Pathological gambling and general practitioners (GPs): A focus group study in Finland and France Michael Egerer (University of Helsinki/Department of Social Research) Paper presented at the Nordic Alcohol and Drug Researchers’ Assembly 2010, Reykjavik

Outlook 1.Gambling in Finland and France 2.Gambling and addiction 3. Interview method 4. Data 5. Analysis 6. Results 7. Discussion

1. Gambling in Finland and France Finland: everyday gambling; widely available; France: time-out; limited access; Both: treatment of pathological gambling integrated into programs on addiction

2. Gambling and addiction Medicalisation of pathological gambling has followed model of alcoholism and still bears the marks of a moral issue Non-substance-based addiction – nevertheless, neurobiological quite similar “excessive appetite” (J. Orford)

3. Interview method Reception Analytical Group Interviews (RAGI): Focus group interviews Film clips as discussion stimulus (3 clips on gambling problems: loss of control, neglect of family and cue-dependency) Support questions Least possible interviewer influence

4. Data 7 Finnish groups (35 participants) + 7 French groups (43 participants) in Helsinki area (ca. 1.2 Million), Tampere (ca ) and Turku (ca ) in Paris and rural area (2 interviews there) Finland: 66 % female France: 37 % female

5. Analysis Phase (a): Coded with ”sociologically constructed” codes (A. Strauss) : - biological (personal/environment) - psychological (personal/environment) - social (personal/environment)

5. Analysis Phase (b): Calculating the relative importance of discussion topics for French and Finnish GPs separately to organize the material

5. Analysis (Consequences)

5. Analysis (Therapy)

5. Analysis Phase (c): ”in-vivo coding” (A. Strauss) of the organized material  results

6. Results Consequences: -Comparison between “real addictions” and pathological gambling and their health impairments: gambling only minor health problems -French: psychological disease with a suffering patient -Finnish: social problems more prominent topic and pensioners especially vulnerable

6. Results ”Yes, but one can have somatic consequences, like diarrhoea.” (GP7F I3)

6. Results ”The whole time he readjusts his glasses, takes them off and on, looks to his right and left. This disperses also a sense of suffering.” (GP5F I6) “Yes, but she, she did not get any food for the family, as she gambled her purse empty.” (GP2FIN I3)

6. Results “Yes, some of these people came to me, older people, who go to slot-machines and gamble away nearly all their pensions.” (GP4FIN I4)

6. Results Therapy: -Pathological gambling not GPs expertise -Pathological gambling easier to quit than alcoholism (substance based addictions) -French GPs: see it as their obligation to help and rely on compulsive measures -Finnish GPs: question possibility to help and hope on addicts reason to limit themselves

6. Results ”Well, we have to identify them, talk to them.” (GP7F I3) ”And, I have never seen that we would have the resources for something like that. Well, perhaps on gets RAY money for that, but at least never from the city budget.” (GP1FIN I3)

6. Results ”I would place him under custodianship.” (GP2F I5) ”Perhaps she could place herself under a custodianship…” (GP1FIN I1)

6. Results ”But he, he has got nevertheless his whole head! He is sober, he is not drunk.” (GP1F I2) ”Then it could be that way that as alcoholism is physical, it is then easier to quit form the psychological one.” (GP7FIN I1)

7. Discussion Pathological gambling in France seems to be considered as loss of control, as compulsive measures are necessary  in countries where gambling is time-out, control to come back to ordinary life especially important? Finnish GPs in comparison do not completely follow the Nordic addiction model, as control seems possible  in countries were gambling is everyday activity control is not that important, as one “does not leave society”? Nevertheless, in both countries also institutional background influences images as French follow medical model with emphasis on single patient and Finnish the family of the gambler