The medical practitioner, alcoholism and motivation.

ADVERSE INFLUENCES ON MOTIVATION FOR RECOVERY FROM ALCOHOLISM MUST BE SEARCHED FOR IN THREE AREAS: society, the medical practitioner and the patient. Society is ambivalent because there is a vicarious release through identification with the cheerful "drunk" coupled with unconscious envy and resentment leading to punitive action. The current "alcohol culture" decrees that to drink is to be well, not to drink is to be ill. The medical profession attempts to suppress, deny, rationalize or reject the problem of alcoholism because it involves a change in attitude and recognition of limitations. The alcoholic patient has a notorious lack of motivation, but this must be recognized as a symptom of his disease, and with certain techniques this symptom is treatable. Furthermore, motivation fluctuates and many opportunities for treatment are available when the medical practitioner can detect that motivation is high. At times a coercive approach is required, at times a permissive one; and the optimal use of such approaches will increase the motivation to an effective level.