COVID-19: supporting the most vulnerable drinkers

Mike Ward | April 2020 | 8 minutes

Through the Blue Light programme Mike Ward works with some of the UK's most vulnerable people, those often called 'change-resistant' drinkers - and this group faces particular challenges as a result of coronavirus.

Through Alcohol Change UK’s Blue Light programme, I work with some of the UK’s most vulnerable people: those often referred to as ‘change-resistant drinkers’. This group of people are defined by their reliance on public, often emergency, services. They drink heavily while also facing a number of other challenges: mental health problems, ill-health, homelessness. Too often, they are considered to be beyond help. The Blue Light programme’s revolutionary approach is to assert that this is not the case. No heavy drinker is beyond help. This group of people do, however, require a different kind of support.

Since lockdown I have received a number of calls about the problems coronavirus is posing for this group of people. In this blog I will look at what these problems are, and how treatment providers and other professionals can help.

The problems facing the Blue Light group during the pandemic

  • They might disregard social distancing guidelines, both because they are intoxicated and because they need to go out and access alcohol.
  • They may be vulnerable to exploitation if they have to rely on others to access alcohol.
  • As a group they are very likely to have long histories of smoking and, therefore, have breathing problems which make them more vulnerable to the effects of Covid-19. They may have a variety of other physical health problems which increase their vulnerability.
  • They run the risk of serious unplanned withdrawals if they have an interrupted alcohol supply. These increase the burden on the health service, and could be fatal.
  • If their diet worsens, this could worsen their health problems and increase intoxication.
  • If they are confined in a hostel, or even in a family home, this could increase the risk of violence including domestic violence.

It is particularly important to remember that, while rehousing homeless drinkers is a positive step, it is not risk free. It could increase the risk of unobserved withdrawals and of exploitation by people that they are housed with.

Advice for supporting this group during the pandemic

  • Alcohol services across the country are doing brilliant, proactive work with this client group. If you are a professional working outside an alcohol service, it’s worth reaching out to your local service if you have concerns about a client.
  • Use this crisis as a window of opportunity to build a better relationship with challenging clients and to encourage change.
  • Ensure that supplies of alcohol are well-managed and not interrupted to prevent potentially fatal withdrawals.
  • Monitor how clients are accessing alcohol to ensure it is safe both in terms of Covid-19 and the risk of abuse and exploitation.
  • Ensure changed living circumstances are not laying people open to exploitation.
  • Make sure clients have access to enough food to ensure that they do not decline further.
  • Encourage people to take up e-cigarettes or other nicotine replacement therapy to improve lung health.
  • Emphasise the need to follow government guidance on social distancing.
  • Make sure they receive regular text messages and phone calls to keep them in touch with help. Consider providing a client with a cheap mobile phone and credit, so that they can stay in touch.
  • For some clients, reminders about online Alcoholics Anonymous meetings will be useful (see the AA website). Other local alcohol services may offer similar support at a distance.

Although this is a difficult and challenging time, there are potential positives. This is an opportunity to build a better, supportive relationship with a client. It is also a chance to pilot telephone or online support. We are hearing that services are having positive relationships with these challenging clients even over the phone.

We are keen to hear what impact COVID-19 is having locally on change-resistant drinkers, treatment services and their clients. If there are any significant problems you are encountering or issues that need to be flagged up at a national level, please get in touch.

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