“Alcoholism is a devastating, potentially fatal disease. The primary symptom of having it is telling everyone – including yourself – that you are not an alcoholic.” – Herbert L Gravitz & Julie D Bowden
In school, we’re taught that an important aspect of taking a patient’s history is asking about whether they smoke cigarettes or drink alcohol. And then we’re expected to quantify the person’s cigarette or alcohol use. How much? How often? When did you first start? And invariably most people try to lowball their usage. It’s only after a bit of careful prodding that the truth comes out – or at least something close enough to the truth.
While the legality of alcohol in our culture might not suggest it – cigarettes and alcohol are two of the most potent psychoactive substances. So not surprisingly, we’ve been taught about our role as doctors in counselling patients to quit smoking or to reduce their alcohol intake.
This past rotation in family medicine, we learnt about the five A’s of intervention and the five R’s of motivation. I am sure that each of us, even if we are not doctors, will encounter persons who abuse alcohol and this approach can prove useful.
In trying to motivate a patient to make a change in their behaviour, it’s important to explain to them how the change is relevant to them personally, to talk about the risks of their current behaviour, to educate the patient about the potential rewards of change, and to address possible roadblocks they might encounter while trying to change. And the final R is repetition – doctors should try to respectfully repeat the five R’s each visit to try to motivate their patient to make the changes to live a healthier life.
Let’s take alcohol abuse as an example where the five R’s can be used to motivate a person to cut down on their drinking.
In terms of relevancy to the person, there should be a discussion about how cutting down their alcohol consumption would directly impact their life – it could save them money, improve their quality of life, and if they’re pregnant, it would increase their chances of having a healthy baby. Each person is different, and there will be different issues that are relevant to them and it is important for their doctor to discuss those issues with them in a respectful, non-confrontational manner. Maybe friends can be more casual…but certainly not confrontational!
In terms of risks, there are long-term and short-term risks of alcohol abuse. In the short-term, risks include disruption of sleep, blackouts and a whole host of others. In the long-term, all that assault on your liver can lead to cirrhosis, liver failure and eventually death. Alcohol abuse is one of the most common causes of pancreatitis which comes along with its own range of complications. And then there are all of the emotion risks that come along with alcohol abuse. Long-term over-consumption of alcohol can significantly increase your risk for depression. And I’m sure by now, especially in a country with one of the highest suicide-rates in the world, we’re well aware of the link between depression and suicide. The discussion of risks isn’t meant to be a scare-tactic, it’s supposed to be a frank discussion where the abuser is made aware of the risks and where their perception of those risks is explored.
In terms of rewards, there are all of the health rewards – add on more than a couple of years to your lifespan. And of course, then there’s all of that money that you can save. And for each patient, there are specific areas where their alcohol abuse is causing a problem, so there should be a discussion about how those problems might be ameliorated by cutting down the drinking.
And of course, change is never easy – if it was, they probably wouldn’t have had to come up with five R’s to motivate people. But that brings us to the fourth R: roadblocks. There should be a discussion with the person about possible hurdles they’ll have to face on the road to change and the patient and doctor should come up with strategies on how to handle those problems when they arise. They may suffer withdrawal symptoms, or they may live in an environment that encourages their alcohol abuse.
The final R is repetition. As I mentioned before, doctors should try to respectfully repeat the 5 R’s each visit to try to motivate their patient to make then changes to live a healthier life. Concerned friends and family members should also do the same.
Alcohol abuse is a problem in our country. With alcohol, and I suppose most things in life, moderation is key. Our health professionals have a duty to their patients to motivate them to make the changes towards moderation. And so do we as ordinary citizens.
