Learning to change

A Community Care award-winning project in Luton is helping
people who have a problem with alcohol to change their behaviour
and reclaim their lives. Natalie Valios reports.

“Alcohol abuse is not a disease, but learned behaviour and if
it’s been learned then it can be unlearned, says Breege Begley,
project manager of the James Kingham Project. The project is the
treatment side of Luton-based charity Alcohol Services for the
Community.

Rather than being an anti-alcohol agency, the charity believes
in promoting sensible drinking. Its premise is based on a social
learning model rather than the Alcoholics Anonymous disease model.
The aim of the James Kingham Project is to provide a safe,
supportive, non-drinking environment for people looking to resolve
an alcohol-related problem. It also offers counselling to other
family members, including children.

In Bedfordshire alone there are 10,000 children living with
parents with drinking problems. Most children referred to the
project come via social services because their parents’ alcohol
misuse has resulted in them being in care.

“We give them a safe, comfortable environment of support with
someone who understands them so they can offload how they are
feeling,” says Begley.

In these circumstances, the project may already be seeing their
parents as clients. But it may be that they will never see them,
because they have to want to come to the project themselves.
Referrals come from social services, probation, health, GPs, or are
self referrals.

The project receives about 90 referrals every three months. Of
these, assessments and care plans are put in place for about 60,
the rest never make it that far. From these, about 15 might not
turn up again.

“But once we get people onto a structured programme that’s when
we see a change in them,” says Begley.

Those who never make it to the first appointment are generally
repeatedly referred to the project.

The model that the project works to is the cycle of change,
which is split into five stages:

• Pre-contemplation: the client may not realise there is a
  problem. Awareness needs to be raised of the existence of a problem
  and the possibility of change. Doubts needs to be raised about
  current behaviour;
• Contemplation: ambivalence conflict – change is considered and
  rejected. Risks of not changing need to be emphasised as do reasons
  for change. Balance tips in favour of change – realisation that the
  benefits of change outweigh the costs and that change is
  possible;
• Action: decide to do things differently, change lifestyle to
  break away from the habit and engage in actions to produce a change
  in the problem area. A clear goal, realistic plan, support and the
  rewards of change are all vital;
• Maintenance: arguably the hardest stage. The challenge is to
  sustain change accomplished by action and prevent relapse. Constant
  vigilance and support is required to avoid relapse;
• Relapse: when a person is unable to maintain the change old
  habits return. Sometimes this is due to changes in the person’s
  life. Maybe their support has been withdrawn or become less
  effective. Relapse is normal and does not necessarily mean a return
  to square one, they can resume the cycle.

After the referral and initial contact, clients have an in-depth
assessment so that the project gauges an overall picture of their
drinking, their life, and the people around them. At a second
appointment, the client and project worker draw up a care plan of
services that the client feels would be useful. They can pick from
a range of services including an alcohol awareness closed group;
anxiety management; structured relapse prevention approach;
self-help support groups, aromatherapy massage; and
counselling.

A structured programme is set for a 12-week period, which is
reviewed once a fortnight or once a month. On top of the programme
there is open house three days a week and a women’s day on
Wednesday where workshops are designed to look at alcohol-related
issues for women, for example assertiveness, personal safety,
communication skills, parenting skills and health.

Although there is no detox element to the project, clients can
be referred to the clinical team which provides community or
inpatient detoxification. If the project feels that a client needs
residential rehabilitation, it can assess them and apply for
funding from the local authority.

It is clearly stipulated that clients must not drink on any day
that they attend the programme. If their behaviour leads workers to
suspect that they have been drinking or they smell of alcohol, they
are asked to return another day. Clients themselves insisted on
this rule, says Begley, because if they have made the effort not to
drink they do not want to be next to someone who smells of
alcohol.

The project doesn’t, however, tell clients to stop drinking.
“That’s their decision, we just give them the information so that
they can make an informed choice,” says Begley. “If someone says
they want to learn to control their drinking we will help them do
that. Then if they come back and say that they can’t have
controlled drinking, they have to stop, that insight into
themselves works better.”

Three quarters of clients may want to stop completely, and out
of that about 60 per cent do so by the end of the programme. After
the 12 weeks they can continue to use the project, and there is a
development group which meets once a week for those who have
successfully completed the programme.

“It’s very hard to measure success in this field,” admits
Begley. “If someone cuts their drinking from 200 units a week to
50, they are still not drinking within safe recommended limits, but
that is a success for them.”

One client was drinking at least a bottle of spirits a day, now
he is down to a glass of wine or a couple of pints if he goes out.
His unit intake for the last three months has been between 10 and
14 units a week.

“I continue to see somebody on a monthly basis so that they know
someone is there after the 12 weeks. As long as they know they have
contact then they feel safe.”

The client sees more women than men, but the client group is not
your stereotypical single mother living in a deprived area at the
end of her tether, or young man on income support, but includes a
cross section of professionals as well as unemployed people.

In fact, it was the project’s work with employees at the
Vauxhall plant in Luton which won it the Community Care
Award last year. The We Can Make It Work initiative came about
after a Vauxhall employee attended the project because of his
alcohol problem. A survey of his colleagues found that 78 per cent
of respondents drank above the safe limits; half had missed work on
at least one occasion because of drink; and one third were at work
under the influence of drink or a hangover.

This spurred the employee on to raising the issue of a joint
approach. Vauxhall developed a formal link with the James Kingham
Project and 70 workers have approached the link worker. Twelve
staff have formally linked into the project, of these seven have
reduced their alcohol intake and four are now abstinent.

The fear is that this work will soon be undermined. The Vauxhall
plant is due to close at the end of March 2002, and there will be
redundancies. “There will be a big alcohol problem in Luton,”
predicts Begley.

“We have already seen it happening. We are getting some
referrals from the plant again. And the link worker says the amount
of employees who have approached him is unreal.”

It looks as if the project is going to have its work cut out
over the next year.

Turning Point sponsored the Community Care Awards 2000
drugs and alcohol category.

Project Profile

• Project: The James Kingham Project.
• History: Alcohol Services for the Community began as a charity
  in 1979 with two workers. James Kingham was a local judge and a
  trustee of Alcohol Services for the Community. He was killed in
  1995 and when the project was set up in October 1996, the charity
  put his name to it.
• Funding: From Luton social services department, Luton
  Probation, and Bedfordshire Health Authority. For 2000-1 it was
  £86,500.
• Staff: Project manager Breege Begley, one full-time project
  worker, five part-time project workers, two volunteer counsellors,
  four volunteers, and an aromatherapist who is contracted in to
  offer aromatherapy massages to clients.
• Clients: Anyone with an alcohol problem, as well as support for
  “significant others”, partners, children and friends affected by
  the drinking behaviour of someone close to them.
• Contact: Breege Begley, Alcohol Services for the Community,
  26-30 John Street, Luton, Bedfordshire LU1 2JE. Tel: 01582
  723434.