Investigating community gardening as a form of rehabilitation for people with alcohol misuse problems in Northern Ireland: A pilot study

Note: This report was funded and/or written by our predecessor organisation, Alcohol Research UK (ARUK).

Following the observation of a major gap in research in the dual areas of eco-therapy and alternative alcohol interventions, this study set out to explore the scope of eco-therapy services in Northern Ireland, with the aim of assessing the potential for a larger research project assessing eco-therapy for people with alcohol problems.

Eco-therapy refers to any engagement with the natural world which has a therapeutic aim. Following the conception of land-based occupational therapy in the 1960’s, eco-therapy projects have been instigated around the world. According to a longitudinal examination by Sempik et. al (2005) the number of Social and Therapeutic Horticulture (STH) projects in the UK has been on the rise since the 1980s, peaked in 2002 and have since been flagging somewhat due to the economic downturn. Northern Ireland faces unique alcohol abuse trajectories when compared with Great Britain, and this, combined with the fact that Sempik’s assessment of eco-therapy in the UK left out Northern Ireland inspired this research.

Many studies of the effectiveness of eco-therapy interventions have been carried out amongst people with a wide spectrum of needs, ranging from people with learning disabilities (Bruce, Hill and Mawhinny, 2008), to severe psychiatric disorders (Berget, 2006), the elderly (Milligan, Bingley and Gatrell, 2003) and recovering cancer patients (Simprich, 1993). There is much anecdotal and observational evidence for the utility of Eco-therapy, with over 90 per cent of all studies reporting health improvements across the various evidence grades in a systematic review of eco-therapy conducted recently (Annerstadt and Wharbourg, 2011).

However, a cursory literature review reveals that there appear to be very few studies focusing specifically on the impact of eco-therapy on people with alcohol problems. People for whom alcohol is co-morbid with other mental health issues represent a larger group (Regier, et al.,1990), in which the alcohol abuse element may remain undetected in their diagnosis. However, according to a survey of 836 horticulture projects for vulnerable adults in the UK via the eco-therapy charity ‘Thrive,’ 8.9 per cent of UK STH projects work with people who have alcohol problems. Existing studies examining the effects of eco-therapy for alcohol problems demonstrate that, as well as the general benefits experienced by those with mental ill health, eco-therapy can make a positive contribution to the rehabilitation process for alcohol problems (Chalquist, 2009).

With the above in mind the aim of the project was: To investigate existing provisions of eco-therapy opportunities in Northern Ireland with particular recourse to interventions whose users include people with current or historical alcohol problems.

The overall aim was to engage with the eco-therapy community in Northern Ireland, build relationships with these projects and map out existing provision. While several projects did not respond within the very short timeframe of initial surveying, this study still built a fairly comprehensive picture of existing provision to inform a larger study.

The team made contact with around 50 organisations and individuals who either operated gardens, facilitated gardening schemes in conjunction with other organisations, or who operated other forms of eco-therapy project, including equine assisted therapy and care farming. Interviews with facilitators, project leaders, staff members and service users uncovered several important features to consider when studying community gardening in relation to problematic alcohol use, most notably alcohol misuse as a co-morbid condition operating alongside other social and mental health problems, and the fact that problematic alcohol use is often not the reason service users begin working with projects.

In total, over 80 relevant parties were contacted, of these 39 qualified for inclusion in the database of existing provisions. A further eight facilitators or facilitating organizations were included in the extended study but as they have no physical base of their own they were omitted from analysis. Of these 47 projects, 18 work with users with alcohol problems, and only five exclusively.

Qualitative data drawn from interviews with participants and leaders identified themes including: motives & project initiation; activities on offer; barriers and adversities; benefits of the project; future plans; and funding considerations. Service users also corroborated information on several of these themes, as well as giving insight into the reasons why people begin working with eco-therapy projects. These themes are a useful starting point from which to develop a more in-depth ethnography of eco-therapy in Northern Ireland, and they also highlighted a number of important considerations.

Projects were asked if they would consider being part of a pilot project to study the benefits of eco-therapy for people with alcohol problems. In total, 16 projects stated a willingness to participate, provided there was some degree of funding to support the new users. 21 projects did not respond to this question or were not eligible for inclusion. Of the projects willing to participate, 3 were equine assisted therapy, and 13 were gardening or farming projects.

Implications:

Scope

It seems more feasible that a larger research project would have a broader scope than alcohol alone; a project looking at service users’ social and health problems – of which alcohol may form a component – and how these may be ameliorated by engaging with eco-therapy would be more informative. Furthermore, looking holistically at the reasons why people engage with gardening projects is likely to provide more information about the level of alcohol problems among vulnerable and marginalised groups.

This pilot study aimed to estimate the total number of service users who could potentially participate in a larger study. Based on figures provided by projects, there are in excess of 1,000 service users per year – allowing for a sufficient sample size from data collection within the timeframe of a 3 year Doctoral programme.

All projects were asked if they were interested in being publically listed with the organization Thrive, whether or not they wished to participate in the research. Contact details – along with website, activities offered etc. – have been forwarded to Thrive. The ICCR at Queens University Belfast will put forward a press release with the objective of highlighting the provision and benefits of eco-therapy in Northern Ireland.