Alcohol and self-harm: A qualitative study

26 August 2021


Amy Chandler and Annie Taylor

Key findings

  • Separation of mental health and alcohol services: Despite participants describing drinking and self-harm as related and often as deeply intertwined, the services they described did not often enable drinking and self-harm to be considered together. Many participants suggested they hid either their drinking or their self-harm in order to access services.
  • A lack of needs-based services provision: Participants described services which were diagnosis-led, which meant that many had been unable to access the services they wanted or needed, with long waiting lists to access any support. With both self-harm and alcohol use, this led to some people ‘falling between the cracks’ – with no ‘treatable’ diagnosis, left with limited or no support, despite experiencing significant distress and seeking help for this.
  • Services not flexible or not accessible: Related to the above, participants described services that were either absent or structured in a way that made them inaccessible.
  • Being dismissed: Many participants described feeling dismissed when they tried to access services about their self-harm. This is potentially dangerous as it could lead to people feeling they need to self-harm more frequently or ‘seriously’ in order to access support.
  • Harmful or cruel treatment: In addition to the systematic problems with services, many participants described cruel and painful treatment and harmful attitudes from practitioners, including being given stitches without anaesthetic, being told their problems were ‘invented’, being told their scars would make them ‘ugly’, and not being believed when they were seeking treatment for medical problems other than self-harm.

Executive Summary

This qualitative study was commissioned by Alcohol Change UK in Wales to explore how and why alcohol and self-harm are related, and how alcohol, self-harm, and related services, are experienced and understood. Eleven people who had experience with self-harm and alcohol use were recruited through mental health support organisations across England and Wales. Interviews invited participants to ‘tell their stories’ about self-harm, alcohol use, the relationship between the two practices, and their experiences with services in relation to these.

Participants described a wide range of drinking and self-harm practices, and service experiences. Interviews highlighted the ways in which both self-harm and drinking are embedded in society and culture and do not take place separately from it. Accounts suggested that drinking and self-harm were deeply connected in multiple complex ways.

Drinking was described as sometimes exacerbating a ‘bad headspace’ or enabling self-harm by lowering inhibitions, and sometimes as a type of self-harm in itself, or - for some - as a way of avoiding self-harm. Both alcohol use and self-harm were described by some as representing a valuable coping mechanism. Participants varied in terms of how much of a ‘problem’ either self-harm or alcohol use were at different times in their lives.

Participants had experienced a range of services. A clear message was that current services were frequently unable to acknowledge or respond to their needs, for a number of reasons as stated in bulleted points above.

Participants highlighted the importance of communication, relationships, and accessibility, and the need for services to be able to cope with complexity and respond to need. This has implications for services relating to alcohol and self-harm, suggesting that a more flexible approach, enabling acknowledgment of the complex connections between drinking and self-harm, and the social aspects of both, is required.