Alcohol treatment: Time for action

Dr James Nicholls | May 2018 | 8 minutes

The alcohol treatment sector is facing acute challenges.

Yesterday [1 May 2018] politicians, service providers, researchers and charities met in the Houses of Parliament to set out what they see as the key challenges facing the sector, and how Government might help address them.

At the centre of the meeting, held by the All Party Parliamentary Group on Alcohol Harm, was the new report from Alcohol Concern / Alcohol Research UK, which details the crisis facing alcohol services and sets out 14 recommendations for action.

Left to right: Professor Colin Drummond; Dr Emily Finch; Lord Brooke of Alvethorpe; James Nicholls; Oliver Standing; Fiona Bruce MP; Mike Ward; Richard Piper

The media loves to talk about whether a glass of wine might add or take a few weeks from your life, about glass sizes, and binge drinking – but is surprisingly silent on the ongoing crisis occurring in alcohol treatment services, which threatens to hit some of society’s most vulnerable people.

Treatment isn’t just about individuals achieving recovery – though that is at its heart – but about whole families and communities who suffer when alcohol problems are not addressed. And untreated alcohol issues (very often occurring alongside untreated mental health problems) lead to knock-on effects for hospitals, A&E, police and a range of other services.

You can read more about what alcohol treatment is and why it’s important here.

This is why cuts to treatment services are a false economy. Left unaddressed, alcohol problems don’t just go away: they remain for other services, and people, to deal with. Public Health England estimates that every £1 invested in alcohol treatment brings £3 in social return, and our work developing the ‘Blue Light’ project suggests considerable savings to local services when alcohol problems are addressed with a concerted effort.

So why and how has the system got into this state without public and political outcry?

“… cuts to treatment services are a false economy… why and how has the system got into this state without public and political outcry?”

At the meeting yesterday [1 May 2018] Paul Hayes, Director of Collective Voice, suggested there is a culture of ‘systemic indifference’ to alcohol problems, which leads to both low levels of funding and lack of political concern about the consequences. Speakers from the floor talked about the continuing stigmatisation and overlooking of people with alcohol problems.

But, as Mike Ward from Alcohol Concern argued passionately, this is about real people. Alcohol problems are not just statistics, they are real lives – which often end in tragic outcomes when treatment is not available.

There was a remarkable level of agreement among speakers and attendees on what the key problems in the treatment system are. Everyone broadly felt that:

  • Local funding is simply not capable of supporting an effective system, especially when areas with the highest need are often the areas with the least resources.
  • People with combined mental health and alcohol issues are not being properly supported
  • There is the risk of a loss of expertise across treatment systems – from commissioning through to delivery

Beyond this, we highlighted a range of wider issues. Professor Colin Drummond, representing the Royal College of Psychiatrists, emphasised that ‘treatment’ is not just about helping those at the most severe end alcohol harm: it is also key to preventing people moving into dependency. Treatment and prevention are not two ends of a spectrum; they are two sides of a coin.

“Treatment and prevention are not two ends of a spectrum; they are two sides of a coin.”

One attendee described how people seeking support for alcohol are often put off by services they experience as designed for illicit drug users – a key issue that emerged in our survey. Seeking treatment can be incredibly hard, and any barriers that arise – from acknowledging a problem, to finding and accessing services, to poor experiences of services themselves – can derail an already difficult journey.

Some suggested that alcohol is too complex a problem, too much of a ‘chameleon’, for local authority public health teams to deal with alone. Public health professionals were clear that they welcome all the support they can get – but social work training also needs a better focus on alcohol, and addiction psychiatry is under enormous threat. Yet there are examples of good practice, especially around hospital liaison teams that collaborate across areas of expertise.

Despite the severe challenges and lack of political recognition, people working in treatment services continue to do so with empathy, strength and commitment. Many have responded to budget cuts with innovation and enterprise. But there is only so much that can be done as budgets get ever tighter.

“… people working in treatment services continue to do so with empathy, strength and commitment.”

The meeting confirmed the need for concerted action to protect, improve and support alcohol treatment services. We hope that our report and its recommendations provide focus for change. Because this isn’t a lost cause – there are things that can be done and decisions to be made, some high-level and some matters of detail, some potentially radical. Without action the consequences will be felt by all of us.

“Without action the consequences will be felt by all of us.”