Impact of Alcohol Abuse
Research has shown that there is a prevalence of excessive drinking among people who experience self-harm ideation and behaviour, the severity which also increases with the alcohol consumption. The abuse of alcohol by a client has also been shown to create difficulties both for the counsellor and the counselling process. Recent findings in the north-west region of N. Ireland indicated that this geographical area had the highest levels of alcohol use in episodes of self-harm recorded in Accident & Emergency departments of the local hospitals. The aim of this study was to investigate if there was a prevalence of excessive drinking among clients who were referred to community and voluntary sector counsellors and if this had any impact on the self-harm ideation/behaviour and the counselling process itself, including the counsellor’s confidence and competence.
A qualitative study was carried out using semi-structured interviews with seven experienced self-harm counsellors from the Western Health and Social Care Trust area. Five of these were generically-trained counsellors and two were cognitive behaviour therapists. The data from the interviews was analysed using a seven step method and relevant information was gathered at baseline then analysed around the questions of, prevalence of drinking, effect of this on self-harm ideation and behaviour, effect on process, effect on counsellors’ confidence and competence and whether the counsellors identified any needs in this area of work.
All of the counsellors experienced a high and in most cases very high prevalence of alcohol abuse where some clients seemed to be oblivious of the problematic nature of the drinking. All of the counsellors experienced that it lead to increased self-harm ideation and behaviour and, in turn, a greater increase in risk to the clients’ well-being. The counsellors experienced an ‘unpredictability’ with clients who abused alcohol compared with those who did not. The counselling process did suffer because of this with the counsellors reporting occasional anxiety and frustration and many experienced negative effects on their confidence and competence. They unanimously agreed that training in this area of work should be part of the core counselling training programmes. Most of the counsellors agreed that professionals need to review the assessment and referral procedures they use as many alcohol abusing clients are inappropriately referred. The CBT therapists seldom engaged alcohol abusing clients as these are screened out at assessment stage and referred on.
There is a high prevalence of alcohol abuse among self-harming clients that leads to increased risk through unintentional episodes of self-harm ideation and behaviour. Self-harm counsellors require more extensive training in working with the problem of alcohol abuse because of this prevalence and in order to minimise the dynamics of low confidence and feelings of being unskilled in working with this client group. The statutory services would need to review the extent of this problem and focus on assessment and referral protocols as well as ensuring substantial resources are allocated to working with this increasing rise in alcohol abuse especially with this client group. They might also want to reflect on CBT as the preferred model for many who self-harm if, despite the percentage who abuse alcohol, these clients are not engaged because of their drinking.