Alcohol strategy – will it cause a hangover?

Bottoms up was probably not the toast the government had in mind
when it launched the alcohol harm reduction strategy,
¹
writes Katie
Leason.

But as those in the alcohol field have been keen to point out,
“arse” (AHRS) is the resulting acronym. And for those
who work on the treatment side of things, this was probably what
they thought when they first laid eyes on the document.

For the strategy, finally launched last month after a wait of six
years, does little to help beleaguered treatment services out of
their immediate financial crisis. While the identification and
treatment of alcohol misuse is one of the strategy’s four
central pillars, it seems that the government’s preoccupation
with antisocial behaviour is what has really driven its agenda.
Cold comfort for the one in 13 UK adults dependent on
alcohol.

The treatment chapter of the strategy is by far the weakest and
offers little prospect of bringing services back from the brink as
there is no cash with it. Waiting lists for treatment are long and
access can be very difficult for those living outside main urban
areas. Yet the 100,000 referrals taken by services each year
represent just a third of the estimated 300,000 who need
support.

Services struggling

Even the services that do exist are struggling to stay open. Liz
Smith, chief executive of Alcohol and Drug Services in Manchester,
says she hoped the strategy would have money with it as a big
expansion of services is needed.

“We can’t market our services to the public. You cannot
market a service that doesn’t exist or which is already over
capacity. People are coming to us with chronic problems and
sometimes there is simply nothing we can do,” she says.

In one area of Lancashire, she continues, just two alcohol
counsellors from her service receive all the referrals from social
services, doctors and other agencies. They deal with about 400 new
clients every year and in order for the service to cope it has to
be staffed with volunteers.

“One local GP said people are being allowed to die. Nothing
can be done because the services are not out there. The only route
into hospital is through A&E departments,” says
Smith.

Flicker of optimism

Although the absence of cash is a major disappointment to those
on the frontline, there is a flicker of optimism regarding the
government’s plans to audit the demand and provision of
alcohol treatment by 2005. The strategy says this information will
be used as a basis for “a programme of improvement”.
However, the amount of time needed to carry out the audit could
have disastrous consequences.

“This audit is a good thing in principle, but it leaves the
treatment field in crisis for a year. We want to see things put in
place to make sure treatment capacity is not lost,” says
Richard Phillips, director of policy and services at Alcohol
Concern.

He suggests a contingency fund of between £10 million and
£20 million, accompanied by a clear direction from the
government to primary care trusts telling them they must not reduce
treatment capacity while the audit is going on.

Historically, alcohol services have been funded out of the money
allocated for drugs services, but with the National Treatment
Agency breathing down their necks some of those who commission
services have felt under pressure to stop funding alcohol
services.

The strategy proposes setting up pilots to experiment with
screening and interventions in primary and secondary care. This has
irritated those who have already carried out work in this area as
it suggests a lack of confidence in previous findings.

Phillips says there are already many examples of good practice so
why is there the need for pilot schemes? “We know what to do
and we know how to do it. All we need is a strategy to roll it out.
We know what we need to get GPs to do, but unless it is linked with
the GP contract it is not going to happen.”

Impact on children

However, there is one area where piloting is desperately needed.
Alcohol is often a factor in cases that come to the attention of
children’s services. Pilots could involve schemes to help
parents whose drinking is putting their children at risk, or to
build alcohol interventions into the recommendations that come out
of case conferences.

“We’re not on top of that at all and we don’t
know how to offer relevant sorts of services,” says Bob
Purser, chief executive of West Midlands treatment charity
Aquarius.

He once worked with a mother who drank to cope with her
husband’s illness and eventual death. “I met her some
years later on the train and we were reflecting on things. What
wasn’t offered to her family was support for her child while
she was going through that. That’s a huge gap which still
exists,” he says.

Aquarius’s services are in high demand. “We know that
if we’re going to deliver an effective service to people then
we need to respond quickly. Putting them on a waiting list is no
good as by and large they will go away. We want to offer an
appointment within a week. In Birmingham we run two community
alcohol teams. The reality is we have twice as many referrals as we
have resources to respond to them,” says Purser.

Services are being pushed to the limit. But given that the number
of referrals increases whenever EastEnders features alcohol misuse,
there is a strong possibility that services will be swamped should
the strategy’s proposed public education campaign take
effect.

¹ Prime
Minister’s strategy unit, Alcohol Harm Reduction Strategy for
England, Cabinet Office, 2004

Case study

Carole Low knows just how essential treatment services are.
“Not many people take alcohol problems very seriously. Some
say they are self-inflicted, but when you go so far into it, it
becomes a mental battle with the bottle,” she says.

Her alcohol misuse started with social drinking at the weekends,
but developed until she would wake up needing a drink just to be
able to cope with the day. She started to suffer from blackouts,
sometimes on the stairs or in the living room if she was unable to
make it to bed. Her partner eventually asked her to leave and get
help.

“It wasn’t really living. After a while it takes
over,” she says.

A jobcentre put her in touch with charity Turning Point’s
Smithfield Project, which offers drug and alcohol support, and
after four days she was given a place for a 10-day detox. The
project also has a day centre and a drop-in, which two years later
she still attends.

“This service is a lifesaver. I lost my sister to an
alcohol-related problem. Without the Smithfield centre I’d
probably be joining her.”

She adds: “I know people who have got drug problems as well
but you can’t just push the alcohol part under the
rug.”

For the ‘bigger picture’ on alcohol services with links
to extra sources of information
click here