When Drinking Is Part of the Problem

A Family Approach to the Detection and Management of Alcohol Abuse
  • Susan H. McDaniel
  • Thomas L. Campbell
  • David B. Seaburn


Alcohol abuse is one of the most serious and underrecognized health problems in primary care. One in ten Americans abuse alcohol (1) and one in three families report problems related to drinking (2). Alcohol abuse is the leading cause of death in 15 to 45 year olds and is associated with 10% of all deaths in the U.S. including suicide, homicide, and fatal accidents. Suicide is 30 times more common in alcoholics, and one half of all fatal automobile accidents are due to drunk driving. Patients who abuse alcohol use medical services much more often than other patients. The direct health costs related to alcohol misuse is estimated to be $15 billion, and indirect costs (lost productivity, MVAs, fires and crime) account for an additional $90 billion (3).


Alcohol Abuse Family Therapy Alcohol Problem Alcohol Treatment Alcoholic Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fifth Special Report to the US Congress on Alcohol and Health. Rockville, MD, DHHS publication No. (ADM)84–1291, 1983.Google Scholar
  2. 2.
    Fein R: Alcohol in America: The Price We Pay. Newport Beach: Care Institute, 1984, p 10.Google Scholar
  3. 3.
    Barnes HN, Aronson MD, Delbanco TL: Alcoholism: A Guide for the Primary Care Physician. New York, Springer Verlag, 1987.Google Scholar
  4. 4.
    Kamerow DB, Pincus HA, Macdonald DI: Alcohol abuse, other drug abuse, and mental disorders in medical practice: Prevalence, costs, recognition, and treatment. JAMA 1986; 255: 2054–2057.PubMedCrossRefGoogle Scholar
  5. 5.
    Soloman J, Vanga N, Morgan JP, Joseph P: Emergency room physicians’ recognition of alcohol misuse. J Stud Alcohol 1980; 41: 583–586.Google Scholar
  6. 6.
    Bush B, Shaw S, Cleary P, et al.: Screening for alcohol abuse using the CAGE questionnaire. Am J Med 1987; 82: 231–235.PubMedCrossRefGoogle Scholar
  7. 7.
    Lewis DC, Niven RG, Czecheowicz D, Trumble JG: A review of medical education in alcohol and other drug abuse. JAMA 1987; 257: 2945–2948.PubMedCrossRefGoogle Scholar
  8. 8.
    Porkovay AD, Soloman J: A follow-up survey of drug abuse and alcoholism teaching in medical schools. J Med Educ 1983; 58: 316–321.CrossRefGoogle Scholar
  9. 9.
    Sadler D: Poll finds MD attitudes on alcohol abuse changing. Am Med News 1984; 27: 60.Google Scholar
  10. 10.
    Clark WD: Alcoholism: Blocks to diagnosis and treatment. Am J Med 1981; 71: 275–286.PubMedCrossRefGoogle Scholar
  11. 11.
    Groves JE: Taking care of the hateful patient. N Engl J Med 1978; 298: 883–887.PubMedCrossRefGoogle Scholar
  12. 12.
    Holder HD, Blose JO: Alcohol treatment and total health care utilization and costs. JAMA 1986; 256: 1456–1460.PubMedCrossRefGoogle Scholar
  13. 13.
    Jones KR, Vischi TR: The impact of alcohol, drug abuse and mental health treatment of medical care utilization. Med Care 1979; 17: 1–82.PubMedGoogle Scholar
  14. 14.
    Juntunen J, Asp S, Olkinuora N, et al.: Doctors’ drinking habits and consumption of alcohol. Br Med J 1988; 297: 951–954.CrossRefGoogle Scholar
  15. 15.
    Stanton MD, Todd TC, et al.: The Family Therap for Drug Abuse and Addiction. New York, Guilford, 1982.Google Scholar
  16. 16.
    Stanton MD: The family and drug abuse: Concepts and rationale, in Bratter TE, Forrest GG (eds.): Alcoholism and Substance Abuse: Strategies for Clinical Intervention. New York, Free Press, 1985.Google Scholar
  17. 17.
