significant barrier to treatment. Naltrexone treatment costs about $4.50 daily or $400 for a three month allotment of the drug and accompanying liver function tests. However, the costs of naltrexone may be ubstantially less than the amount previously spent on alcohol, depending on alcohol usage and how much of the cost of treatment is actually incurred by the patient. Overcoming the Barriers

The alcoholic, as well as his/her family and friends, all experience denial and doubt. The first step in working toward treatment is for the alcoholic's family and friends to overcome their denial and recognize that a serious problem exists. This denotes that it is time to get serious and prevent the alcoholic from continuing his/her destructive behavior. The family and friends must stop “rescue missions” that coddle the alcoholic; instead, they must allow the individual to experience the full brunt of his/her behavior.

The second step is that alcoholic's family and friends - a sort of "intervention team" - should educate themselves about alcohol and its effects. This education will help erase some of the doubt and stigma and the intervenors will be able to understand why the alcoholic continues to drink. This knowledge will also allow the intervention to proceed in a non-judgmental fashion, reducing the chance that the alcoholic will become defensive and thwart the efforts.

After educating themselves about the importance of treatment, the friends and family members can attempt to educate the alcoholic as well. The intervenors should be specific by stating the consequences of not entering treatment and only making threats they are truly prepared to carry out. Giving ultimatiums may be difficult for some, but family members/friends need to remember that they are acting in the best interest of their loved one, the alcoholic.