The Alcoholic Stereotype: Clinical Reappraisal and Implications for Treatment

Psychiatrists know that alcoholics are difficult patients to treat.^{1, 2} Many of them would, in truth, rather not treat an alcoholic at all.^{3, 4} Despite an initial interest in formulating the psychodynamics of alcoholism and addiction, psychiatrists have found that hypothesizing about unconscious conflict and providing a successful treatment for the alcoholic are quiet different procedures.⁵ Furthermore, psychiatrists continue to be frustrated by the alcoholic, who ideally should relinquish the symptoms of the disease before treatment begins, yet who rather perversely persists in periodic or often continued drinking, particularly at those times when treatment demands behavioral restraint to facilitate affective awareness.

As a result of this type of experience, many psychiatrists have lost interest in treating alcoholics and have turned their backs on the problem. A survey of psychiatrists in private practice in Massachusetts revealed that 23 percent of the respondents would not accept an alcoholic for treatment.⁶ In another survey of forty-six psychiatrists and thirty-five psychiatric residents, all but one acknowledged negative feelings about working with alcoholics.⁷ Such therapeutic disenchantment with these patients has undoubtedly resulted in psychiatric residency programs that include limited and often minimal exposure to alcoholics.

Many doctors have excused themselves politely and turned the problem back to the patients who, in desperation, long ago developed their own organization, Alcoholics Anonymous.⁸ The emergence and success of AA now provides a particularly convenient and even gracious rationalization for these psychiatrists. This is often expressed as some variation on the theme of “AA does a better job with alcoholics than I do. I refer all alcoholics to AA.” Such glib endorsement clouds the doctor's underlying rejection of the alcoholic patient. It also obscures the fact that many psychiatrists know relatively