Experiences of alcohol dependence: a qualitative study.

INTRODUCTION AND AIMS OF THE STUDY: Despite the increasing incidence of alcohol misuse and the costs it incurs, British society continues to hold equivocal and ambiguous attitudes towards drinking, and understanding of the nature of alcohol dependence and related issues is limited. This qualitative study aimed to investigate the experiences of individuals with alcohol dependence to enhance understanding of the illness, identify key issues and common themes and provide insight into the experiences of the participants during their alcohol dependent period and recovery. METHOD: A qualitative approach, using narrative method, was used. Eight participants, all members of Alcoholics Anonymous (AA), were interviewed by the researchers. Using a grounded theory approach and content analysis, the in-depth narratives of the eight participants were systematically analysed. RESULTS: While participants continued to deny the existence of a problem to those around them, their behaviours indicated that they were aware of the problem but were afraid to admit it openly through fear of other people's reactions. Participants generally regarded GPs as helpful but other health professionals less so, especially nurses and Accident and Emergency staff. Participants considered that the success of treatment depended on their own motivation and willingness to engage in radical behaviour change. They considered that reaching this stage represented a turning point in their illness. The point at which this stage was reached appeared to be different for each participant. CONCLUSIONS: This systematic analysis of a small sample of alcohol dependent individuals gives insight into their experiences during alcohol dependency and the journey to recovery. The findings suggest that denial of the problem to the outside world occurs simultaneously with individuals being aware of their problem. Participants felt the illness carries a stigma and their negative experiences of health professionals other than GPs suggests that nurses and other health workers need to revise their understanding of alcohol dependence and their approach to it. AA was a significant factor in recovery for these participants.

Alcohol misuse and older people.

Alcohol misuse in older people is a hidden issue. Older people are neither being diagnosed nor receiving treatment, yet they may be more vulnerable to harm at lower levels of consumption than younger people. Assessment tools need to be adapted for older populations. More training of healthcare staff is required and attitudes need to change. Screening, referral and interventions need to take place in a range of setting, such as GP surgeries, day centres and fracture clinics.

Alcohol dependence: a significant and destructive illness.

Alcohol dependence is a destructive and devastating experience both for the individual and those around them. It can cause significant costs and harms and prevalence is widespread. Despite this there is still limited understanding about the nature of the illness, and negative attitudes towards those with alcohol problems remain prevalent in society. For those who are concerned about someone who is drinking excessively or is affected by it, the experience can be equally destructive and devastating. If we are to make any serious impact on this problem there has to be increased understanding of the nature of the illness, a shift in professional and public attitudes and appropriate levels of funding for specialist support and services.

Managing tragedies: understanding conflict over common pool resources.

Conflicts over the management of common pool resources are not simply material. They also depend on the perceptions of the protagonists. Policy to improve management often assumes that problems are self-evident, but in fact careful and transparent consideration of the ways different stakeholders understand management problems is essential to effective dialogue.

Accentuate the positive.

During a recent clinical supervision session with a carer, we were discussing what she had done that day. 'Oh, nothing special,' she said, 'just the day-to-day stuff.' She was, of course, referring to meeting the essential human needs of the residents, such as helping them with meals, taking them to the toilet, chatting with them, helping to meet their social and psychological needs. Further discussion revealed that although she thought that these activities were of vital importance to the residents, she felt that other people would not think they were important or valuable. This is a typical example of staff who work in nursing homes undervaluing themselves and what they do, and one has to ask how much of that is caused by external perceptions.