Alcohol treatment: what is it and why does it matter?

Maddy Lawson | May 2018 | 7 minutes

On 1 May 2018 we released our new research on the state of the alcohol treatment sector in England.

The research finds that the sector is in crisis, and that hundreds of thousands of people are at risk as a result.

But what do we mean by ‘treatment’?

Types of treatment

Alcohol treatment is an umbrella term to describe a range of different interventions, delivered in various settings, to people with a range of different needs. It can involve everything from psychosocial support, such as cognitive behavioural therapy (CBT) or group support, to pharmacological interventions, to detox services for people who need to withdraw from alcohol with medical assistance or under supervision. Mutual aid or ‘peer support’ groups and fellowships (such as AA or SMART Recovery) also provide effective support for many dependent drinkers, though these are not generally considered specialist treatment as such.

Who gets treatment?

Public Health England estimates that almost 600,000 adults in England alone are dependent on alcohol and would benefit from specialist treatment. But the number actually accessing treatment is far lower: around 80-110,000. This means only about 20% of the people who would benefit from treatment are accessing it. This is for a whole range of reasons, some of which we’ll go into below. One of the key reasons is stigma: many people feel ashamed to seek support. But there’s no shame in asking for help with a problem that such a significant proportion of people experience at some point in their lives.

Treatment providers

Until a few years ago, most treatment was provided by the NHS – though there have always been private and charitable providers. More recently, the third sector has become the main provider of services, increasingly through large providers such as Addaction, CGL and Turning Point. The shift from NHS provision to the third sector, and absorption of many smaller charitable services by large national providers, has changed the landscape dramatically.

Funding

Changes to funding systems have also had an impact. Since 2013, treatment has been commissioned by local authorities through the public health grant. This, alongside severe cuts in the amount money available in many areas, has led to significant changes in the delivery of treatment services. Among the impacts of this (many of which are discussed in our report) there are now very few alcohol specific services: rather alcohol treatment is increasingly provided alongside treatment for other drugs. We still aren’t sure what the impact of this is overall. Merged services have advantages in terms of efficiencies and pooled experience, but there is some evidence they may be less attractive to people with alcohol problems. Intensive treatment programmes – especially residential rehabilitation – can be expensive, and so are bearing the brunt of funding restrictions despite good evidence of their effectiveness.

What works?

It would be great if we could say – ‘Alcohol dependent? Here’s what you need to do.’ But in reality the types of treatment that work, and in what contexts, is not a simple matter. The effectiveness of any given type of treatment depends on who it’s for, where they are in their lives, whether the treatment approach fits with their needs, and – more than anything else, it seems – whether they make a positive connection with the person (or people) providing the support. The so-called ‘therapeutic alliance’ (which is a technical term for striking up an empathic, human relationship) is known to be the most important element in successful treatment.

Why is treatment important?

Recovery from alcohol dependence changes lives. It reduces the suffering of the alcohol dependent person, but it goes beyond that, changing the lives of families and wider communities.

And alcohol treatment is how many people get to recovery; that’s why Public Health England estimates that every £1 spent on alcohol treatment brings a £3 social return. Measuring success is difficult; recovery is a complex journey that can take years, but the effectiveness of treatment Is more often measured in whether people are alcohol-free after a few months. But despite the wide variations in treatment approaches, and the sometimes-unpredictable nature of their effects, evidence shows that treatment has positive outcomes for a significant majority of those who access it.

And the future of treatment?

In an era of public service cuts, and especially as funding systems change in 2020 (more on this in the report), alcohol treatment services face even greater challenges, especially in the geographical areas of greatest need.

Our report sets out a series of recommendations for building a treatment sector equipped to support the hundreds of thousands of vulnerable people – and their families and communities – who rely on it. First and foremost, the Government must come up with a National Alcohol Strategy, with treatment at its heart.