Reducing alcohol harms requires joined-up approach, experts say

WithYou is a drug, alcohol and mental health charity based across England and Scotland. “About half of our clients are alcohol clients,” says Robin Pollard, Head of Policy & Influencing, “so it’s a really core issue for us, but it’s not at the same level of prioritisation as drug treatment in terms of political space.”

Another challenge is the political handling of alcohol use in isolation, ignoring its links with mental ill health, poverty and discrimination, among other risk factors, as well as the treatment of alcohol dependence as symptomatic of an individual rather than societal failing. “That is a huge thing that the alcohol industry has succeeded in over the last decade,” Pollard says. “They’ve managed to frame the issue around alcohol as a personal responsibility issue. When we look at drug use, we look at the holistic factors – deprivation, trauma – whereas, with alcohol, the government is still tied to that personal responsibility framing.”

WithYou’s priorities surround improving access to and quality of treatment. “Very few people who need alcohol treatment get the treatment they need,” says Pollard. “Only one in five people who are dependent actually get the support they need, and this isn’t a new issue, it’s been going on for a long time.

“There is a huge issue around [drug and] alcohol services, and how people are able to access them. So, for example, a lot of services are very male dominated. They can be intimidating places, and they can be based in parts of town where people may not feel that comfortable or that safe. If you’re a woman who’s had traumatic experiences with [male] partner abuse, you may not want to go somewhere where that partner may also be, or where there are large groups of men.” Mothers may also fear losing a child if they present as experiencing alcohol dependence. This can have a deadly impact – “there is a faster rising alcohol-related death rate among women”.

In fact, many demographics are excluded from traditional support services. “There are a lot of quite specific barriers to older people that don’t really exist for other groups, Pollard says. “If you’re an older drinker, you may not have the mobility to regularly go to a service.” Older people are also more likely to experience certain risk factors for high alcohol use, such as loneliness and bereavement. This is particularly significant because “they are the group that experiences the most harm, they are the group that consumes the most alcohol, and they are also the group with the highest alcohol-related death toll.”

From 2015 to 2020, WithYou delivered the Drink Wise, Age Well support programme, which focused on understanding and reducing alcohol harms among over-50s, including raising awareness of “the specific needs of that group” when accessing support services.

Public perceptions can also impact people’s willingness to seek treatment. “There is a misconception that you need to be at rock bottom to be able to access support, and I think people don’t realise that there are all different types of support available,” Pollard says, underscoring the importance of increasing awareness.

Without a joined-up approach, treatment can also risk endangering people who are using alcohol to cope with mental ill health, which may deteriorate without wraparound support during recovery. Further, “there’s been a long-standing issue whereby people who present with a dual diagnosis of mental health and alcohol issues have additional issues accessing services,” Pollard says. “Mental health services will sometimes not allow someone to access their services if they are drinking, while drug and alcohol services also sometimes fail to support people with complex mental health needs – they would say, ‘They need to manage those mental health needs before we can work on their alcohol use.’

“There is meant to be a ‘no wrong door’ approach to working with people with mental health and alcohol needs, but while the guidance is there, the practice is much more chequered. It is improving, but a lot of places just don’t have the capacity to deal with more complex clients.”

As a result, like many organisations working in and around alcohol use, WithYou are calling for an increase in government funding. The recent investment to improve the quality and capacity of drug and alcohol services has had an impact, but funding was only committed for three years, and the sector is now facing a financial cliff-edge. But, Pollard says, “there is also a feeling among many in our sector that alcohol is bolted on to [the governmental] approach [to substance use and addiction], and the initial focus was really around drug treatment and those outcomes. I don’t think that alcohol has the appropriate level of priority that it should.

“While the additional investment is really welcome, we’re still catching up to the quality and level of services that were lost during the austerity years, and the lack of certainty over the duration of that funding creates lots of issues with services – it makes forward-planning much more difficult, it makes investment in staff much more difficult – and all these things act as a constraint on the quality of services.

“Alcohol harm is so complex. There are so many contributing factors – you can’t solve these problems with one- or two-year funding cycles. The Drug Strategy is a 10-year strategy, and we need the new government to commit to that long-term funding cycle to be able to change the dial on some of these issues.”

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We are calling on the government to commit to developing – and properly funding – a national alcohol strategy that will focus on education and support, and that acknowledges the increased vulnerability of marginalised people. Please join us in our efforts by signing our petition, writing to your MP and sharing our #DyingForADrink campaign on social media.