ABSTRACT
Community-based counselling services have a common origin in the disease model which emerged in the 1960s to deal with the disabling effects of chronic problem drinking. Many community-based services have been severely constrained by what we might call the ‘action-stage orientation’, a therapeutic model which is geared primarily towards those at the action stage. Training alcohol counsellors is an ongoing process. The excessive drinkers do not necessarily identify themselves as clients needing specialist help, and the staff involved, mostly doctors and nurses, are not alcohol specialists. Counsellors who work with severely dependent drinkers have daily contact with problems caused by the perceived stigma associated with having a drinking problem.
