The UK’s approach to alcohol harm is shaped by assumptions that no longer align with reality, according to a new report from the Clean Slate Clinic, Adfam and the University of Sussex.
‘Clinical risk and self-identification are systematically misaligned’, says Impact and barriers: a national survey of UK adults on alcohol dependence – with 90 per cent of people who meet the AUDIT-C criteria for increasing or higher risk of alcohol dependence not actually self-identifying as heavy drinkers. Just under 60 per cent of self-identified moderate drinkers, meanwhile, did meet the clinical criteria for ‘at least increasing risk’. This disconnect is ‘structural, not confined to individuals in denial’, the report states, with ‘significant implications’ for service access models predicated on self-referral.
The main barriers to accessing support remain system capacity and stigma rather than information deficit, however. The most frequently cited barriers among higher-risk drinkers were ‘long NHS wait times’ and ‘fear of stigma’ (both 24 per cent), along with the cost of private healthcare (19 per cent) and not knowing where to look for help (17 per cent). This suggests that ‘awareness campaigns alone are unlikely to address the structural impediments preventing help-seeking behaviour’, the report concludes.
The report’s findings are based on a poll of more than 2,000 people conducted in December. Half of UK adults know someone they consider to be a heavy drinker, it states – of these 25 per cent are a close family member. Work pressures and stress were also key factors in heavy alcohol consumption, it adds.
The document calls for the creation of alternative pathways to reduce NHS waiting times and stigma barriers, such as ‘digitally-enabled home-based detoxification models’ and family-inclusive pathways with appropriate safeguards – as families and colleagues are likely to recognise escalating risk before the engagement of formal services.
The UK’s approach to alcohol harm has ‘long been shaped by assumptions that no longer align with empirical reality’, says former health minister Dan Poulter in the document’s foreword. ‘We have designed services for people who self-identify as “problem drinkers”, commissioned awareness campaigns to address an information deficit, and targeted interventions toward specific demographics or geographic areas. This white paper demonstrates, through nationally representative data, that all three assumptions are fundamentally flawed.’
He had ‘witnessed the consequences of this misalignment’, he said, including ‘families recognising escalating risk in loved ones but finding no pathway to facilitate intervention’ and NHS capacity ‘stretched to breaking point while awareness campaigns continue to emphasise information provision rather than access’. The findings would be uncomfortable for policymakers because they ‘challenge interventions we have funded for years. The evidence shows that 90 per cent of higher-risk drinkers do not self-identify as heavy drinkers – suggesting a mismatch between cultural norms and clinical thresholds. It shows that “not knowing where to go for help” ranks only sixth among barriers, well below NHS wait times and fear of stigma.’
At the launch of the report, Dr Poulter said the catalyst for seeking help was ‘often when people hit their lowest point, and sadly sometimes this is too late.’ Chairing a panel discussion, Dr David McLaughlan asked how we could engage people meaningfully in service design. People with lived experience could help to involve people ‘in the right way at the right time in the right place,’ said Recovery Connections’ CEO Dot Smith, while Adfam’s CEO Viv Evans mentioned the support family members could provide, which was too often seen as ‘just an add-on with no funding provided’.
A recent report from the University of Manchester found that alcohol treatment in England was dramatically failing disadvantaged young people, while an open letter to health secretary Wes Streeting from campaigners and medical institutions last year stressed the urgent need for a ‘preventative and evidence-led approach’ to addressing rising levels of alcohol harm.
Impact and barriers: a national survey of UK adults on alcohol dependence available here