Alcoholism, brief intervention and the institutional context: a focus-group study with French and Finnish general practitioners

Abstract

The moral problem of heavy drinking has become medicalised. However, when taking into account the different levels of medicalisation, French alcohol policy and treatment organisation has traditionally gone further than Finnish policy, although physicians in both countries are now becoming more important in the treatment of alcoholism. General practitioners (GPs) are often the first to diagnose alcoholism and they are expected to apply brief interventions, which have been proven effective in reducing heavy alcohol consumption. Focus-group interviews were conducted in Finland and France using three film clips as a stimulus for discussion. The short vignettes show incidences of alcohol problems from scenes in international fictional movies, with themes of loss of control, harm of loved ones and cue dependency. Interviews were analysed for GPs’ narratives about alcohol problems and alcoholism, using the semiotic concept of focalisation. The influence of historical approaches to alcohol problems was evident in the French GPs’ focus on the suffering of the alcoholic in comparison with the Finnish GPs’ emphasis on the alcoholic's family misery and their obligation only in caring for the physical problems of the alcoholic. The organisation of primary health care is identified as one important factor for these differences in conceptualising heavy drinking. Implications are that the compatibility of brief interventions with institutional and cultural contexts of health care should be considered before implementation.