We can do something about entrenched alcohol dependency.
“The alcohol agency relies on clients being motivated… Often if people don’t attend a couple of appointments their case is closed.” [1]
That quote came from a worker involved in the very first Blue Light pilot, over a decade ago. Sadly, it could have been said yesterday: the problem it describes has not gone away. In short, the Blue Light Approach is about transforming systems, not labelling people. Too often, people experiencing entrenched alcohol dependency are labelled ‘unmotivated’, ‘chaotic’, or ‘making lifestyle choices’. They don’t show up to appointments, or drop out, or don’t meet service goals, so services disengage. At best, they’re handed back to GPs or left with community safety teams. At worst, they are abandoned entirely.
This manual challenges that thinking.
In short, the Blue Light Approach is about transforming systems, not labelling people.
In 2011, a man in Rochdale was killed by his ex-wife - a woman he had abused over many years. He had a long term alcohol use disorder. The Domestic Homicide Review that followed summed up the attitude of many services: “Appropriate referrals were made to addiction and medical services. He had a stubborn resistance to engaging with them, preferring…to continue his drinking unabated…” It concluded: “Services cannot be effective unless the client wants to change...” [2]
The original Blue Light manual opened with this quote, but it’s a belief that still echoes today.
In 2018, the Bristol Safeguarding Adults Board (SAB) reviewed the murder of a woman by a man with significant alcohol issues. A key decision? His care coordinator didn’t refer him to drug and alcohol services because “they did not think there was any realistic prospect that Mr X (the perpetrator) would engage.” [3]
In 2019, a review into the death of Leanne Patterson in Northumberland noted that services saw her as someone “‘making choices’ around lifestyle that were increasing her risk and made her difficult to engage…” [4] - despite clear signs of exploitation, injury, and escalating risk.
In 2021, Sunderland SAB’s Safeguarding Adults Review into “Alan”, who died in a fire linked to his drinking, found that professionals involved in his care noted in their reports that “Alan was a capacitated adult who chose to live a chaotic lifestyle whilst being cognisant of the risks this entailed.” [5] This was despite brain injury, suicidality, and signs of alcohol-related cognitive impairment.
The phrase ‘lifestyle choice’ is often used to describe people who are seemingly resistant to engage with services. This was the case with both the Alan SAR and Leanne Patterson SAR mentioned above. It has become a convenient way to rationalise inaction - a label that shifts blame onto people whose lives are shaped by trauma, poor health, structural poverty, and stigma.
But we know this simply isn’t true. Calling entrenched alcohol dependency a “choice” is outdated and dangerous. People in such situations are often caught in a perfect storm of addiction, physical illness, trauma, and social exclusion. Many are exploited, many die preventable deaths, and many never even get offered meaningful help.
Even Alcoholics Anonymous, often held up as the gold standard for peer recovery, is clear that the only requirement for membership is a desire to stop drinking. [6] So, what happens to the people who don’t yet have that desire - or can’t express it?
The Blue Light Approach was developed as a direct response to this culture of fatalism.
It’s not about blaming services. Many are under-resourced, overburdened, and doing their best within rigid systems. But it is about challenging the belief that ‘nothing works’.
The Blue Light Approach offers a practical, realistic set of strategies to engage people who seem resistant or ambivalent - not by waiting for them to ‘hit rock bottom’, but by starting where they are.
It shows that:
- Progress is possible, even without initial motivation
- Costs to services can be reduced
- Risk and harm can be minimised
- People who are written off can stabilise - and even recover
This manual isn’t a magic solution. But it is a toolkit - built from front-line experience - for workers who are tired of watching the same people fall through the same cracks. It sets out strategies and techniques that specialist and non-specialist workers can consider in working with this client group. However, this guide is just a starting point. This is not meant to be the definitive statement on working with people with entrenched alcohol dependency that services find difficult to engage; its main aim is to inspire workers to think differently.
It’s for anyone who believes that doing nothing is the worst option of all.
[1] Worker comment from Alcohol Change UK’s 2018 report: The Hardest Hit
[2] Rochdale Safer Communities Partnership, Domestic Homicide Review. Victim Male 1, Died August 2011. See: Section 6.3.3
[3] Bristol Safeguarding Adults Board. Caroline. (2018).
[4] Northumberland Safeguarding Adults Board: Leanne Patterson, Safeguarding Adults Review (2019)
[5] Sunderland Safeguarding Adults Review (2011). Alan. Available at: https://www.sunderlandsab.org.uk/wp content/uploads/2021/08/Alan-SAR-Summary-v4.docx
