The government has suggested forcing benefit claimants with an alcohol dependency into treatment. But rehabilitation staff are adamant that compulsion will not work. Mark Hunter reports
There is no quick fix to alcoholism. No easy way to break the iron grip of a chemical dependency and embark on the long, slow process of rebuilding a life. Certainly those who enter the Red Bank drug and alcohol rehabilitation service in Manchester know they are in it for the long haul.
The process begins with a gruelling two-week detox programme under close medical supervision. Then the real hard work begins as clients start to tackle issues such as housing, debt, mental health problems and legal difficulties that so often accompany a drink problem. It is a drawn-out process that requires long-term commitment.
“The key to it is admitting you’ve got a problem, first to yourself then to others who may be able to help you,” says David Lewis, regional manager with the charity Turning Point which runs the Red Bank centre.
“From there it’s all about motivation and a commitment to identifying and addressing the issues that are linked to your dependency. It’s very rarely just the chemical addiction that’s the problem. You have to be able to deal with all the life stresses that have led to the dependency in the first place.”
Lewis rejects the idea that people can be coerced into tackling such a gargantuan task against their will. He is therefore bemused by the recent government idea that unemployed alcoholics have their benefits cut if they refuse to seek help for their drink problems.
Work and pensions secretary James Purnell suggested last month that the Welfare Reform Bill could give Jobcentre advisers the power to test claimants for alcohol problems and to force those with an addiction to undergo treatment. Claimants who refuse would lose benefits. The government’s 10-year drug strategy introduced similar measures for drug addicts last year.
Lewis says this attitude won’t work: “If people were coerced into seeking our services, my concern would be whether we would be able to engage properly with them.”
There is also the issue of whether alcohol dependency services have the capacity or even the correct approach to deal with a large influx of reluctant clients. Charity Alcohol Concern estimates that only one in 18 alcohol dependents are able to access treatment.
“When we are dealing with problems of illegal drug dependency we use a tiered approach in which the first tier would be aimed at people who are unwilling or unable to give up their habit,” says Lewis. “So, initially, we focus on trying to persuade them to use a little more safely and then gradually chip away at their use until they are more receptive. But what we don’t have at the moment is the same type of service aimed at people with alcohol problems.”
Lewis’ final concern is with the implications of removing benefits from someone whose alcohol problem may already be a sign that they are struggling to cope.
“It’s possible that cutting someone’s benefits could add to their life stresses and exacerbate their alcohol issues. There would also be a concern about how they are going to continue to fund their dependency and about the harm that financial problems might cause to their family or other people around them.”
To facilitate the use of benefits sanctions Purnell has reportedly asked Glasgow University to come up with a workable definition of alcoholism, what treatment alcoholics would be required to take and how to judge whether they were complying.
But Turning Point’s head of substance misuse John Mallalieu has doubts about this: “Jobcentre Plus advisers may not have the training to identify those people who need access to treatment and we have concerns that sanctions could deter some people from seeking help for fear of losing their benefits,” he says.
“Any proposal which encourages people into treatment must be welcomed. However, a proposal like this will only work if there is a treatment place available. Unfortunately the availability of alcohol treatment services is extremely patchy. Turning Point is calling on the government to treat alcohol misuse as seriously as the misuse of illegal drugs, and invest equally in alcohol treatment provision.”
]Don Shenker, chief executive of Alcohol Concern, agrees: “While the secretary of state is right to want to support alcohol dependents into treatment, making welfare benefits conditional on treatment or work is misguided,” he says. “People with alcohol dependency issues require financial stability to seek, undergo and move away from treatment. Any threat that welfare benefits will be cut simply adds to the risk of relapse.”
For DrugScope chief executive Martin Barnes, one of the major concerns about the Bill is the sweeping and unprecedented powers it gives to Jobcentre staff to investigate and potentially drug test a claimant if they feel he or she may have a dependency problem.
“We understand that there will be guidance for staff on how to make these judgments but we don’t know how that will work, especially with alcohol dependency where there is no simple test or threshold level that you could apply,” he says. “There’s certainly the potential for discrimination if judgments are just going to be based on appearance.”
Barnes is also concerned about the sharing of sensitive information by benefits and health service agencies.
“Under the NHS constitution a patient has the legal right to confidentiality during treatment. How is that compatible with sharing information with the DWP on whether someone is complying with their rehab programme?”
With such united opposition, it seems likely that the idea of benefits sanctions for alcoholics will, at some point be quietly dropped. It is unlikely to survive beyond the next election. But, if it does get that far, the final nail in its coffin may be the government’s commitment to test the policy in a pilot programme before rolling it out nationally.
Recent experience from projects piloting benefits sanctions have not been encouraging. In February prisons minister David Hanson announced the results of a pilot scheme to impose benefits sanctions on offenders who were not complying with their community orders. The minister admitted that improvement in compliance had been “modest” at only 1.8% and had cost the taxpayer £5.60 for every £1 it saved. The scheme has now been abandoned.
Welfare reform bill
The Welfare Reform Bill was published on 14 January and had its second reading in the House of Commons on 29 April. The Bill follows last year’s green paper No One Written Off: reforming welfare to reward responsibility, and white paper Raising Expectations and Increasing Support: Reforming Welfare for the Future.
The Bill aims to improve support and incentives for people to move from benefits into work. It contains measures to increase personal responsibility within the welfare system, cut down fraud and streamline the benefits system.
Regarding drugs and alcohol, it gives benefits staff the power to ask claimants of JobSeeker’s Allowance or Employment Support Allowance whether they are “dependent on” or have “a propensity to misuse” drugs or alcohol and whether this is likely to affect their prospects for finding work. Claimants who refuse to answer can be obliged to undertake a “substance related assessment” and undergo a drug test. Those who do not comply either with the test or any resulting rehabilitation plan can lose up to 26 weeks of benefit.
Published in the 14 May 2009 edition of Community Care under the heading ‘An idea without substance?’