    Coleman SB, Davis DI: Family therapy and drug abuse: A national survey. Fam Proc 1978; 17: 21–29.CrossRefGoogle Scholar
  18. 18.
    Singer M: Family comes first: An examination of the social networks of skidrowment. Human Organization 1985; 44: 137–142.PubMedGoogle Scholar
  19. 19.
    Wolin SJ, Steinglass P: Interactional behavior in an alcoholic community. Med Annals of D.C. 1974; 43: 183–187.Google Scholar
  20. 20.
    Steinglass P, Bennett LA, Wolin SJ, Reiss D: The Alcoholic Family. New York, Basic Books, 1987.Google Scholar
  21. 21.
    Goodwin DW: Alcoholism and heredity: A review and hypothesis. Arch Gen Psychiatry 1979; 36: 57–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Wolin SJ, Bennett LA, Noonan DL: Family rituals and the recurrence of alcoholism over generations. Am J Psychiatry 1979; 136: 589–593.PubMedGoogle Scholar
  23. 23.
    Weinberg JR: Assessing drinking problems by history. Postgrad Med 1976; 59: 87–90.PubMedGoogle Scholar
  24. 24.
    Doherty WJ, Baird MA: Treating chemical dependency in a family context. Family Therapy and Family Medicine. New York, Guilford Press, 1983.Google Scholar
  25. 25.
    Steinglass P: The alcoholic family at home: Patterns of interaction in dry, wet and transitional stages of alcoholism. Arch Gen Psychiatry 1981; 38: 578–584.PubMedCrossRefGoogle Scholar
  26. 26.
    Steinglass P, Davis DI, Berensen D: Observations of conjointly hospitalized “alcoholic couples” during sobriety and intoxication: Implications for theory and therapy. Fam Proc 1977; 16: 1–16.CrossRefGoogle Scholar
  27. 27.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.). Washington, DC: American Psychiatric Association, 1987.Google Scholar
  28. 28.
    Steinglass P: The impact of alcoholism on the family: Relationship between degree of alcoholism and psychiatric symptomatology. J Stud Alcohol 1981; 42: 288–303.PubMedGoogle Scholar
  29. 29.
    Ford DE, Kamerow DB, Thompson JW: Who talks to physicians about mentl health and substance abuse problems? J Gen Intern Med 1988; 3: 363–369.PubMedCrossRefGoogle Scholar
  30. 30.
    Woodall HE: Alcoholic remaining anonymous: Resident diagnosis of alcoholism in a family practice center. J Fam Pract 1988; 26: 293–296.PubMedGoogle Scholar
  31. 31.
    Cyr MG, Wartman SA: The effectiveness of routine screening questions in the detection of alcoholism. JAMA 1988; 259: 51–54.PubMedCrossRefGoogle Scholar
  32. 32.
    Ewing JA: Detecting alcoholism: the CAGE questionnaire. JAMA 1984; 252: 1905–1907.PubMedCrossRefGoogle Scholar
  33. 33.
    Bernadt MW, Mumford J, Taylor C, et al.: Comparison of questionnaire and laboratory tests in the detection of drinking and alcoholism. Lancet 1982; 1: 325–328.PubMedCrossRefGoogle Scholar
  34. 34.
    Leckman AL, Umland BE, Blay M: Prevalence of alcoholism in a family practice center. J Fam Pract 1984; 18: 867–870.PubMedGoogle Scholar
  35. 35.
    Liepman M. Alcohol and drug abuse in the family, in Christie-Seeley J (ed.): Working with the Family in Primary Care. New York: Praeger Press, 1983.Google Scholar
  36. 36.
    Baird M: Chemical dependency: A protocol for involving the family. Fam Syst Med 1985; 3: 216–220.CrossRefGoogle Scholar
  37. 37.
    Johnson V: I’ll Quit Tomorrow. New York: Harper and Row, 1973.Google Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Susan H. McDaniel
    • 1
  • Thomas L. Campbell
    • 1
  • David B. Seaburn
    • 1
  1. 1.School of Medicine and Highland Hospital, Jacob B. Holler Family Medicine CenterUniversity of RochesterRochesterUSA

Personalised recommendations