It takes courage to ask for help
If your patient has mustered up the courage to call your office, schedule an appointment, and show up to ask you for your help with their drinking, then congratulations! You have a highly motivated, engaged patient who is ready to take responsibility for their own recovery.
You probably already understand that patients who are engaged in their health decisions are more likely to be successful. If reducing alcohol intake, with or without the ultimate goal of abstinence, is a health decision your patient wants to make, then it is your ethical obligation as a physician to help them. If you refuse, you are complicit in making it more likely they will continue to delay treatment for harmful drinking.
When a patient comes to your office with the belief that a treatment such as the Sinclair Method will work to help them reduce their drinking, or quit completely, they have already taken an important step toward not undermining their success. These patients are highly motivated to make a change and to adhere to medication requirements and protocols, which also increases their chance of success. They are looking to you for guidance as a partner in health. Your willingness to treat them using a method based in both science and practice reinforces the mindset in your patient that you care about their well-being.
For additional reading on mindsets, see: Crum A, Zuckerman B. Changing Mindsets to Enhance Treatment Effectiveness. JAMA. Published online: April 13, 2017. doi:10.1001/jama.2017.4545
Things to remember
On average, most people with alcohol use disorder struggle without seeking help for about 10 years. During this time, they have seen the many ways alcohol has negatively affected them and they have most likely tried to cut back or stop on their own with limited success. If your patient has come to you for help, they are not likely to respond well to a lecture about why harmful drinking is bad. They already know it is bad for them. What they want is help to make the necessary change to become healthier.
It is estimated that 85-90% of people who need treatment do not seek it out. Imagine how the medical community would react if 85% of those with cancer or any other treatable disease went untreated until their disease was so advanced that it was nearly impossible to reverse the health damages.
Saying "just stop drinking" is like telling a starving person not to think about food.
Think about how you respond to patients with other medical conditions that require some level of behavioral change. Would you require a patient with diabetes or high cholesterol to prove they are ready for change before considering adding medication to their treatment regimen?
Research has shown that addiction changes the way the brain processes information. There is a biological process involved in compulsive alcohol use, and that process can be addressed with medication.
"Rock Bottom" is, for some, a death sentence.
Think about other progressive health issues. While it is absolutely true that many people respond well to a "wake up call," such as a heart attack, before they are ready to commit to making changes that positively affect their health, is it ethical and morally responsible to force people to wait until the wake up call is received before taking the necessary steps to treat a condition?
Modern medicine has extended our life expectancy and improved our quality of life thanks to early screening techniques for many conditions. We can now take preventative steps toward averting personal health disasters thanks to preventative interventions. Alcohol use disorder is progressive, so when it is caught and treated early your patients may be able to avoid losing everything they care about, in some cases their freedom, or even their life.