Looking towards the future of alcohol treatment & recovery
This post provides an overview of some of the key issues to be highlighted in a new (April 2016) paper by Adfam on behalf of the Recovery Partnership: Innovative practice in alcohol treatment and recovery. The report is based on a number of roundtable discussions across the country.
Context
In 2014/15, there were 89,107 adults in treatment for problematic drinking alone, with a further 61,533 treated for alcohol and other substances. Around nine million adults in England drink at levels which pose a risk to their health, with around 2.2 million drinking at higher risk of harm. Over 1.5 million are thought to have some degree of alcohol dependence and, of these, around 250,000 are believed to be moderately or severely dependent – and would benefit from structured alcohol treatment.
Alcohol-related harm is estimated to cost society £21 billion a year, with the NHS incurring £3.5 billion a year in costs.
Engaging with the client group
One of the biggest challenges for alcohol services is engaging the largely hidden population which may be drinking at harmful levels and identifying those in need of support or treatment.
Roundtable participants recognised that intervening in problem alcohol use ‘upstream’ can prevent more serious issues developing at a later date. Preventative initiatives targeting young people and raising awareness of alcohol-related harms can be an effective way of reducing long-term harms, and participants discussed proactive outreach in the community and night-time economy and making use of social media to spread the messages.
Social media provides an effective platform to disseminate information and engage younger people, whilst a presence in the night-time economy setting allows for targeted identification and brief advice (IBA), as well as signposting to appropriate agencies. New approaches to engaging people in non-traditional environments was thought by participants to present myriad opportunities in the field of preventative work, early intervention and IBAs.
New and emerging trends
Participants discussed a number of new trends in alcohol use:
- Pre-loading – where young people in particular opt to drink at home in significant amounts before going out. Because these young people were already intoxicated when they arrived at pubs and clubs, it was not possible to conduct meaningful outreach work in these settings.
- The rise of legal highs/New Psychoactive Substances alongside alcohol meant that treatment agencies needed to be prepared and able to work with service users who used a variety of substances.
Commissioning and investment in alcohol services
Many participants agreed with the view that alcohol services have long been the ‘poorer relative’ of drug treatment, and that this was unfortunately still the case. Participants thought that the demand for alcohol services had increased, but the challenges presented by cuts to public health budgets meant that making the case for investment was a difficult task for providers. Reflecting on the low proportion of the eligible population in contact with services, one participant stated:
It’s difficult to make the case, sometimes, for more money and investment in alcohol treatment if people are not coming forward for treatment. There is a need for alcohol services, but there’s not necessarily the demand.
Complex needs
Another key point arising from the discussion was the challenges of managing clients with complex needs and dual diagnosis and providing appropriate and effective support, whilst bearing in mind the similar pressures on mental health services.
Participants described mental health services being under-resourced and strained. Some mental health services still require patients to be abstinent from alcohol before being eligible for support, creating a barrier to ensuring clients get the support they need.
However, some innovative local practices were highlighted, including designated dual diagnosis nurses and leads, partnership working, and care pathways facilitating inter-agency communication between mental health and substance misuse services.
Participants suggested that national guidance on the issue is desperately needed to support the workforce in overcoming the challenges presented by the cohort of clients suffering from complex needs.
Conclusions
The roundtable raised a number of key points that provide an insight into the challenges and opportunities for alcohol services across the country.
Financial pressures were of great concern to participants, some of whom feared disinvestment in their own services, but there was positivity in the acknowledgement that the wide-ranging benefits of alcohol services to health, social care, criminal justice and community wellbeing would sufficiently demonstrate the value of alcohol services – and the importance in health and social terms of investment.
Given the low levels of referrals into treatment, more work needs to be done to target populations who may not see their drinking as a problem, do not realise the potential harms to their health, are afraid of seeking treatment or are resistant to changing their drinking behaviours.
Close joint working with universal health services is a way of identifying and intervening early, and maximising the potential for having conversations with people about their alcohol use. For this to be successful, however, staff from a wide range of agencies and disciplines will require training to recognise the signs of alcohol-related harm and have the knowledge to refer individuals towards appropriate treatment and support.
In order to maintain investment, alcohol services may have to take a more proactive approach in engaging the community, thereby increasing referrals and demonstrating the demand for services. This is by no means an easy task given the pressure on public health services. Nonetheless, the work highlighted at the roundtable is evidence that a range of projects and initiatives are engaging previously hidden cohorts and providing support and treatment to help people manage and overcome problems with their alcohol use.
