Alcoholism: a challenging physician-patient encounter.

Physicians can be most helpful to alcoholic patients, whatever the stage of progression of their illness, by adopting the following strategies: 1. Become familiar with the interactional dynamics that result from denial so as to improve data gathering and interpretation, resulting in better diagnostic acumen. Expect to feel uncomfortable because of the interpersonal nature of alcoholism's defenses. Tolerate these feelings through helping the patient to see how uncomfortable he is because of the illness. 2. Adopt a nonjudgmental stance regarding the complex origins of the problem, and develop the skills to communicate respect and compassion to people who feel demoralized, ashamed, afraid, depressed, and hopeless. 3. Support and encourage the patient in surmounting the obstacles to accepting each day the responsibility for participating in whichever form of treatment fits his or her stage of the illness. 4. Refuse to give up on the patient, unless the patient manifests irreversible cognitive impairments that preclude participation in active treatment for alcoholism.