Implementing an Ideology. A Case Study from Leicestershire, England

Abstract

In the late 1970s, we established for the county of Leicestershire in England (pop. 850,000) what was then a highly innovative service for problem drinkers. It was based upon a number of core beliefs about the nature of people with alcohol problems and about what would be helpful for them. Most notably it rejected the concept of “alcoholism” and treated the clients (“customers”) at all times as being responsible and therefore able to make decisions about what would be helpful for them. It was a community based tiered service, non-abstinence oriented and client demand led. That system of intervention generated a burgeoning referral rate and there was evidence that compared with neighbouring similar counties, the service may have had a positive impact on the long term morbidity and mortality related to alcohol use. The data available were correlational and incomplete but were encouraging. Changes in the style of provision in the neighbouring counties and administrative and structural changes in health and social services nationally meant that it was not possible to continue the service in its comprehensive form, and tracking changes in the indirect indicators of alcohol problems became unfeasible. The natural experiment was terminated by factors beyond our control. Nonetheless, the service still exists, though in a truncated form. Its presence played a part in the development of the template for local alcohol service provision in Britain.