Alcohol is a problem for many individuals across society. Unfortunately, only a small proportion of people who could benefit from alcohol support actually receive it. A fear of stigma, concerns about the help available, and the access criteria for services are all barriers that prevent people from seeking support.
No group experiences these barriers more than individuals experiencing multiple disadvantage – a combination of problems that can include homelessness, contact with the criminal justice system, and mental ill-health alongside alcohol issues. Yet these are also the people with the most need; individuals with alcohol issues experiencing multiple disadvantage are among the highest alcohol consumers in society. Because of this they both suffer more than others and are a have a greater impact on public services when their problematic drinking is not addressed.
People facing multiple disadvantage tend to have had previous interactions with services that have been unhelpful or uncaring. Rigid systems and protocols that conflict with their complex lives, combined sometimes with staff who can be perceived as inflexible and judgemental, can make individuals feel failed, let down, and stigmatised. This can make trusting local substance misuse services difficult and lead to individuals being hesitant in engaging with alcohol support.
For alcohol services to provide help effectively for people experiencing multiple disadvantage, there must be high-quality assertive outreach provision. Dedicated workers need to go out across local communities and actively try to find and directly engage with people experiencing multiple disadvantage who have alcohol consumption problems. It’s often helpful to involve other partner agencies such as housing officers and homeless outreach teams. Simply waiting for this group to show up at services will inevitably let them down.
Interventions, interactions and support sessions with this cohort need to be orientated to suit their needs, strengths and circumstances. To be effective, the service must fit the individual, not the other way around. Taking more time to build trusting relationships and allowing more patience and flexibility for this group increases the likelihood of positive engagement. This might mean meeting people outside of service buildings, in locations most convenient to them and at times best suited to them.
Assertive outreach and flexibility can seem particularly difficult during times of sustained funding cuts, something substance misuse services have experienced extensively of late. When budgets are reduced outreach is often the first thing slashed. Flexibility can seem challenging when caseload numbers escalate.
However, there are ways of ensuring outreach support and flexible working for people facing multiple disadvantage within local alcohol services continues, even in testing times. For example, specific provision and flexibility for people experiencing multiple disadvantage should be built into all substance misuse contracts as standard. Commissioners need to be informed and directed by people with lived experience on what this should look like at a local level. Similarly, local alcohol strategies should expressly reference this group and set out actions to make sure they are supported to reduce their harmful alcohol consumption.
Alcohol issues can be both a cause and consequence of other issues for people facing multiple disadvantage. Individuals can become homeless as a result of alcohol consumption or conversely begin drinking due to becoming homeless (42% of rough sleepers in London last year report an alcohol support need). Addressing these multiple issues simultaneously creates the best chance for an individual to make changes to their alcohol consumption.
Building local partnerships with other local agencies is one of the best methods of achieving this. It ensures alcohol services get the right people referred to them and creates relationships that allow them to refer people more easily to other services, such as mental health and housing. This provides the individual receiving support with a better opportunity to address the underlying causes of their harmful drinking.
Assertive outreach, a flexible approach built into service specifications and building local partnerships are just some of the ways to make sure that everyone, even those with the most complex needs, gets the support they need. If we can get alcohol support right for people facing multiple disadvantage, we will be able to do so for everyone in local communities.
The policies laid out in the Alcohol Charter represent realistic, powerful ways to reduce the harm caused by alcohol. Help make them happen.
