Alcoholism: Beliefs and Attitudes Among Canadian Alcoholism Treatment Practitioners

Eduouardo E Meza, MD1, John A Cunningham, PhD2, Nady el-Guebaly, MD3, Linda Couper, BA4

Objective: To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism.
Method: A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%:  95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé’s posthoc comparisons.
Results: Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment,  pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication.
Conclusions: Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.

(Can J Psychiatry 2001;46:167-172)

Key Words: pharmacotherapy, alcoholism, dissemination, therapist attitudes

The use of adjunctive pharmacotherapies is increasingly viewed as a promising strategy in the treatment of alcohol problems (1). These developments have generated interest in the professional community (2–10) and the general public and is evident at the institutional level (for example, National Institute on Alcohol Abuse and Alcoholism) (11,12). Despite abundant research, however, little is known about the degree to which findings are being translated into daily clinical practice. Further, some evidence suggests that medications recently found useful in treating at least some individuals with alcohol problems may not easily fit into some established nonprofessional (that is, self-help) approaches (13). The transfer of research findings to clinical practice is not straightforward (14,15). Several factors play a role in determining

Manuscript received February 2000, revised, and accepted September 2000.
1Postdoctoral Research Fellow, Addiction Research Foundation Division, Centre for Addiction and Mental Health, Toronto, Ontario.
2Scientist, Addiction Research Foundation Division, Centre for Addiction and Mental Health; Assistant Professor, Departments of Psychology and Public Health Sciences, University of Toronto, Toronto, Ontario.
3Professor, Department of Psychiatry, University of Calgary; Head, Foothills Hospital Addiction Centre, Calgary, Alberta.
4Research Assistant, Addiction Research Foundation Division, Centre for Addiction and Mental Health, Toronto, Ontario; Student, Research Analyst Program, Georgian College, Toronto.
Address for correspondence: Dr JA Cunningham, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1
e-mail: John_Cunningham@camh.net

which findings will impact on practitioners’ clinical armamentarium. The dissemination of research results is likely affected by numerous factors related to the originators’ professional biases and prestige, the vehicle chosen or available for the publication of results, and the recipients’ theoretical inclination, training, and skills (1).

The area of pharmacotherapies for substance use disorders exemplifies some of the obstacles in transferring research to practice (14). This report clarifies some of the factors influencing the applicability of well-established findings in the routine clinical care of individuals with alcohol problems. The practicalities of implementing sound and cost-effective pharmacotherapy research findings to the field of alcoholism have not been assessed in detail. Given the multidisciplinary nature of the field, an initial step is to explore how professional affiliation correlates with different views of alcohol problems and their treatment. Of particular interest are beliefs and attitudes regarding the nature of  “the alcoholism process,” psychosocial interventions, and the use of medications.

We hypothesized that professional affiliation would be correlated with views on alcoholism and treatment. Four groups of practitioners who treat alcoholism were surveyed and compared on the basis of their readiness to view medications as valid and effective treatment options, their theoretical orientation (“disease” versus “behavioural” approaches), and their specific training. Further, the institutions or systems in which they practise were evaluated in terms of current “prescribing conditions.”

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