If general practitioners are to take an active role in the secondary prevention of problems connected with alcohol, they must be able to discuss the subject in an adequate fashion. Interviews from a trial study showed that the greatest difficulties were lack of time and fear of spoiling the relationship with the patient. Earlier studies indicate that the latter problem may have several causes, in part arising from a desire not to infringe upon the integrity of the patient, and partly due to condemnation of excessive drinkers. In other words, the root cause is often contradictory conceptions of alcohol problems on the part of the physician. In order to ensure effective alcohol counselling in primary care, such conceptions must be dealt with in future training courses.