OK, tell me specifically what a hospital - or anyone else - can do, to 'help' a patient that won't help themselves? Lock them up and dry them out against their will? Should we lock up drug addicts to keep them away from drugs? how about forcing blood pressure meds down the throats of people who are on the verge of a stroke, but won't stay compliant?

My guess is you have never worked in primary care, if you did, you would have a very different opinion about the limits of how much you can help someone that won't help themselves, or even admit they have an issue.

Easiest thing in the world to say is 'someone should do something', and what you usually mean is 'someone else should do something'.

This person is right that hospitals, or health care systems in general should be working on this. It's more complicated than simply not helping people who won't help themselves. The difficulty is that no one knows the best, most effective systems or approaches for doing this, and emergency medicine resources are stretched very thin here in the United States. Emergency departments were designed for the stabilization of life threats, but in our modern collapsing medical system, limiting their scope to this falls short of community needs. There are many people whose only contact with the medical system will be the ED, and finding ways to treat and integrate them into more sustainable programs should be a goal. There are promising advancements being made, however, in initiating standard of care treatments in emergency department settings. On the opioid front, we can start suboxone in the ED, which has proven a pretty effective method of stabilizing people and increasing their participation in treatment down the road. (1)

As someone who is working on this, I don't think it's unfair for people who aren't experts in the field to recognize and call out the fact that something should be done differently. The experts agree, and many of us are trying to figure out a better path forward.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523/

Referral to psychiatric consultation would be a start. There is a reason why people resort to harmful behaviours and without addressing this you are never going to cure the underlying problem.

I guess the alternative is to do nothing and expect people to cure themselves purely through sheer will, as, more or less, what happens now?

Please explain how this is working?