CHAPTER NINE: PERCEPTIONS OF WHAT WORKS
GAPS IN SERVICE PROVISION
From the research it is difficult to provide an in-depth discussion of perceived gaps in service provision. In general, the main ‘gap’ appears to be in peoples’ awareness and knowledge of services available. In that sense, the ‘gaps’ identified did not relate to the need for new or different types of services but the provision and promotion of more of the kind of services that are already in existence.
“There aren’t enough groups like this. It is two things, there aren’t enough groups and I think the information about them is not available” (Female, service user, voluntary, Edinburgh)
“*There should be more places like this. **There are not enough of these places. *They need to advertise them”
(NHS service users, Male, Glasgow)
There was also a perception that services for drug users were more widely advertised and available, therefore giving the impression that there is more support for drug misusers than alcohol misusers. Alcohol services should be as visible as drug services.
“If you’re a drug addict and your family is disrupted, they’ll do somersaults to get you back together. See if you’ve got a drink problem they’ll maybe help your wife, maybe, it all depends on the circumstances, but you are left to fend for yourself. It’s your fault it happened whereas if it is a drug problem they will do anything to get you all back together” (Social Work service user, Male, Glasgow)
As shown above, respondents identified a large number of factors essential to any service and, while many services provide these elements, not all do and if this is the case, these can be translated into gaps in service provision.
A specific issue raised by some service users who believe that alcoholism should be treated as a disease, was that health professionals do not necessarily agree with this view and, as a result, did not always offer appropriate treatment.
“I think our biggest problem is the health professionals. They cannot or will not accept that alcoholism is a disease. Whilst they keep playing this game of degrees of drinking problems our people will die and misappropriate referrals will take place.” (Voluntary sector service user, Male, Glasgow)
“Willpower will not work on a disease, it does not work on cancer or diabetes so why should we expect it to work on alcoholism.” (Private sector previous service user, Male, Glasgow)
Again, this indicates that all of those who may be approached by someone with alcohol- related problems looking for help should be aware of all the different types of services available and be capable of assessing which service would be best suited to a particular individual. Nevertheless, the main point to be made in relation to gaps in service provision is people perceive there to be a huge gap, principally because limited publicity results in a perception that there are no services to help people with alcohol related problems. While there may be room for increased service provision, a number of such services clearly exist and people need to be made aware of this.
SUMMARY
Participants saw some characteristics of services as essential requirements of any kind of alcohol-related service provision. Confidentiality was considered to be a crucial element of any service provision, and this was generally framed in terms of the fear of stigma surrounding alcohol misuse. Several issues relating to the accessibility of services arose in the research. Participants felt that services should be free, easy to get to, and available at the times when they were most needed (which is often during evenings and weekends). They also felt services should also provide childcare facilities.
There was a widespread belief that a holistic, positive and practical approach was required. Alcohol problems need to be examined within the broader context of people’s lives and services should consider the potential causes of the alcohol problem. Moreover, practical help should be provided to enable service users to fill the gap in their lives left by not drinking alcohol (or drinking less alcohol). Participants also felt that service provision should be on- going rather than time-limited and that follow-up services were crucial to prevent the alcohol problem recurring.
There was little consensus in relation to which types of alcohol services actually work, however, there was widespread consensus that there is a need for a range of services – with different methods for different people and at different stages in their treatment. Perhaps the most important point to note in relation to perceptions of what works is that alcohol services need to be tailored to the individual needs of the clients and be revised during the process of service contact. Opinions were divided as to whether a ‘no drinking’ or a ‘controlled drinking’ model was most effective. Although participants disagreed on the relative merits of different service approaches, it was generally felt that the range of services should comprise detoxification programmes, medication, day or drop-in centres, group counselling, individual counselling, follow-up support and advice (practical and psychological) and support and advice for family and friends.
Overall, the limited knowledge people have about what services are available suggests that there needs to be increased publicity about the existence of alcohol services and what they offer.