Compliance and risk‐taking: the case of alcoholic liver disease

Abstract

This paper describes an exploratory study of ‘compliance’ with doctors’ advice in an extreme situation: reduction of drinking, or abstention from alcohol, in patients with alcoholic liver disease. A preliminary postal survey had suggested that at least three‐quarters of these patients continued to drink. An intensive interview study explored the reasons for this. Only a minority of the patients were identified as alcoholic, or had a history suggesting dependence. It was concluded that communication between doctor and patient, and factors involved in the patients’ perception of their illness, were crucial first steps towards a change of behaviour. The statements of doctors had to be reinforced by a subjective appreciation of danger. Even if advice about the management of their condition was understood and accepted, however, what then constituted ‘compliance’ in the patients’ eyes depended very much upon social norms. Even then, the success or failure of attempts to follow the doctors’ advice depended crucially upon the circumstances of the patients’ lives. The model of ‘compliance’ or ‘non‐compliance’ which thus emerges is a complex one which has several stages. Copyright © 1984, Wiley Blackwell. All rights reserved