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Alcohol and me: reducing inequalities in alcohol support

 

"Every one of us has a relationship with alcohol, including the people who don't drink at all.” - Joshua Stapleton 

 

This week is Alcohol Awareness Week, a national campaign led by Alcohol Change UK. This year's theme is ‘Alcohol and Me,’ which encourages individuals to reflect on the role alcohol plays in our lives and understand the impact alcohol use can have on our mental health and wellbeing.

To acknowledge the link between alcohol-related harm and mental health, we spoke to Joshua Stapleton, Service Lead for King's College Hospital Addiction Care Teams and South East London Alcohol Outreach Services and Dr Emily Finch, Addictions CAG Clinical Director and Consultant for Alcohol Care Outreach Team, about why support should be focused on more than drinking patterns alone. 

What is the role of your team and what does your day-to-day look like?

“The Alcohol Care Outreach Team is an assertive outreach team. At its core our role is
about supporting patients who have a lot of hospitalJoshua Stapleton admissions and presentations. Plenty of people drink heavily and rarely end up in hospital, so when someone is coming in repeatedly that usually tells us something bigger is going on, and our job is to work out what that is and help with it. Often it's inappropriate housing, or someone who needs mental health support, or unmet social care needs. We build a plan around the person and support them with what they actually need. By focusing on those things first, rather than the drinking, we start to unpick the barriers that have been stopping them accessing support and driving them back to hospital. Day to day that's home visits, joint work with Alcohol Care Teams, GPs, mental health teams, housing and A&E, a lot of relationship building, and working with our in-hospital colleagues to identify people who are presenting and could use our support.”- Joshua Stapleton.

How does the team support patients to reflect on their personal relationship with alcohol?

“The first thing to say is that people don't have to want to stop drinking, or even want to change, to be under our team. They just have to be willing to work with us. That takes the pressure off, and it's often what makes change possible. Most people already know more about their own drinking than anyone else does, so our job isn't to convince them of anything. It's to create the space and the safety for them to look at it honestly. You can't force change on people, but you can make sure that when they are ready, they have the support they need and already have the information so they can take action.”-  Joshua Stapleton.

How do you approach conversations about alcohol in a way that feels non-judgemental?

“For a lot of people drinking is a way of coping with trauma, pain, loneliness or their mental health, so meeting that with judgement or being too directive just confirms what they already fear and shuts the conversation down. Because our model works with patients over a year, we have time to build a relationship. Sometimes that's very difficult, as people don't always trust services and professionals. We try to work at the pace the patient is comfortable with, and when we do talk about alcohol we make sure it's supportive. That usually means asking open questions, being curious rather than directive, and working out a plan with patients to help support them.” -  Joshua Stapleton 

Dr Emily Finch"We try to make conversations about alcohol as normal as possible. We address it very regularly with our patients. Indeed, we encourage outpatients to evaluate their own relationship with the substance." - Dr Emily Finch

How will the expansion to other London boroughs help to increase outreach and support more of London?

“We have long been aware of the needs in the South East London boroughs beyond Lambeth and Southwark. The is particularly because of our close working relationship with the teams in the acute trusts who see patients from all over South East London who we were not able to help. So it's very exciting to be able to take on more people and build relationships with new partners services across SEL who are trying to support them.” - Dr Emily Finch

 

How can alcohol use impact our general mental health and wellbeing?

"Alcohol and mental health are closely linked. Alcohol is a depressant, so while it can feel like it helps in the moment, over time it tends to deepen anxiety and low mood, disrupt sleep, and damage the things that keep us well, like relationships, work, finances and self-esteem. From a mental health team's point of view, it also affects how well antidepressants and antipsychotics work, and it significantly increases the risk of suicide, with people who have alcohol use disorder around 5 to 6 times more likely to die by suicide. People often drink to cope with how they're feeling, but the drinking then makes the feelings worse, and it becomes a difficult cycle to step out of alone. What we see in our work is that it's rarely the only thing going on, which is why we try to support the whole person rather than just the drinking. Rates of alcohol and drug use among patients in mental health services are very high, so it's rarely a side issue." - Joshua Stapleton.

  The theme for Alcohol Awareness Week this year is 'Alcohol and Me.' Why is it important that we all evaluate our relationship with alcohol?

"Every one of us has a relationship with alcohol, including the people who don't drink at all. It's so woven into our society that we rarely stop to think about it. Reflecting on it doesn't have to mean deciding whether you're a "problem drinker". It can simply be about being honest with yourself about the part it plays in your life and whether that's the part you want it to play. Asking the question is something we can all do, and it helps break down the stigma that stops other people from asking it too. From a professional point of view, people often find it awkward to talk about and explore, but the rates of alcohol and drug use among the caseloads of most mental health services are very high. The more we learn and understand, the better we'll be at talking to our patients about it. If we're not treating these as linked, co-occurring issues, then we're ignoring a major factor in recovery, both from alcohol and in supporting someone's mental health."- Joshua Stapleton.

How does your team work to identify and support patients earlier, particularly within mental health services?

"So much alcohol-related harm and mental health need go together, but for years the two have been treated separately, and people have fallen between them. We work to close that gap by working alongside mental health colleagues with patients. Within the hospital we support screening and joint working with our mental health liaison colleagues, so that someone's drinking gets noticed and addressed early, rather than only when it lands them in crisis. We also work closely with the Alcohol Care Teams to make sure that those who do start presenting more frequently are referred to our service so we can support them." - Joshua Stapleton.

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