Supporting women with alcohol issues: what social workers need to know

Problematic alcohol use among women is often associated with domestic or sexual abuse or self-harm and requires a tailored and sensitive response from practitioners, says Dr Patsy Staddon

Photo: John Birdsall/Rex (posed by models)
Photo: John Birdsall/Rex (posed by models)

By Dr Patsy Staddon

Alcohol is a pleasurable and attractive drug, easily accessible and socially acceptable. It helps with relieving anxiety and stress, and beginning to use it is part of the process of achieving and demonstrating adulthood. It helps us to try out other ways of being ourselves, what is sometimes called ‘acting out’.

At specific times, such as Friday and Saturday evenings, or at Christmas, it is seen as an acceptable way to stretch boundaries a little – or a lot – to enjoy a sense of carnival, even transgression. These are all behaviour patterns common – though not always acknowledged as such – to all societies, and more accessible to some social groups, such as the rich, celebrities or young men, than others.

Escaping miseries

However women, in particular, may sometimes drink not so much for pleasure as to be acceptable to their peers; and, more worryingly, an estimated 50%-90% (Women’s Aid, 2005) may also drink to escape briefly from such miseries as domestic abuse and depression. Other reasons include loneliness, mental health issues and poverty, conspiring to make a woman take refuge in alcohol in the first place.

As a society we expect ‘femininity’ in, especially, young women, and drunkenness is seen as interfering with its performance. ‘Women who drink’ may be seen as greedy, immoral and shamed. It would be naïve to believe that either social workers, or those working within the alcohol treatment sector, including GPs, nurses and other specialists, are unaffected by such feelings themselves. Shame, embarrassment, and concern about professionals’ reactions are among the reasons why women may be less likely than men to admit to an alcohol problem.

From self-respect to shame

A major factor in the recovery process is regaining self-respect, thus moving away from shame. Those who work with women recovering from alcohol issues should do so ‘in a manner that is empowering, compassionate, and respectful, and to allow people self-determination and risk taking where no one else is harmed’ (Galvani, 2015, p.5).  This approach is similar to the ‘unconditional positive regard’ advocated by Carl Rogers (Rogers, 1951) – but throughout the alcohol treatment sector, this is often inadequately supplied.

In addition, women benefit particularly from women-only treatment.  Also very much appreciated are identification and brief advice (IBA) centres, These resources are not available in all areas, and are too little advertised, but some support on similar lines is also provided online. An example of this is the Club Soda website

Women-only support

The shaming nature of the condition means that women-only support may be needed in dealing with the loss of family and other social networks, and in discovering what their own real needs are. This is much more likely to be problematic in a mixed-sex environment, where women may take on a mothering role to help male members of the group and not attend enough to their own needs. Some may also enter a relationship with men in recovery. Not only is this likely to be too early to take on new emotional ties while they may still be vulnerable, but there is also the considerable risk that should one of them start drinking again (often called ‘slipping’) the other is likely to follow.

Women frequently feel too embarrassed to share freely in mixed groups, particularly if their drinking has been associated with, or been a response to, sexual, physical or emotional abuse of any kind. Painful and humiliating experiences need to be disclosed in a safer place.

There may also be issues with childcare, so the times of their groups need to be chosen carefully, for example so women can get to and from the group while their children are at school); and they may worry about how much to tell their families.

Peer support

Facilitators should be female, and ideally one of them will be a woman who has herself recovered from alcohol issues – for at least a year – who can talk from personal experience about the different strategies and tactics that were of help to her. Such a group will begin to develop life-skills, and life-long friendships may develop.

This is the approach we have adopted at our small, third sector organisation in Bristol, an approach which research consistently recommends as being the best way to restore confidence, side-step the ‘revolving door’ syndrome, recognise the person you are and what are your needs, and to move forward with a good chance of achieving these.

What can social workers do if they find that their area lacks the breadth and the depth of provision which is recommended? For social workers in London, Gloucester, Milton Keynes and Buckinghamshire a new approach is being provided by the Family Drug and Alcohol Court, which tries to keep drug and alcohol using families together, under supervision. The scheme is to be extended to other parts of the country, following its success in these areas.

Link with domestic abuse

It is also important to remember that over half of the women who develop alcohol issues will have suffered from, or will still be suffering from, domestic and sexual abuse, including having been abused as a child. Such abuse may not be evident initially, but responding to it appropriately will be an enormous step forward in helping a woman recover from alcohol misuse.

Women’s Aid and Refuge jointly run a national helpline for domestic abuse survivors (0800 2000 247) and can refer callers to local support services  which offer expert advice and support which may well be a crucial turning point in the recovery journey. Other useful support organisations might include NAPAC (National Association of People Abused in Childhood), and The Survivors Trust, an umbrella organisation that holds information on lots of rape and abuse support services around the country.

Self-harm

Many women who are using alcohol as a prop are also using other methods to try to deal with their distress. For example, self-harm is a common strategy which women might use to try to deal with their feelings of shame and worthlessness, including actions such as cutting, starving and bulimia. Social workers need to be aware of support groups and services in their local areas, and ensure that their leaflets are readily available (preferably on display).

Many women’s services are offered by small, third sector organisations, often set up by women who themselves experienced problems. Their variety is their strength, for each person’s alcohol journey is different, their recovery road will be different, and it is only in recognising the need for multiple responses to a complex set of problems that we can succeed in helping women to improve their lives.

For example, Self Injury Support (previously Bristol Crisis Service for Women and now a national organisation), now a national organisation,  offers support for women and girls who self-harm: clients can access the service themselves and speak with or text and email with the workers. The section of the Mind website dealing with self-harm may also be of help to some women.:

Building social capital

Additionally, increasing clients’ social capital is central to their recovery from alcohol and development as people (Bogg with Bogg, 2015), and encouraging participation in almost any social activity is likely to have beneficial effects, whether it is volunteering to help in a play-group or joining a zumba class.

The latter is particularly good at boosting feelings of well-being, perhaps previously only encountered by using alcohol. Increasing a variety of social interactions, wherever possible, whether in person or on social networks, is most likely to help women in moving away from the despairing circle of detox, slip, relapse which we have seen far too much in alcohol treatment services to date.

This article is based upon workshops run at the British Association of Social Workers and the Social Perspectives in Mental Health Network (SPN) conference on 15 February 2015. Dr Patsy Staddon, a trustee of SPN, recovered from alcoholism in 1988.

She runs Women’s Independent Alcohol Support, the small peer-led charity, which is able to discuss issues around women and alcohol with social workers and treatment providers. For more information visit its website.

Women and alcohol: social perspectives,which Staddon has edited, has just been published by Policy Press. 

References

Bogg, D, with Bogg, T (2015) ‘The social model in alcohol treatment services: the impact for women’, in Women and Alcohol: social perspectives, ed. Staddon, P. Bristol: Policy Press.

Galvani, S (2015)  Alcohol and other Drug Use: The Roles and Capabilities of Social Workers. Manchester Metropolitan University.

Rogers, Carl R (1951) Client-centered Therapy: Its Current Practice, Implications and Theory. Boston: Houghton Mifflin.

Women’s Aid (2005) The Survivor’s Handbook. Bristol: Women’s Aid.

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