Posted on: 17 January, 2020
Annie Steele, Director of Operations
Working in alcohol and drug services over the past 24 years, I have seen a number of changes including the move from alcohol specific services to alcohol and drug integrated services. Despite alcohol misuse having been identified as the biggest risk factor for death, ill health and disability across the 15-49 year old age group, there has been a reduction in those being treated for alcohol dependence. Public Health England (PHE) recognises the need to continue to prioritise alcohol treatment and has identified reducing harmful drinking as one of its seven priority areas[1].
There are an estimated 586,780 alcohol-dependant adults in England[2]. For them to stop drinking suddenly without the right support would result in significant harm. People drink for many different reasons and at different levels. Therefore we strive to reduce alcohol-related harm in all its forms. This includes providing information and support to prevent those drinking at low risk escalating to increasing risk, and similarly from increasing risk to high risk, and from high risk to possible dependence.
Cranstoun’s approach understands that not every service user is motivated to make or sustain change and therefore it’s our role to show that change is possible as we demonstrate how they can make changes in a smart way. That shapes our language, focuses us on identifying their skills and recovery capital already available to them to achieve their goals and always sharing our belief in their ability to do so. This approach builds on the value of the therapeutic alliance (the relationship between the worker and service user) and in my experience makes such a difference to the service users. When PHE visited Sandwell during their deep dive into falling alcohol numbers in treatment, as one of the five services who had seen an increase in numbers in alcohol users on treatment between 2013-14 and 2016-17, service users fed back to PHE that our workers were tenacious, didn’t give up and the service user felt that they mattered.
As well as alcohol directly impacting on health, there is a paradox in play for those who have a low personal or neighbourhood social economic status (SES). Those with lower SES who consume the same or less alcohol, experience more alcohol related harm than those of their more affluent counterparts. To reduce the risk of harm Cranstoun therefore offers a targeted approach.
Through our work with Alcohol Concern (Alcohol Change), where we were one of only two providers to contribute funding to support the Blue Light Project, we developed an approach for those who were not engaging with service and were resistant to treatment. We were keen to identify barriers and make treatment accessible. We came to understand that when people felt like there was a possibility to change, we needed to grab this window of opportunity. We made sure that we embodied the following most important message identified in the manual[3]:
“The one thing you can do more than any other is to demonstrate that you believe the person can change. Promoting self-belief is crucial: you will help them believe they can change if you demonstrate that belief yourself.”
Blue Light Manual
I think our involvement with the Blue Light project and commissioner involvement has contributed to moving this approach forward and influences how we have gone on to deliver services. Blue Light focuses on treatment resistant drinkers, but we started to look at our core services and adapted our approach across the board underpinned by our mission to support people to be healthy, safe and happy. For example, in our Worcestershire integrated service, our alcohol nurses complete an alcohol specific supervision with workers to focus and identify what specialist support they could give people with alcohol dependency to reduce their use, or consider and complete a safe planned detoxification. All our approaches are more successful due to our joint working with partners, including GPs, and hospital teams.
We will continue to focus on being responsive and inclusive which is evidenced by the fact that this year Sandwell Council, a key Blue Light partner, won The Guardian Health and Wellbeing Award and The Royal Society for Public Health Transforming Lives Award. In addition, our Sandwell Care Quality Commission rated us good overall with outstanding aspects: “the service was inclusive, and person-centered to support individual clients’ preferences”.
We are really excited about the year ahead as we look to expand our specialist alcohol services whether within integrated services, innovative diversionary schemes, targeted projects such as Blue Light or even an alcohol specific service, if indeed a return occurs.
[1]Evidence into action: opportunities to protect and improve the nation’s health Public Health England 2014
[2] Alcohol dependence prevalence in England – Public Health England March 2017 updated November 2019
[3] Working with Change Resistant Drinkers: The Project Manual, Mike Ward and Mark Holmes Alcohol Concern 2014