Intended for healthcare professionals


General practitioner screening for excessive alcohol use

BMJ 2003; 326 doi: (Published 08 February 2003) Cite this as: BMJ 2003;326:336

Paper enables open debate about a complex intervention

  1. Stephen Rollnick (, senior lecturer
  1. Communication Skills Unit, Department of General Practice, University of Wales, College of Medicine, Cardiff CF23 9PN
  2. National Addiction Centre, Institute of Psychiatry, Maudsley Hospital, London SE5 8AF
  3. Department of General Practice, University of Wales, College of Medicine, Cardiff CF23 9PN
  4. Department of Psychological Medicine, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W2 1PD
  5. St Mary's Hospital, London W2 1NY

    EDITOR—The response on to the paper by Beich et al is probably the first time that open debate has taken place about how alcohol screening and brief intervention for excessive drinkers fits into everyday practice. The strength of feeling is unmistakable, from a general practitioner's scepticism about intervention itself to a seemingly flat refusal from a group of leading European alcohol researchers to accept the validity of a qualitative study that reported concerns expressed by practitioners.13 Views are differing about how far public health initiatives can and should be integrated into everyday practice.

    Beich sent me his group's paper for comment, and my impression was of a diligent researcher who sat in the uncomfortable zone between research and everyday practice. His findings struck a chord with me, as I had encountered many of the same issues when running an outcome study in the mid-1980s. Hence my attempts on several occasions to suggest modifications to preventive work on alcohol consumption.4 Beich et al's paper seemed to more than match other qualitative studies for methodological adequacy. To dismiss the findings as largely a byproduct of poor research methods seems curiously overstated.2

    General practitioners are being cajoled to change their consulting behaviour on many fronts. At the centre of this is their relationship with their patients. In …

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