Here, Dr Wulf Livingston* highlights some of the issues around Covid-19 and alcohol giving relevant resources for social workers.
Alcohol is probably the nation’s preferred drug, with off-licences identified by the UK government as essential and allowed to trade during the first March 2020 lockdown. The sale of alcohol, including pubs and restaurants staying open or selling ‘takeaway’ has remained a hot policy topic during the continued pandemic. Its use plays a significant role in healthy social lives, as well as coping with difficult experiences and contributing to health and social harms. As such it has enhanced considerations for social workers during particularly unusual or special times, and the continuing global pandemic for Covid-19 is one of these.
Two very good sources, Alcohol Change UK - Coronavirus: information and advice hub and the Institute of Alcohol Studies, are providing excellent guidance about alcohol and the Covid-19 pandemic, as well as links to further reading. The Alcohol Change UK site has specific resources aimed at professionals (scroll down the page to find this). The Institute of Alcohol Studies second Covid briefing provides an updated on the first six months of the pandemic.
We can summarise the things social workers need to focus on in four key messages:
1. Changes to individual drinking
Covid-19 has forced changes in the way many people drink. As pubs and restaurants closed, all drinking is being done at home, for different motivations, more hidden and outside of normal habits and routines. During lockdown periods, people are drinking either in isolation with immediate household members or alone. Media reporting suggests that many people are drinking more at home during this period. This is driven by a combination of increased opportunity (time) and coping with feelings of anxiety (for example, fear for self and/or others, or guilt) bought about by the pandemic. The stress being generated for some by home situations and their relationship with family members is also really high. Increased consumption tends to come with increased risks to physical health and psychological well-being see the Alcohol Change UK - Coronavirus: information and advice hub for more information. This will also include increases in the adverse effects alcohol has on many prescribed medications. Where social workers are making actual or virtual home visits, awareness of these issues needs to be added to any understanding about risk assessment for the individual (and the social worker).
For some individuals Covid-19 will represent a time of anxiety about not being able to drink or get enough alcohol. This might be because of isolation and being unable to go to the shops, or reduced income through unemployment, furlough, benefit complications or no income at all. Some people, older and/or housebound, are reliant on others to buy their alcohol. This may lead to increases in psychological insecurity and associated mood swings, and, where acute, to mental health breakdown or increased feelings of self-harm and suicide. For dependent drinkers, loss of income may result in unwarranted rapid withdrawal, which can be life-threatening in some cases. The How to Gauge the Severity of Alcohol Withdrawal Symptoms guide from the United States provides a useful and succinct summary about withdrawal.
Alcohol will be used, perhaps more than is advisable by drinkers and families to cope with the pressures of the current Covid19 situation. This will also include moments of bereavement in which alcohol plays a particular role.** For most this should be short term and not overtly problematic. For a smaller number this will heighten concerns about physical, psychological and social well-being and for others the responsibility of being with children 24-7 can have a significant impact. Social workers should be alert for this happening and the possibility of supportive and early interventions.
2. Changes to support for drinkers
People’s ability or willingness to access help for non-life-threatening conditions will be much lower during the pandemic and especially during periods of lockdown. While alcohol services continue to operate, many of them have moved to increased levels of phone and on-line support. Their websites detail what services are available where and when. A good example in Wales is Kaleidoscope’s Virtual Support in Covid-19 Outbreak with opening hours, contact details and some additional resources for self-management
Social workers will play a key role in appropriately signposting individuals to support services and in some instances actively encouraging or supporting attendance to them. The British Association of Social Workers’ Special Interest Group for alcohol and other drugs has a range of additional information on its website, including links to other resources for social workers.
Many drinkers get their support from other (ex) drinkers through a range of peer-to-peer led recovery networks, for example, Alcohol Anonymous and Soberistas. Many of these already operated on-line and offered remote support, while others have rapidly moved into the online environment. Social workers should encourage people to access these services if they want to.
3. The impact on alcohol use in families
Social workers are already very family-focused and familiar with the impact of excessive adult drinking on children. These concerns will be heightened in some families where increases in parental alcohol consumption are taking place and children are particularly unable to escape or get respite through times out of the household (for example, at school, or with friends or other family members). A good summary of these issues is available in a Parliamentary Post Note on parental alcohol misuse and children. Support for families is available from ADFAM, they are also provide a range of online training events.
There is already an emerging account of the combination of lockdown and pressures of Covid-19 leading to an increase in domestic abuse. Alcohol plays a specific role in this situation. Lecturers from Manchester Metropolitan University in conjunction with Alcohol Change UK and ADFAM have produce an excellent short guide on the combination of Covid-19, domestic abuse and alcohol.
For more general information on domestic abuse and violence during the Covid-19 crisis visit our page on Domestic violence and abuse – guidance for professionals.
A third group of potential concern for social workers is carers. Many carers will be acutely anxious about increased vulnerability of those they care for, are possibly struggling to access their normal support, and feeling isolated – this might lead to more physically demanding caring, combined with increased stress. Alcohol is often used as a coping mechanism in these circumstances.
4. Support for social workers
The above suggests social workers need to be especially active in considering the role of alcohol (and other drugs) in their caseloads – listening and looking for it, and having short motivational conversations with individuals where they feel drinking is a matter of concern or becoming one. An excellent range of brief (practice/pocket) guides on how to do this with a range of different client groups is available from the British Association Social Workers.
Social work is already identified as particularly stressful, and already requiring strong levels of resilience. The current Covid-19 situation heightens this perspective. All (some or all) of the above points may also apply to the workforce who then find themselves dealing with problems which they then find replicated in their personal lives. Social workers should try to give specific attention to self-care, including monitoring their own additional consumption of alcohol, as well as peer support, team support and access to supervision.
* Dr Wulf Livingston is Reader in Social Science at Glyndwr University. He has been a qualified social worker since the mid 1990’s, and a full time academic since 2010, with a particular interest in studying the effects of alcohol and other drug use. Wulf is currently researching alcohol pricing policy for the Welsh and Scottish Governments.
** Livingston, W. (2017) Death, Grief and Bereavement: Relationships with Alcohol and Other Drug Use, in Thompson, N. and Cox, G. R. (eds) (2017) Handbook of the Sociology of Death, Grief and Bereavement: A Guide to Theory and Practice, New York, Routledge, pp. 224-236.