Making alcohol services accessible

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SONY DSCAvoiding the airlock

Entering alcohol services can feel like a trap to the uninitiated. Mark Holmes looks at why technology may offer more people the support they need to make changes to their drinking

The first time I was about to step into an alcohol service, I was petrified. I asked myself questions such as, ‘What will I find behind the doors? Will people be drunk? Will they be nice to me?’ As I entered through the heavy wooden door, I smelt the disinfectant and my anxieties heightened. The door slammed behind me with another door in front of me. Welcome to the ‘airlock’. Behind the glass to my right was a worker, the scene akin to stepping into a secure facility. The friendly worker asked me what I had come for. I explained that this was my first day at work as an alcohol nurse specialist.

Once inside, I was met with energy and empathy from staff towards service-users and enthusiasm for specialism of the field of addiction. My first impressions of the ‘airlock’ nevertheless raised a question: if I was scared to enter this building, how can we expect those that need our support to overcome the fear they feel on entering our services?

There are many reasons why people may not seek support with their drinking. The stigma of entering an alcohol service remains a major one. We know that despite the high numbers excessively drinking, the majority of people at risk of alcohol-related harm are not accessing services. In its 2013 publication, 15:15 the better case for access to alcohol treatment, Alcohol Concern highlighted that only 6 per cent of dependent drinkers are in contact with treatment services at any one time. Retention is also a problem, with national and international statistics indicating that 40–60 per cent of people who enter alcohol treatment services drop out within as little as two sessions. If we want to achieve the Department of Health’s alcohol needs assessment research project benchmark of engaging 15 per cent of the problem drinkers in a given area in treatment, then alcohol services must not only deliver high quality specialist support but also find innovative approaches to reaching risky drinkers.

Is technology the answer?

Telehealth technology is increasingly being looked to as a way to reach people with all sorts of health advice, information and support, with the most promising option offered by Voice over Internet Protocol (VoIP). But what of the ‘therapeutic alliance’ and that magic ingredient, rapport, I hear you say? VoIP has been proven to be on par with face-to-face contact in terms of the quality of human interaction (Roberts, Vlahovic, Dunbar 2013).

The acceptance of telehealth solutions to alcohol misuse and other health issues should not be a surprise, with the general population spending more and more time online. Last year, Ofcom reported that ‘we’re now spending more time using media or communications than sleeping.’ With so many people having access to the internet and becoming increasingly comfortable with its use, there is a real opportunity for alcohol treatment providers to take alcohol interventions to an online audience.

Online intervention

Alcohol action charity HAGA, based in north London, has gained a reputation for innovation and has recently focused on bringing a variety of technological innovations to the early identification and treatment of alcohol misuse. In particular, they have strived to attract those drinkers that are currently under-represented in alcohol services – typically those increasing and higher risk drinkers scoring 8-19 on the Alcohol Use Disorders Identification Test (AUDIT) – and to offer them psychosocial interventions in the right place at the right time.

HAGA first developed an online screening, advice and referral tool, DontBottleItUp (dontbottleitup.org.uk), and then DrinkCoach (www.drinkcoach.org.uk), a smartphone and tablet app. Around 40,000 people visited DontBottleItUp in 2014 and it is currently commissioned in seven local authorities (with four more due to launch in the next month). Working with Alcohol Concern recently, they piloted offering VoIP-based interventions to higher risk and mildly dependent drinkers identified via DontBottleItUp.

This initial pilot was successful, with service users and staff giving excellent feedback. Qualitative findings are soon to be published, with service users reporting the main advantages as ease of use, avoiding their concerns about going into an alcohol treatment service, and the relative anonymity of the interventions. One told us that: ‘The main appeal was that it was easy; I didn’t have to go anywhere. For me it was the only option, when other options weren’t available.’

Staff also found the concept of VoIP sessions acceptable, with the benefits of no travel times between sites, the ability to see more service users in their working day and potentially accessing a new cohort of people seeking help for alcohol problems top of their list of advantages. There were positive experiences too in delivering the sessions despite some initial anxieties about using their therapeutic skills in a different medium. A HAGA worker commented: ‘I found the session more comfortable than I expected. I had concerns about if the interactions would be “cold” – ie difficult to build up a therapeutic relationship.’

The pilot is now turning into a mainstay online alcohol extended brief intervention appointment option, launching in Haringey this month via DontBottleItUp, and more widely in April.

Even though ‘airlocks’ have largely become a thing of the past, the poor image of alcohol services looms large in the public psyche. Developing online alcohol support is one way that HAGA is striving to break down the barriers experienced by people affected by alcohol misuse, and to open the door onto new options for change.

Mark Holmes is telehealth coordinator at HAGA, a charity working with and on behalf of people, families and communities affected by alcohol, www.haga.co.uk