Taking a new approach to alcohol treatment

The National Treatment Agency for Substance Misuse (NTA), the NHS body that focuses on improving the availability, capacity and effectiveness of drug and alcohol treatment, has released its annual report on alcohol treatment in England.

The results indicated that over 38,000 people left alcohol treatment programmes having recovered from their alcohol dependency in 2011-12, an increase of over 2,000 people compared to the previous year.  

While this result was broadly welcomed, longer-term trends are yet to be established and a further analysis of the numbers raises some questions and concerns for treatment providers, such as the Westminster Drug Project (WDP). 

‘It is time to bring the debate on alcohol dependence into the mainstream and not solely focus on binge drinking’

First, the numbers indicate that only a fraction of those who need treatment for alcohol misuse actually enter treatment. Second, the funding of alcohol treatment services is a continual problem, with little appreciation of the financial and social returns they generate.

The final concern is the lack of structural and strategic integration between the healthcare system and the drug and alcohol treatment providers. While all agencies involved in the addiction field support the recovery agenda, the outcomes we strive for can only be achieved with clear direction and investment in treatment and prevention for all harmful substances, from illicit drugs to alcohol.

Social cost

The NTA estimates 1.6 million people in England have some degree of alcohol dependence. But with such a broad base of dependency, it is worrying that less than 110,000 people accessed treatment for alcohol dependence last year. 

For WDP, a charity that provides drug and alcohol treatment in London and the south east of England, this is evidence that the vast majority of people with some level of alcohol dependency are either not aware of the physical and social harm caused by their drinking, or are not able to access the treatment services that they need.

The financial cost of alcohol misuse in the UK is estimated at £21bn annually − or 40 per cent more than the overall cost of drug addiction. Of course, the social cost is impossible to measure, and WDP feels it is time to bring the debate about alcohol dependence into the mainstream and not solely focus on the debate on hazardous and binge drinking.

A worry commonly expressed by WDP practitioners is the poor links between accident and emergency departments and alcohol treatment services. Many people present themselves with alcohol-related problems at A&E but the level of referrals to treatment services is unsatisfactorily low.  

The NTA shows only one per cent of referrals to alcohol treatment services come from hospital emergency departments, while an estimated 35 per cent of presentations to A&E are alcohol-related. With poor structural and strategic integration, it is no surprise the level of alcohol-related deaths in the UK has almost doubled since 1991.  

What is particularly disappointing about the national approach to alcohol misuse is there is strong evidence that the treatment system works. For example, the NTA estimates that for every £1 invested in specialist alcohol treatment, £5 is saved on health, welfare and crime costs.

Funding awareness

However, WDP is increasingly worried that there is not enough funding for awareness and specialist treatment services. The obvious consequence of this is the social, physical and financial costs of alcohol abuse that are pervasive in our society continue without reasoned debate.  

We strongly believe there are a range of “invest to save” approaches which need to be prioritised in the public health agenda to prevent alcohol-related harm. The National Institute for Health and Clinical Excellence advocates for an investment in preventative interventions, including screening in a range of settings to prevent alcohol-related disorders.

‘Specialist alcohol services need to ensure the support they offer people includes a holistic approach’

But there has been concern over disinvestment in these types of services. A study by the University of Central Lancashire and Liverpool John Moores University showed how effective drink-related advice services provided by pharmacies can be in reducing alcohol related harm and in preventing prevent further problems. However, WDP has observed that many of these services have now been decommissioned, which is a worrying trend.

We also support the government’s latest alcohol strategy, which advocates for health professionals, including GPs, to carry out more alcohol screening and more “alcohol liaison nurses” in hospitals.

As a drug and alcohol treatment provider, we would welcome a more effective referral pathway between the health sector and specialist alcohol services. This means alcohol treatment services would be able to reach people who may otherwise not access the help they need. We also believe it is important to expand programmes aimed at identifying “at risk” drinkers, such as the identification and brief advice, across the health and public sector. 

Holistic approach

The identification and brief advice comprises of a short screening using a validated tool such as the World Health Organisation’s alcohol use disorders identification test, followed by brief advice lasting from 5 to 10 minutes to motivate “at risk” drinkers to reduce their alcohol use. 

Our experience, and there is supporting independent evidence, is that identification and brief advice are an effective tool for preventing many of the social and public health harms related to problem drinking.

Any professional who may come into contact with risky drinkers − from drug and alcohol workers, probation staff, to GPs and nurses − should be fully trained and receive ongoing support to deliver identification and brief advice. But none of this can be achieved without commitment and investment at government level.

Specialist alcohol services, like drug treatment services, need to ensure the support they offer people includes a holistic approach, with a strong focus on sustained recovery and overall wellbeing.

Intervention and prevention

One of WDP’s alcohol services supports problem drinkers in the London borough of Redbridge through early intervention and preventative information.

The service offers a programme that includes brief interventions, counselling and a range of group sessions to help service users with their alcohol problems. The charity’s alcohol workers also support service users with harm minimisation and reduction techniques, signposting to relevant services and referrals to detox, rehab and prescribing.

‘The transition to Public Health England and localism will have a significant impact on drug and alcohol treatment’

More importantly, service users receive support and advice on any other problems they may be experiencing. Their key worker will help them identify what options are available for them to support their recovery and reintegrate back into the community.

This can be from accessing other treatment services to attending Alcoholics’ Anonymous meetings, signing up to a gym, accessing employment, training support and much more. By taking an approach focused on the person rather than the alcohol, our service users can truly build and sustain recovery.

Recovery-focused services, such as the Redbridge Alcohol Service, should be more widely available and referral pathways need to be improved. We are committed to improving the referral routes into treatment by tightening our partnership work with healthcare workers, including via A&E departments and GPs.

Major public health issue

We hope the localism agenda, in particular the new powers held by the health and wellbeing boards, will address the issues behind the lack of funding and integration in the current system, without disinvesting in other crucial services such as drug treatment.

We have come a long way in terms of dealing with alcohol-related harm in the UK. The government’s alcohol strategy, published last year, is promising but it is clear more integration and investment is needed to develop the alcohol treatment system. 

The transition to Public Health England and localism will have a significant impact on the drug and alcohol treatment sector. Alcohol misuse is a major public health issue and we need to treat all substance misuse issues with the same attention, from illegal drugs to alcohol and prescription drugs.

It is key that local decision making makes a priority of investing more in specialist treatment programmes and in a healthcare system that identifies problem drinking early on − before it has a negative impact on health, society and relationships.

Yasmin Batliwala is chair at the Westminster Drug Project