The Recovery Partnership have published a number of briefings relevant to the substance misuse sector, including Innovative Practice in Alcohol Treatment and Recovery (pdf), which identifies a number of key themes following a recent stakeholder round table.
The Recovery Partnership was formed in May 2011 to provide a collective voice for the treatment sector on the ambitions set out in the 2010 Drug Strategy. Following Drugscope's closure last year Adfam have taken on the delivery of the partnership's final year work strands.
The briefing states a number of clear messages emerged from the round table discussion, which appear largely consistent with those reported in last year's review of alcohol treatment services by Alcohol Concern and the Recovery Partnership.
Firstly it identifies engaging the client group as 'one of the biggest challenges for alcohol services', with those drinking at harmful levels and needing support being a 'largely hidden population'. Although the briefing was not intending to address prevention, it highlights the need for population level activities to help raise awareness of alcohol harms and support services. As well as brief intervention (IBA) by the wider non specialist workforce, utilising other key stakeholders and social media were identified as particular opportunities, although persistent and proactive approaches would be needed to capitalise on these.
Discussion around new and emerging trends was also identified as an important area, with high levels of intoxication amongst young people in night time economies linked to 'the phenomenon of ‘pre-loading’. The rise of novel psychoactive substance (NPS) use amongst alcohol users was also noted, and therefore services must understand poly-use. Engaging older people who may be at a heightened risk of alcohol harms or dealing with significant life transitions such as bereavement, isolation or retirement was also identified as a key area needing further attention.
On commissioning and investment in alcohol services, alcohol is still considered the ‘poorer relative’ of drug treatment and as such stakeholders were disheartened by the lack of central funding and cuts to public health budgets. However whilst demand was thought to have increased - indeed backed up by some rise in national figures - making the case was still challenging given the low proportion of people seeking help.
As a long running issue, complex needs and managing dual diagnosis were again identified. Whilst in some cases good practice or dedicated leads existed, overall pressures on capacity coupled with the complexity of some clients continued to prove a significant challenge. More national guidance to support workforce development in this area was sought.
Finally, on 'a national conversation about alcohol', participants felt more progress was need to address 'misconceptions and lack of understanding around alcohol and its harms amongst the general population'. Further basic awareness of units, guidelines and the need for 'making every contact count' programmes were identified.
Concluding, the report states that 'more work needs to be done to target populations who may not see their drinking as a problem, do not realise the potential harms to their health, are afraid of seeking treatment or are resistant to changing their drinking behaviours'. As such 'alcohol services may have to take a more proactive approach in engaging the community, thereby increasing referrals and demonstrating the demand for services'.
Re-framing 'alcohol treatment'?
Many of these issues will be all too familiar for those in the field, although arguably progress has been made over the last ten years through local, regional and national programmes and investment. Earlier this year PHE sought to help keep momentum through a resource to support the 'commissioning and delivery of evidence based treatment interventions to address harmful drinking and alcohol dependence in adults', building on a comprehensive set of NICE and other guidance.
However it is hard to disagree that engaging more harmful drinkers 'upstream' would be beneficial to prevent potential health conditions, dependency or other problems developing. Many harmful drinkers though are not 'help seeking' and do not want referral into specialist services or peer support. Whilst the report identifies some case studies, whether support can be routinely offered in any way that significantly increases demand amongst harmful drinkers is a big question... even leaving money matters aside.
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