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Alcoholic Women

Patricia L. Foster, MD
JAMA. 1987;258(15):2061. doi:10.1001/jama.1987.03400150053013.
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To the Editor.—  I commend Bissell and Skorina1 for their timely and comprehensive study of alcoholic women physicians. They focus on the behavior of severely impaired alcoholics and conclude that "the earlier intervention takes place in the course of an alcoholic's career, the better." The issue raised is what prevents women from seeking treatment sooner.As a psychiatrist working in a treatment facility that specializes in addictive disease, I have seen very few patients, men or women, seeking treatment on an outpatient basis for alcohol or drug abuse as the chief complaint. When substance abuse emerges as the primary problem, either from the history or from the positive results of a urine drug screen, by gas chromatography, enzyme multiplied immunoassay technique, or immunoassay, one must judge clinically whether confrontation (ie, insisting on the patient entering a recovery program as a prerequisite for treatment) is appropriate or whether engaging the


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