title: What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.
abstract: BACKGROUND
  General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.
  
  
  METHODS
  Twenty Belgian GPs were interviewed. De Vries' Integrated Change Model was used to guide the interviews and qualitative data analyses.
  
  
  RESULTS
  GPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients' situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients' responsibilities in managing their own health as well the GPs' abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare.
  
  
  CONCLUSIONS
  Motivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.
authors.forename: Frederic
authors.initials: F
authors.lastname: Ketterer
authors.forename: Linda
authors.initials: L
authors.lastname: Symons
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Lambrechts
authors.forename: Philippe
authors.initials: P
authors.lastname: Mairiaux
authors.forename: Lode
authors.initials: L
authors.lastname: Godderis
authors.forename: Lieve
authors.initials: L
authors.lastname: Peremans
authors.forename: Roy
authors.initials: R
authors.lastname: Remmen
authors.affiliation: Department of General Practice/Family Medicine, University of Liege, Avenue de l'Hôpital 3, CHU B23, Liege 4000, Belgium. marc.vanmeerbeek@ulg.ac.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Vanmeerbeek
mesh_terms: D000328:Adult; D001530:Belgium; D003657:Decision Making; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008960:Models, Psychological; D009042:Motivation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy*