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Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

Alcohol treatment in crisis

Services are in a cycle of disinvestment, staff depletion, and reduced capacity, and this is due to get worse; in 2020 ring-fenced public health funding will end, posing additional risk to the areas of highest need.

The hardest hit

A new (1 May 2018) report from Alcohol Concern warns that the alcohol treatment sector is in crisis. The report “The hardest hit: addressing the crisis in alcohol treatment services” highlights how severe funding cuts, rapid re-tendering cycles, loss of qualified staff and lack of political support are impacting on some of the most vulnerable people in society.

It is estimated that around 595,000 people in England alone are dependent on alcohol and in need of specialist support. But only around 108,000 are receiving treatment for their alcohol dependency. This has a significant impact not only on the individual but on their families; around 200,000 children live in a household with an alcohol-dependent carer.

In the UK roughly one person dies every hour as a result of alcohol. Over the past forty years we have seen liver disease rates in the UK increase by around 250% – far outstripping liver disease rates seen across much of the developed world, which have reduced in recent years.

Public Health England estimates that every £1 invested in alcohol treatment brings a social return of £3.

Key findings from the report show:

  • Only 12% of respondents felt that resources were sufficient in their area;
  • Respondents reported cuts of between 10% and 58%, with one treatment provider saying local areas were ‘paring back to a skeleton service’;
  • 59% of respondents felt that aspects of services in their area had worsened in the last three years, with particular threats to community detox and residential rehabilitation facilities;
  • 62% of respondents said that in their area appropriate care is not available for people with both a mental health and an alcohol problem, with many told they must resolve their alcohol problems before they can access mental health services;
  • Only 7% described the quality of engagement between JobCentre Plus and local alcohol services as ‘good’.

To address the issue, the report sets out several key recommendations, including:

  1. The Government must develop and implement a National Alcohol Strategy, with treatment at the heart of a broader suite of interventions to reduce alcohol harm.
  2. The Government must urgently plug the gap in treatment funding and reduce health inequalities arising from local funding structures. The report contains recommendations for how this might work.
  3. There must be a national review of commissioning of alcohol services, and the balance of staffing in the alcohol field.

The report is an in-depth piece of work and well worth reading in full. Below, I summarise its findings on three key issues: funding cuts; commissioning and mergers between drug and alcohol treatment services.

Funding cuts

The report is based on official data and an online survey completed by 154 professionals and service users in the alcohol treatment sector, supplemented by 40 telephone interviews.

Lack of funding was, by far, the threat to service provision most commonly cited by survey respondents. Only 12% of respondents felt resources were sufficient in their area, and comments revealed widespread frustration at the impact of lost funding on staff numbers, treatment capacity and workforce morale. Cuts of between 10% and 58% were reported, with knock-on effects for a range of critical services. 
 
Reduced funding was seen as having an especially acute impact on particular types of service. Only 55% felt there was sufficient availability of community detoxification. The situation was worse for inpatient detoxification (45%) and residential rehabilitation (40%).
 
There were also concerns about the availability of community services, especially to individuals living in rural areas. Where service provision is consolidated into a single centre, it often creates difficulties for people who either lack transport or, because of complex needs, may miss appointments.  
 

 

Commissioning

There was considerable frustration with the commissioning process. Only 41% of respondents said they felt commissioning was working well in their area, despite commissioners forming a significant proportion of respondents.  Two key problems were identified: the speed of re-tendering cycles and the level of commissioning expertise.

Re-tendering cycles

We estimate that 44 out of 152 alcohol treatment services – about one third of the total – were recommissioned in 2017 alone. 67% of respondents to our survey had seen their local treatment systems re-tendered in the last three years, and 26% had seen them re-tendered in the last year. 63% of respondents had seen a new local provider as a result of the tender.

Mergers

The merging of drug and alcohol services has become standard practice in many areas. Indeed, only one participant area reported that the two services were still delivered separately. There are good reasons for merging drug and alcohol services: as a number of participants noted, there is a degree of crossover in terms of treatment as well as use. Merging services not only allows for efficiencies, it highlights the fact that alcohol is a drug of dependence as much as an illicit substance.

Nevertheless, merging services was viewed by many respondents as creating a number of critical, unintended consequences. In particular, many felt that the co-location of drug and alcohol services could deter alcohol users, especially older drinkers, from attending. A number of respondents used the phrase ‘Cinderella service’ to describe alcohol treatment in relation to drug services. For some, the merger represented an opportunity to increase the proportion of funding that went into alcohol services, thereby addressing a long-standing skew in funding which meant
the large majority of money went towards substances which, in overall numbers, were used by far fewer people. 
 
However, others expressed concern that the merger would only exacerbate alcohol’s ‘Cinderella’ status: diluting the particular skills and approaches appropriate to alcohol treatment, while making the service less attractive to those
clients who felt, for whatever reason, that they did not belong in an environment that was geared towards supporting people dependent on illicit drugs.
 
Alcohol Concern notes that the impact of merging services on the experiences of alcohol-only clients has yet to be evaluated properly.

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