How Do People Who Frequently Attend Emergency Departments for Alcohol-Related Reasons Use, View, and Experience Specialist Addiction Services?

ABSTRACT

Background: People who frequently attend emergency departments (EDs) for alcohol-related reasons, cost health systems greatly. Although specialist addiction services may be more appropriate for their needs, drinkers often experience barriers accessing specialist alcohol-related support. Objectives: This study explores how people who frequently attend EDs for alcohol-related reasons use, view, and experience specialist addiction services. Methods: We conducted semi-structured interviews with 30 individuals recruited from six EDs across London, United Kingdom. Data relating to participants' socio-demographic characteristics and service use were systematically coded using qualitative software, and analyzed following the Framework. Results: ED usage over the last 12 months was high, whereas current use of specialist addiction services was low. We found little evidence that structural barriers were preventing participants from attending specialist services; rather, participants seemed not to require help with their alcohol use. When asked what support they desired for their drinking, only 11/30 participants identified alcohol-specific treatment. More commonly, they wanted help relating to mental health problems; social contact; paid or voluntary work; housing-related issues; or gym access. Women were more likely to be receiving, and to have support from a specialist addiction service. Conclusions/Importance: People who frequently attended EDs for alcohol-related reasons expressed low levels of interest in, and motivation for, alcohol-specific treatment but desired broader psychosocial support. Case management and assertive outreach appear to be valuable models of service delivery for this population (particularly for men). However, further qualitative and quantitative research is now needed to verify these findings in different countries, regions, and health care systems.

KEYWORDS:

• Alcohol
• alcohol dependence
• emergency departments
• addiction services
• frequent attendees
• qualitative methods

Acknowledgments

We would like to thank the 30 individuals who participated in the research for sharing their experiences, and numerous hospital staff for facilitating access to patients and hospital data. We would especially like to acknowledge Paul du Buf and Beverley Harniman for their support.

Declaration of interest

The authors declare that they have no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

We would like to thank Alcohol Research UK (ARUK) for funding this project. Dr. Joanne Neale and Professor Colin Drummond were part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London; Colin Drummond was also part-funded by the NIHR Collaborations for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of ARUK, the NHS, the NIHR, or the Department of Health.