Many people who drink at risky levels pass through primary care without their alcohol use being noticed, even when they present with symptoms linked to drinking. New research suggests the problem is not just time pressure or lack of resources, but the beliefs healthcare professionals hold about alcohol itself and about the people who drink it. The findings were published in Alcoholism Treatment Quarterly.
The qualitative study examined how doctors, nurses, and other primary care staff think about alcohol consumption and how those beliefs shape their willingness to screen patients early. Early detection is widely seen as crucial for preventing long term harm, yet it remains inconsistently applied in everyday healthcare.
Researchers worked with 157 healthcare professionals across 18 primary care centres in Mexico City as part of training sessions linked to an early detection and brief advice programme. Group discussions revealed that alcohol is often viewed as a normal and socially accepted part of life, rather than a health risk that should be routinely addressed.
Many professionals described drinking as something embedded in family gatherings, celebrations, and social rituals. This normalisation made it harder for some staff to view weekend binge drinking or heavy social drinking as a medical concern, especially when patients did not fit stereotypes of severe dependence.
Beliefs about who is at risk also played a role. Some professionals associated alcohol problems mainly with young people, men, or people from lower socioeconomic backgrounds. As a result, women, older adults, and people perceived as stable or well educated were less likely to be asked about their drinking, even when symptoms suggested alcohol could be contributing.
Institutional pressures reinforced these attitudes. Short appointment times and heavy workloads meant alcohol screening was often seen as an extra task rather than a core part of care. Some staff felt that addressing alcohol use should be left to specialists, such as psychologists or addiction services, rather than handled in routine consultations.
There was also scepticism about whether brief conversations in primary care could really change drinking behaviour. Several professionals doubted that short interventions were effective for habits they viewed as deeply ingrained, leading to reluctance to raise the issue at all.
At an individual level, some healthcare workers admitted they expected patients to minimise or deny how much they drank. This mistrust reduced motivation to ask detailed questions or to offer advice. Personal drinking habits among healthcare staff also shaped attitudes, with some viewing regular alcohol use as compatible with professional functioning.
The researchers identified three overlapping layers shaping these responses: sociocultural beliefs that normalise alcohol, institutional constraints that limit time and support, and individual assumptions about patients and behaviour change. Together, these factors can quietly undermine early detection efforts, even in systems designed to support them.
The study argues that improving alcohol screening is not just about adding tools or guidelines. Training needs to address stigma, challenge stereotypes, and help professionals reflect on their own beliefs about alcohol. Creating space for discussion and support may increase confidence that early conversations can make a meaningful difference.
With alcohol related harm remaining a major public health issue, the findings highlight why many opportunities for early intervention are missed. Addressing beliefs within healthcare may be as important as addressing alcohol use itself.