Friday, 23 March 2018

The future of Alcohol Research and Concern

Alcohol Research and Concern are, as you'll probably be aware, merging, and they're currently conducting a consultation on various aspects of their work to think about what the shape and aims of the new organisation might be.  They will be inviting comment on specific issues and questions and I'd really encourage people with any interest in alcohol-related issues to comment.  Here's what I wrote on treatment (you can access the original post by Richard Piper asking for feedback just by going to the home page of either organisation):

In terms of the specific questions you ask, yes I think there’s the potential for greater private/charity involvement in delivering to a wider group of people without addition state support.  Certainly our services (deliberately) focus on areas of greatest socio-economic need, so there may be opportunities to increase charity donations or encourage people to contribute to their own treatment or intervention – even if that’s just paying to download an app.  But this has (at least) two potential problems: (1) how do you ensure that it’s only those who can afford to pay that feel they have to; and (2) are you OK with this position politically/ethically in terms of diluting a commitment to universal healthcare free at the point of use?

As to whether the charity should seek to influence government, I think it’s perfectly reasonable to campaign for greater use of evidence-based programmes.

In terms of innovation, there’s not only technical stuff but also more general evidence that could make services more efficient and effective.  This means not just encouraging people to go online but also viewing their issues as part of a wider life, especially thinking about family, employment and housing.

Families can of course be crucial to recovery, as other respondents have emphasised, but there are plenty of people who are at risk who don’t have accessible or supportive family networks: family can be absent or indeed as much a part of the problem as the solution.

And while taking ‘a whole family approach’ is the current popular phrase for PHE and local authorities, this is often at root about reducing costs for children’s services.  I’m suspicious of this instrumentalism, given the experience of New Labour and the NTA failing to achieve sustainable acceptance of drug treatment using crime as a fig leaf for what was really about providing health and care to a group of people in need of support.  So there are key dangers with focusing on ‘family’: first, the neglect of drinkers who don’t live with children; and second the pathologising of all parental drinking, or at best painting it all with the same brush when in fact there are myriad problems where alcohol is implicated.

And this is the key point: although the Alcohol Concern/Research charity will inevitably be focused on alcohol – and this is reasonable as it is a specific and unique substance with its own history and policy – people relate to this substance in an infinite number of ways, in connection with everything else in their lives, and therefore any analysis, policy or treatment cannot and should not focus on an ‘alcohol problem’ that the UK has.  Alcohol may play a role in people’s problems, but that’s something quite different.  Even dependence is hard to isolate as a uniform condition, and certainly its implications vary.  It may or may not be seen as part of a wider ‘substance use disorder’.

And so my plea would be to avoid discussing ‘alcohol treatment’ as a monolith (when there will be a range of issues, and solutions must look beyond alcohol) and not to equate this with something that is designed to address ‘dependence’.  But you and your colleagues know all this already.  Good luck!

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