James Morris: Why harmful drinkers reject change: coping and cognition in maintaining heavy drinking

Public Health England identifies approximately 600,000 dependent drinkers as the target treatment population. However they identify an additional 1.3 million ‘harmful’ drinkers who do not have serious dependency but are drinking at levels already causing harm to themselves. For instance, 1 in 5 hospital attendees have been identified as harmful drinkers, reflecting the contribution of heavy drinking to a wide range of health-related conditions. However, harmful drinkers are characterised by low problem recognition, or in some folk language, ‘denial’. Here I present a conceptual model for understanding how and why harmful drinkers reject change via cognitive ‘coping’ responses. I will explore some of the ways in which interventions and policy may address some of these barriers with a few to increasing problem recognition as a key first step to change.

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