Supporting street drinkers to make positive changes

1. Supporting street drinkers to make positive changes Juliette Hough and Paul Wilson Broadway 2 November 2011

2. This workshop • Research findings – Juliette • An experience of making positive changes after street drinking – Paul • Questions and discussion

3. Voices of experience: Research aims • To explore and understand factors which bring about positive change for persistent street drinkers. • To inform and influence practitioners and policymakers to support persistent street drinkers to make positive change.

4. Research methodology • Qualitative research: • Provides an in-depth understanding of people’s lives and experiences. • Enables us to identify turning points and key factors in change. • Does not focus on numbers, trends, relationships, costs and benefits. • The sample: • In-depth interviews with 61 former / current persistent street drinkers (PSDs) in Nottingham, Brighton and London (not CEEs) (our sample size is large for qualitative research) • Interviews with commissioners and practitioners

5. The sample

6. Key characteristics

7. What is positive change? Common aspirations and achievements: • Home, work, family, financial security, ‘normal’ life. • Confidence, self-worth, meaning and purpose. • Dealing with physical and mental health and emotional issues. • Dealing with drug problems. Aspirations and achievements around drinking: • For many: abstinence • For many: controlled drinking off the streets • For some: cutting down (often as a stepping stone)

8. The possibility of change • Almost everyone wants to change. • But drinking serves a purpose, often psychological: • To escape / forget traumatic experiences, feelings and thoughts • Habit, need, addiction • Fun, social and something to do • Many street drinkers do not change. • Several people who had achieved change had believed / been told by peers and staff that change would not be possible.

9. Motivators to change Physical health • Serious / life-threatening illness. • Fear of self-destruction. Psychological • ‘Had enough’. • Accepting you have a problem. • ‘Being given a push’. • Seeing other people who’ve changed. • Belief in the possibility of change and the value of changing / ‘blind faith’. ‘Readiness’ and ‘rock bottom’ describe some of these other factors, but can be unhelpful concepts by delaying change.

10. Barriers Self-medication (mental health and emotional issues). Self-destruction (drinking as a form of self-harm / suicide). Normalisation of lifestyle. Lack of self-belief or self-worth. Facilitators Self-worth and self-belief. People believing in you. Support from staff who genuinely care. Barriers to and facilitators of change: psychological

11. Barriers Lack of information about / access to services. Services facilitate drinking lifestyle (eg. other drinkers in hostels, provision of food, not ‘strict’ enough). Facilitators Information and access to services. An immediate service response. Having multiple opportunities (after lapse). Rules (often in specialist services) and staff ‘being strict’. Support with emotional and mental health issues. An individual / personalised approach: abstinence or controlled drinking; home / residential detox; CBT / 12 step rehab / no rehab. Barriers to and facilitators of change: practical

12. Maintaining change • Leaving the group. • Recreating identity, meaning and purpose. • ‘Putting positive things into my life’ / ‘Replacing the habit’: • Finding meaningful things to do and avoiding boredom. • Access to ongoing tenancy support. • Opening up and talking to people: • Professional support with emotional and mental health issues. • Informal support networks: family, friends, AA. • Having realistic expectations, taking it slowly and continuing the work.

13. Examples of effective services • Michael Varnam House (alcohol support accommodation; abstinence or controlled drinking; quick access; rules and focus on change; creates multiple pathways). • New Steine Mews (phased accommodation). • Home Straight (ongoing floating support of flexible duration). • Enforcement (targeting very entrenched individuals in Brighton. Enforcement can lead to a reduction in street drinking, but displacement of the most vulnerable). • Old Theatre (keeping very vulnerable people in accommodation).

14. Gaps / problems • Needs can be unmet by outreach teams which work only with rough sleepers. • Mental health needs are often unmet – drinking as self-medication. • Accommodated PSDs have nowhere to go for support / to socialise. • Waiting lists for detox / rehab. • Transferring addictions between alcohol and drugs. • Nothing to offer people without a local connection. • Work is an aspiration for many, but it is hard for people with low basic skills and little experience to get work.

15. Turning points and potential points of intervention • Seeking housing at housing office. • First nights on the streets. • Leaving prison. • Lapse / relapse: ‘back to square one’ or part of the cycle of change? • Post-detox / post-rehab and moving on – appropriate accommodation. • Points of crisis and reflection: health scares; hospitalisation; birthdays; deaths of peers, family or friends.

16. Conclusions • PSDs are a distinct (but complex) group, whose needs are not always met by current provision. • Most PSDs want to make positive changes. • Positive change means different things to different people. • This research has highlighted a range of good practice and ways in which we can encourage / facilitate positive change.

18. Recommendations for practitioners and commissioners • Believe in people, challenge people and focus on change. • Ensure people can access the services they need. • Stop people falling through the gaps between services. • End stigma and exclusion from mental health services. • Help people create meaningful lives after change.

19. Paul Wilson Board member, Broadway

20. Questions?

21. Areas for further thought and discussion • How can belief in the possibility of change be instilled in both street drinkers and staff? • How can people be supported to create social lives, support networks and find meaningful activity during and after change? • Positive change means different things to different people, and there are many different routes to achieving it. How can the need for a personalised approach be reflected in a service pathway? • Relapse can send people ‘back to square one’. How can a service pathway support people who have lapsed so that they remain within the cycle of change?

22. Contact details Juliette Hough, Research Officer, Broadway Juliette.hough@broadwaylondon.org 020 7710 0601