One thing we can say for sure about alcohol issues is that they’re complicated. Someone’s drinking might be shaped by their childhood or the reality of their life right now. They might be drinking to escape or to fit in; constantly or episodically. And alcohol will often not be the only thing they’re dealing with.
One of the most important roles of Alcohol Change UK is to recognise this complexity and develop ways to address it effectively. We know, for example, that heavy drinking can be linked to disordered eating, excessive gambling and a range of mental health issues. We also know, from listening to service users and providers, that alcohol use and self-harm are two issues that often overlap. That’s why, last year, we commissioned Amy Chandler from the University of Edinburgh and Annie Taylor at Edinburgh Napier University to investigate this interface for us. This week, we’re pleased to be able to publish the results of their work.
Their report is based on interviews with eleven adults who have experience of both self-harm and alcohol use. Whilst qualitative studies like this don’t give us the 'big numbers' we get from population surveys or data trawls, what they give us is depth and nuance – once again, complexity. As the researchers note, “Although all the participants said that drinking and self-harm were connected, they did not all describe them being connected in the same ways”. For some, drinking brought a loss of inhibitions that facilitated self-harm or led to more serious injuries (although all were definite that alcohol was not the cause of their self-harm). For others, drinking was a way of avoiding self-harm: an alternative coping strategy when emotions were coming to the boil. One or two raised the challenging idea that alcohol use itself could be seen as a form of self-harm: “My drinking for the last four years, I class as self-harm. Every single drop”.
Whilst their reasons for drinking and/or self-harming were varied, the interviewees painted a sadly consistent picture of services failing to meet their needs. Their most common complaint (and it’s far from new) was about the organisational split between services for mental health and substance misuse - a division that makes little sense when drinking and self-harm are closely intertwined in someone’s life. According to one interviewee, the message from mental health services seemed to be: “I’m sorry, I can’t see you unless you’re sober”. But it’s not just a matter of people being turned away by services. Equally concerning is that some interviewees said that they had avoided disclosing either their drinking or their self-harm in order to access help - in order not to be too complex for entry to a particular service. One person summed up very clearly the general desire for better joint working: “There seems to be a line between the two, between the mental health and drug and alcohol services…There shouldn’t be a line. It should be all under one banner”.
A related issue was the tendency of some services to be “diagnosis-led”: to focus on defining and naming someone’s condition before offering treatment. It’s a point that’s arisen in our work with people experiencing both alcohol misuse and issues with food, whose eating patterns may be disordered but not diagnosable as a specific “eating disorder”. Medical diagnoses provide a useful framework for understanding health and illness, but there has been a movement within some services recently away from seeking to define and fix a problem, towards seeking to walk alongside people and understand their life experiences. As part of this, the question many practitioners are now asking their clients is not “What is wrong with you?” but “What has happened to you?”. In the same way, in their report, Amy and Annie noted the importance of recognising the social aspects of both alcohol use and self-harm – of understanding the factors in someone’s life to which their behaviour may be a reaction. For example, one interviewee expressed dismay at the failure of services to understand or explore the homophobic bullying that he felt was at the root of much of his pain.
Where interviewees reported positive experiences with services, these were characterised by good communication, trusting relationships, a recognition of complexity, and a flexible approach to meeting needs. As one interviewee said, “I was in the police cell and I thought, I really don’t want a life like this anymore, and a woman came round and she said, ‘Does anybody want any help’, and I said, ‘Yeah, I do.’”.
“I was in the police cell and I thought, I really don’t want a life like this anymore, and a woman came round and she said, ‘Does anybody want any help’, and I said, ‘Yeah, I do.’”.
We hope that this new research will spark a conversation within alcohol services and self-harm services – and between those two sectors – about how to improve the support for people facing these two challenges in life. It’s imperative for services to adopt what the Australian Department of Health has called a “no wrong door policy”, so that no one is turned away because of the complexity of the issues they’re facing. At Alcohol Change UK, we’ll now be seeking to engage with local services to test some new approaches to joint working, with the aim of ensuring that far fewer people fall through the gaps.
