Self-directed change or specialist help? Understanding the pathways to changing drinking in heavy drinkers

Abstract

This article uses qualitative methods to compare two groups of heavy drinkers – those who had recently sought specialist help, and those who were currently ‘self-directing’ change in drinking. Thirty-six heavy drinkers, selected from a larger cohort in the English West Midlands, took part in semi-structured interviews on drinking change. Key themes for the ‘self-directed change’ group were: confidence in self-sufficiency to change, internalised social pressure for change, and social collaboration with other drinkers for changing drinking. In contrast, themes for the ‘specialist help’ group were: feeling ‘out of control’, lacking confidence in the decision to change drinking, external social pressure for change, and alienation from social collaboration in changing drinking. Results suggest that specialist help might exploit or develop opportunities for collaboration with others. To maintain change, specialist help may need to take more into account those social roles that appear to encourage the stabilisation of drinking in the long term.

• Alcohol
• recovery
• untreated
• social support

Notes

Notes

1.  Heavy drinkers were defined as men regularly drinking more than 50 units per week and women drinking more than 35 units per week.

2.  During the Wave Four interviews a number of alternative qualitative topics were available from which interviewers could choose. Those participants who had had treatment for alcohol withdrawal were involved in the ‘Evaluating Change’ rather than the ‘Hospital Treatment’ qualitative focus.

3.  In practice, ‘specialist help’ included a variety of specific interventions (counselling, group therapy, drug therapy, detoxification, alternative therapies and advice from telephone help-lines); from a variety of ‘specialists’ (general practitioners, psychiatrists, psychologists, community psychiatric nurses, a variety of therapists, community mental health team, specialist alcohol service workers; in a variety of settings (hospitals, specialist alcohol services, Alcoholics Anonymous, drop-in centres and community mental health services). Mutual help organisations such as AA were defined as ‘specialist help’ rather than self-directed change, as this was how the consensus of participant opinion perceived AA.

4.  It should be noted that the ratio of men to women in the entire sample was 3:1, in order to approximate the ratio of male to female heavy drinkers in the general population.

5.  This was done in three stages, three reports at a time by each analyst, resulting in a gradual refinement of the theoretical model.

6.  Numbers are used throughout to denote participants by their identifying number in the sample. This is used as a means of preserving confidentiality.

7.  Drug use and financial problems were also identified as alcohol-related problems by a small number of participants.