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• W1997535271 abstract "The conclusions on future challenges for brief intervention (BI) research and for BI dissemination into practice 1, as well as the summary of key BI research findings that the text provides, raise some stimulating issues. As found in the past, a major consideration when interpreting research findings is the difference between northern and southern Europe regarding alcohol research 2, and particularly research into BIs. As the references Nilsen's paper demonstrate, there is no published BI material generated in southern European countries, even if there are a few exceptions that focus upon primary health care 3-5 or emergency rooms 6. This is due probably to a combination of both little tradition of alcohol studies and less concern about drinking in southern Europe, where the meaning of alcohol beverages, drinking patterns and presumably hazardous drinking is divergent from other European regions and English-speaking countries. As a consequence, it is worth asking whether further research on the effectiveness of BI is needed for southern Europe, where such a cultural diversity in drinking exists. This may be particularly useful when ‘obtaining knowledge for . . . understanding . . . under what conditions’ BI implementation interventions may work. If this would be our conclusion, projects such as the World Health Organization (WHO) Early Identification and Brief Intervention Phase IV project, that was developed in the 1990s–early 2000s 7, could be implemented further in southern European countries, and researchers and stakeholders from those countries could be encouraged to take part in some international endeavours such as INEBRIA (International Network on Brief Interventions for Alcohol Problems) on Europe 8. Other aspects regard the obstacles to a successful strategy to promote routine brief intervention at primary health care level—and in other settings. I shall limit my considerations to general practitioners (GPs). One obvious issue is the relation between prevention and clinical work as it is experienced by each GP. Doctors are trained essentially to treat individuals, while screening hazardous drinkers and intervening on them has more to do with life-styles, risk and probability, i.e. it compels the GPs to think collectively. This may be often felt as something beyond the individual GP's role—in other words, a ‘barrier’ due to poor role legitimacy. A natural solution to this barrier would be training on alcohol, and a greater focus on life-style and prevention in university and postgraduate medical education. Another obstacle to BI implementation is the perception and the awareness of alcohol problems by physicians. Experience and literature seem to suggest that when facing the issue of hazardous drinking, GPs can be inclined to become judgemental about the client and his/her drinking behaviour, raising guilt or shameful feelings in the consultation room. In turn, this may hide some kind of worry among GPs, not willing to confront their own drinking, as if it were a sort of self-judgement to be avoided. Of course, this worry may be generated both by society, and through the personal history of the physician. Basic psychological skills and an empathetic approach can help when a professional communicates with their patient about alcohol. Acceptance of the other, that is, the experience of Alcoholics Anonymous in the context of group meetings, is probably a good way to approach subjects who are probably qualified by shame and guilt. The time needed for a BI, certainly less ‘than 20 minutes’ in the practical work of GPs, and the content of the transmission of information about cutting down or stopping drinking—as well as the non-judgemental way in which this content is given to the client—are of paramount relevance if one wants to see if BI ‘works’. On many occasions, the GP's awareness of risky drinking, his/her willingness to use some screening tools and a non-judgmental approach are probably more important in order to give good advice to her client than applying a formally correct BI. In fact, giving advice to a patient implies several relational aspects that are necessarily individual. While a formal BI procedure could be helpful to GPs in a preliminary educational phase in order to introduce a reasonable approach to alcohol problems, a sort of Balint group 9—that focuses on negative and positive emotions generated in the relationship between doctor and patient—might provide a better context to face possible problems in the consultation room later on. A final methodological aspect is the relationship between the investigation about what is happening in the patient/doctor relationship within the consultation room, and what is actually happening in the patient/doctor relationship within the consultation room. In other words, how is any formal research—among the many papers published in the last 20 years on this topic—really able to get what actually occurs within the doctor's office? The questionnaire responses filled in by doctors may also suffer the same problem. The GP's office appears to be a black box, that is prone to be altered by the observer whenever (s)he is trying to open it—‘observer's effect’ as physics (Heisenberg's uncertainty principle) or psychology (Gustav Jung's personal equation) tells us. In all probability, the relational feature of the consultation makes the psychological instruments more suited to the investigation than the epidemiological or sociological tools. None." @default.
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• W1997535271 doi "https://doi.org/10.1111/j.1360-0443.2009.02861.x" @default.
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