National strategy: the treatment perspective
By Victor Adebowale

With the delivery of a national alcohol strategy expected in the Summer 2003, Lord Victor Adebowale, Chief Executive of the social care charity Turning Point talks about his vision of treatment and why the Government must wake up to the reality of alcohol misuse.

As a major provider of social care in the UK, Turning Point has long been arguing that the Government must wake up to the reality of alcohol misuse and come up with a coherent and robust national alcohol strategy. At Turning Point, we think that a Government led alcohol strategy involving a broad range of organisations such as the police, the NHS, voluntary organisations, local councils, and the drinks industry is the key to turning around the current culture of complacency around alcohol misuse.

Turning Point's work at the sharp end of alcohol treatment means that we are well aware that alcohol misuse is a massive social and public health problem in the UK, with serious consequences for individuals and their families. Unlike other drugs in our society, alcohol enjoys a peculiarly privileged status as the socially acceptable and benign face of drug use and the consumption of alcohol is rarely regarded as problematic or dangerous.

By contrast, the available evidence and statistics about people's drinking paints a bleak picture of the harmful effects and growing incidence of alcohol misuse. According to figures recently published by the charity Alcohol Concern, more than 3,000,000 people are thought to be dependent on alcohol in the UK – this represents 1 in 13 of the adult population. At the same time, changing trends in alcohol consumption show that the numbers of young people drinking at hazardous levels is on the increase. Young women are now drinking an average of 12.6 units per week – a worrying 66% increase since 1992. The wider social and economic cost of alcohol misuse is huge and includes a £3bn per year burden on an already overstretched NHS, as well as placing considerable pressure on the police and communities.

Last year, with the creation of a Government Strategy Unit to review policy on alcohol, and the publication of a consultation document with the Department of Health – The National Alcohol Harm Reduction Strategy – it seems that the Government is finally starting to sit up and listen to what organisations like Turning Point have to say about tackling the harmful effects of alcohol misuse. After many false dawns, the Government have at last committed themselves to delivering a national alcohol strategy by the summer of 2003.

A truly effective national alcohol strategy must be all-encompassing and not fall into the trap of only focusing on the most conspicuous and media friendly examples of alcohol misuse, such as binge drinking. Unquestionably, the violence and anti-social behaviour associated with binge drinking needs to be tackled but at the same time, it is crucial that the alcohol strategy has a serious commitment to providing help for dependent drinkers in need of longer-term treatment. While the drinking patterns of dependent drinkers may well be less visible, sustained and long-term alcohol misuse is seriously damaging.

Building responsive models of treatment is a major focus of Turning Point's work and our services aim to reflect the communities they serve by ensuring that treatment is easy to access and available to people who need it, when they need it. In fact, the reality of treatment can be very different and is often characterised by long delays, bureaucracy, and lack of availability. A national alcohol strategy must be committed to providing additional resources and funding to match the investment in drug services.

People with alcohol problems must also be able to access a wide range of flexible and longer-term support. Taking an integrated approach to treatment means that services should be geared up to provide help with housing, health, education, employment, and training, as well as providing frontline and immediate care and accommodation such as detoxification services.

At the Turning Point Smithfield Project– a substance misuse service based in Manchester – alcohol treatment is firmly rooted within wider contexts of social care to best give service users the options and choices they need. The detoxification unit offers immediate treatment and accommodation to those people who urgently need to come off alcohol or drugs. The alcohol detoxification programme is open to 22 people at any one time and has nearly 1000 clients per year with an annual occupancy rate of up to 97%. People can refer themselves and the staff are on hand at any time of the day or night to give an immediate assessment.

In the longer-term, the Turning Point Smithfield Project supports its clients through treatment and towards a more stable life by providing a raft of measures which include: a residential unit where clients are given the opportunity and time to reflect upon the changes they need to make in their lives; therapeutic group work; a drop-in service; social and recreational activities; links with other services; housing and legal advice and links with further education colleges.

Positive outcomes for people with alcohol problems – as well as drug and mental health problems and learning disabilities - are achieved by working in close partnership with other services. Since 1997, the Smithfield has worked as part of a network of treatment providers that includes care management teams from social services; community alcohol teams; and south Manchester Primary Care Trust. Working in multi-agency partnerships means that service workers and their clients can access a broad range of diverse but linked services ensuring that clients needs are assessed and met quickly with minimum bureaucracy.

Turning Point's on-the-ground experience as a service provider means that we are well placed to pick up on overlooked and less conspicuous patterns of alcohol misuse. We know for example that drinking is a growing problem in ethnic communities. In London's Soho, Chinese community leaders and groups have long been aware of the growing incidence of alcohol as well as drug misuse in their community. By forging strong links at a grass-roots level with the Chinese community, the team at our Hungerford service has played a pivotal role in breaking down the taboos and cultural sensitivities surrounding substance misuse. The Chinese Internet Café set up by the Hungerford has proven to be a vital route through which Chinese people can talk about their problems and seek the right help.

We are also aware that many first generation Sikh clients associate problem drinking with spirits such as whisky or vodka rather than other forms of alcohol such as lager. As a consequence, many people of Sikh origin will only seek help in very critical circumstances when their drinking has spiralled out of control.

To date, there is still very little research exploring the drinking habits of different ethnic groups although it is increasingly clear that culture and ethnicity are important factors in determining both how people perceive their alcohol use, and at what point they seek help. The national alcohol strategy must recognise that people from a variety of ethnic backgrounds need a wide raft of support and demonstrate a serious commitment to funding these services.

As crucial as treatment is for people who have developed an alcohol problem, prevention is always better than cure and we are concerned that the forthcoming alcohol strategy demonstrates a serious commitment to providing education, information, and advice for young people.

The consumption of vast quantities of alcohol by young people in the pub, on the streets, or at home, is often regarded as an almost necessary rite of passage. The latest Government figures show that a significant proportion of children under the age of 16 are regularly using drugs and alcohol. The survey asked 10,000 pupils between the ages of 11 and 15 about their substance use and found that the average weekly consumption among pupils who drank in the last seven days increased from 5.3 units in 1990 to 10.5 units in 2002. This sort of hazardous drinking often leads to young people exposing themselves to dangerous situations where they are more vulnerable to crime, violence and unprotected sex.

The drink industry's aggressive marketing of sweet, colourful and palatable alcopops is partly to blame for the increase in alcohol consumption amongst young people. To effectively curb excessive drinking amongst young people and foster a new culture of transparency about alcohol misuse, the drinks industry must work in partnership with the Government, the NHS, the police, and voluntary organisations to find imaginative ways of disseminating the message to young people that when alcohol is used wrongly, it can be harmful, dangerous and life threatening.

There are many different routes through which people with an alcohol problem may seek help including primary care, secondary care, social services and the criminal justice system and treatment must be available to everybody who needs it, regardless of their point of entry. Providing treatment that is built around individual need is key and one of the clearest messages that I am hearing from our service workers and clients is the need for joined-up and flexible services. Many people with an alcohol problem may also have a mental health problem, or learning disabilities, and treatment for people with complex needs must offer a real mix of provision and expertise. Traditionally, clients have had to fit in to what services have to offer and one of the major challenges for Turning Point is to provide flexible and responsive services. There is not one single model of treatment that fits all and treatment demonstrates best practice when it takes a person centred approach that begins with the needs of the individual.