Social workers should be core part of community alcohol services, says proposed treatment guidelines

Social workers should be a core part of community alcohol treatment services, according to proposed government treatment guidelines issued last week for consultation.

They should be members of multidisciplinary teams in every area responsible for assessment, treatment and recovery planning, alongside doctors, nurses and psychologists, say the guidelines on treating harmful drinking and alcohol dependence.

The UK-wide guidelines, drawn up by experts, including those with lived experience, are designed to constitute good practice in delivering alcohol treatment services in community, custodial, residential and inpatient settings.

They are based on “a recovery-oriented system of care” designed to help a person achieve abstinence, while developing a meaningful life, delivered by trained practitioners and experts by experience.

Key skills needed by alcohol practitioners

Though community alcohol services are generally integrated with drugs provision, teams should be inclusive of people with a primary alcohol need, including by having named keyworkers and sufficient specialist staff with relevant knowledge and skills.

These should include the ability to build a trusting relationship with the person, knowledge of harmful drinking and alcohol dependence, assessment skills, motivational skills, cultural competence, a trauma-informed approach and care co-ordination.

These should be underpinned by appropriate caseloads, regular and good-quality supervision and effective training, say the guidelines.

Recovery and harm reduction

Community teams should provide a range of evidence-based services including pharmacological interventions, for example, to support medically assisted withdrawal, and harm reduction provision for those unwilling to consider abstinence.

Alongside these, they should provide recovery support, for example, help with accessing employment, training, education or social activities, and psychosocial interventions that include practical help with basic needs such as accommodation and income.

Outside of specialist services, social care services should be able to identify people with alcohol use disorders using a validated screening tool such as the alcohol use disorders identification test (AUDIT).

They should also be able to offer people “brief interventions” to people whose drinking increases risks to, or is already harming, their health, but who are not dependent on alcohol. These are designed to motivate people to reduce their drinking, with staff delivering these trained in motivational approaches.

Goal of services based on ‘best scientific and medical expertise’

Launching the proposed guidelines last week, minister for public health Neil O’Brien said it was “vital that treatment for those with alcohol dependence is informed by the best scientific and medical expertise, as well as the views of those with lived experience”.

He added: “This consultation will help us develop guidance to ensure alcohol treatment services are of consistently high quality, providing stronger pathways to recovery for those in need of treatment for alcohol dependence.”

Wulf Livingston, a qualified social worker who is professor in alcohol studies at Glyndwr University in Wales, said any focus on alcohol services was welcome as they were “too often neglected”, and there was “much to applaud in the document”.

“Its extra emphasis on recovery while not dismissing harm reduction is helpful,” he added. “It utilises some well-established evidence-based interventions.”

Guidelines ‘too focused on fixing individuals’

However, he said it was too focused on “fixing individuals” and on treatment, rather than on the social determinants of alcohol use and interventions to tackle these.

“The core problem from a social work perspective is that it assumes alcohol is the problem, rather than the means or solution by which individuals seek to cope with a whole myriad of other problems,” he added.