“Times of change are truly a gateway for learning”: what alcohol services have learned from the lockdown

As the country entered a shutdown unparalleled in living memory, a key concern at Kaleidoscope was how alcohol use might be impacted by lockdown. Much research supports the idea that during life’s transitions – be it children flying the nest or the sudden loss of a partner – our reliance on alcohol often increases. The effect of a global pandemic on our drinking behaviours was not straightforward to predict. However, we felt strongly that anxiety bolstered by the news cycle, purposelessness or boredom at being out of work, and prolonged isolation were likely to cause problems.

Just three weeks after lockdown began, we were seeing only 30 per cent as many new alcohol referrals to our services across Wales compared with the same time last year; yet a fifth of people who already drink alcohol were revealed to be drinking more, and sales of alcohol had risen by a third. This painted an alarming picture, and so Kaleidoscope and our partner Barod were desperate to get the word out that support was available amidst lockdown conditions.

We enlisted the help of a number of service users, all eager to encourage anyone struggling to reach out. News of our #TimeToBrew campaign was shared by national and regional media, alongside harm reduction messaging and guidance on drinking safely at home. The aim was to help current and future service users to build resilience if they found themselves reaching more regularly for the bottle. For all of us, lockdown meant that our usual support networks and coping mechanisms, such as close social bonds, an exercise regime and stable routine were radically altered. Peers bravely shared their own experiences and advice for maintaining recovery during lockdown, and eight weeks later we began to see a steady return of alcohol referrals.

This slow return was likely due to a combination of factors. For example, many of our service users reported that they had stopped watching the news and so their anxiety had subsided, also the real world moved quickly into the digital space providing entertainment and engagement that way. So, service users took part in online quizzes, workouts and connected via Zoom. Kaleidoscope with partners was able to adapt at pace, creating support groups and activities through online recovery groups and virtual support.

Our residential services also had to change, and in the case of our complex needs hostel we welcomed many people previously on the street. Our detox unit Birchwood has people on a short-term basis, and so making people feel at home and at the same time keeping everyone safe was very challenging, but these front-line services saw no community infections.

For some of our most vulnerable service users, connection has been important. Luckily, with the help of Mind, we were able to make laptops, tablets and Echo Shows available to the most isolated. We learnt quickly that for those without access to digital support, lockdown had created more challenges, and we endeavoured to find solutions. The issue of digital inclusion was notable across Wales, but particularly among our service users living in the most rural areas of Powys.

To assess the impact of COVID-19 on drug and alcohol use we enlisted the help of a group of peer mentors with lived experience. They conducted a Wales wide survey to uncover what we might have done better, and prepare us for any future lockdowns. More than 200 people receiving support across Wales took part, and 48% attempted to reduce their alcohol intake at home during the lockdown. Alarmingly, 25% suffered a lapse or relapse following a period of abstinence during lockdown, and many relapsed after considerable time in sobriety. In one instance following more than two years of abstinence. For this reason, we recommend that services ensure relapse prevention planning takes place with service users during and before any future lockdowns, regardless of time spent in sobriety.

Many of our clients who suffer from social anxiety or decreased mobility welcomed more online support, and for others it has been a less intimidating first step into recovery, however the fundamental need for face to face support came through loud and clear. 46% of respondents marked face-to-face interaction as their preferred method of support, with just 8% preferring phone support. While there has rightly been some excitement at how quickly service delivery has adapted to make use of online interventions, it was sobering to learn that 60% were either unable to, or chose not to, access online support interventions. 69% did not access online support or community groups, and 58% of those who did access online interventions did not find them effective. We believe services should provide, where possible and in line with social distancing, the opportunity for service users to have face-to-face contact with key workers. You can view the COVID19 Impact Report, full of service user testimony and recommendations, here.

It is interesting to remember that just weeks before the outbreak escalated, many in the field were busy advocating for increased awareness of Minimum Unit Pricing. We stressed that improved access to treatment services was essential and there was much apprehension about how the legislation could impact behaviours – particularly in relation to finances, mental health, relationships, and in the most extreme examples, offending and criminal behaviour. To evaluate the impact of MUP in isolation going forward will be extremely difficult as the pandemic has altered the lives of our service users in all of these areas and more. Providers of addiction and social care services are of course concerned how the picture of alcohol dependency across Wales will alter in the months and years to come, and whether we are yet to see a cohort of newly dependent drinkers that pandemic conditions have produced.

Whatever the future might hold, a crisis such as this forces pressing issues to the foreground, and times of change are truly a gateway for learning. We have been reminded of our mutual dependence, our fragility and indeed our ingenuity, and I have no doubt we’ll continue to emerge with solutions and innovative new ways of serving our community.