Michael Egerer

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

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 alcoholics 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.

Images and theories of addiction

THIS THEMATIC ISSUE STEMS from the work of the international research consortium ‘Theories of addiction and images of addictive behaviours’ and its continuation, the Helsinki Centre for the Study of Addiction, Control and Governance (CEACG). In the Introduction, Pekka Sulkunen (2013) summarises the aims of the consortium and argues for the relevance of integrating the social sciences into the addiction debate. The research articles in this thematic issue can be divided under three subthemes: historical and philosophical reflections; professional and lay perceptions; and images of addiction in popular culture. The articles offer insights into theoretical conceptualisations and images of addictions – understood broadly as behaviours that are deemed problematic and share the element of excessive consumption. Apart from the theoretical value of such endeavours as discussed in Sulkunen’s introduction, the articles provide food for thought at the most pragmatic level as well. Given the lack of consensus over these issues, the views that various stakeholders and lay people have, for example, on the causes of and the solutions to addiction problems may also bear upon the arrangement of treatment systems and policy measures. The first two articles fall under the category of historical and philosophical reflections. Arto Ruuska (2013) discusses a significant period in the history of medical thought on alcohol. During the late 18th and early 19th centuries, the adverse health consequences of excessive drinking as well as excessive drinking itself became established as objects of medical inquiry. The article puts into perspective the common view of contemporary doctors as forerunners of the ‘disease concept of addiction’ which gained prominence in the 20th century. At the core of the disease concept is the notion of an addict’s loss of control over the problematic behaviour. This notion has been and continues to be subject to much theoretical and ethical debate. Susanne Uusitalo, Mikko Salmela and Janne Nikkinen (2013) contribute to this discussion by providing a philosophical critique of the disease concept and its inEditorial

Compromising the public good? Civil society as beneficiary of gambling revenue

ABSTRACT Profits from legal gambling are often channelled to good causes. This system embeds the predicament of whether citizens’ potentially problematic gambling activities should be a source of funding for the public good. In this article, this dilemma is unfolded by the receivers of public grants that stem from gambling revenues. A total of twenty-three representatives of Civil Society Organizations were interviewed as beneficiaries of the Finnish state-owned gambling monopolies. The article illustrates explicit dependencies and hidden ethical dilemmas, suggesting that CSOs may have limited possibilities of making ethically consistent decisions in view of the origin of their funding.

The conceptualisation of problem gambling in social services: email interviews with Finnish social services directors

Abstract Research on handling problem gambling has mostly been concentrated on therapeutic treatment and individual psychotherapy. The treatment focus, however, underscores the financial troubles of problem gamblers. In the Nordic welfare state, citizens’ financial problems fall under the umbrella of social services. Eleven Finnish social services directors were interviewed via email or telephone on their professional experiences with problem gambling and about the support methods available in their institutions. The social services directors believed that gambling problems are rooted in the contemporary consumer society with its financial inequality and pressures of belonging. They had no shared definition or method of recognising problem gambling. Despite being in a supervisory position, the social services directors were unable to give an estimate of the degree of problem gambling among their institution’s clients. A register of cases related to problem gambling in Finnish social services seems necessary. The results indicate, furthermore, that tools should be developed for the early identification of problem gambling in social services as well as for improvement of the linkage between the financial support of social services and therapeutic treatment in specialised centres.

Introduction: Gambling Regulations and the Use of Gambling Revenues in European Welfare States

The introduction presents the framework of gambling regulation currently in place in Europe. It enables the reader to evaluate individual chapters from a vantage point whether social services and other ‘good causes’ should be funded through the gambling proceeds. The chapter explains the importance of gambling in funding the welfare services, why gambling is allowed to expand even though it creates substantial harm, and choices governments face when regulating. The focus of the first section of the book is on case studies showing how gambling revenue is allocated to state-run welfare. The second part shows how gambling funds are earmarked for designated causes. The third part discusses recent legislative changes, and the final part of the book provides a theoretical evaluation on the matter.

Conclusion: Contradictions in Promoting Gambling for Good Causes

The concluding chapter draws together the findings of the case studies in this book by focusing on three contradictions in the ties between gambling and European welfare states. First, state involvement in gambling provision is justified differently based on whom these justifications are directed at, but these justifications also hide financial motivations. Second, how gambling regulation is organised does not have much effect on consumer protection. More important is to understand gambling harm beyond problem gambling, and the role of the state as a regulator rather than as a beneficiary. Third, gambling does not appear to be in line with the welfare ideology socio-ethically or from a financial perspective, as it only generates a cycle in which the same money is transferred between interested parties.

What makes gambling cool? Images of agency and self-control in fiction films.

The study is a qualitative film analysis. It seeks to determine the semiotic and cinematic structures that make gambling appealing in films based on analysis of 72 film scenes from 28 narrative fiction films made from 1922 to 2003 about gambling in North American and West European mainstream cinema. The main game types include card games, casino games, and slot machines. The theme of self-control and competence was identified as being central to gamblings appeal. These images are strongly defined by gender. The study was funded by ELOMEDIA, financed by the Finnish Ministry of Education and Culture as well as the Finnish Foundation for Alcohol Studies. The limitations of the study are noted.

ALICE RAP: Interim Report on Gambling

Permission to include in Alberta Gambling Research Institute research repository granted by Fleur Braddick on November 25, 2013.