Yesterday I presented some work I’ve been doing to colleagues involved in alcohol research at the Institute of Psychiatry. A lot of our research is concerned with treatment of people who have serious alcohol problems, or involves looking at how health services can intervene appropriately when someone has an alcohol problem. The work I presented looks at a slightly different group – women with children, who may not be drinking so much that the wheels are coming off, but who are drinking to the extent that it is starting to affect their lives, and the lives of their families. The interesting thing about this group of women is that it’s really hidden. Excuse the generalisations, but in the main, these women may have an understanding that they are drinking too much, but they remain very wary of asking for help or support. There is a huge anxiety that by doing so, the full might of social services will come down on them, and in a worst case scenario, their children will be taken away. So, they battle their demons alone. Some normalise their drinking, and deny to themselves and others that they have a problem. Secrecy breeds shame, and shame triggers drinking. Some try to cut down or quit, and find themselves in a cycle of binge/quit/shame (shame again…. will we ever escape it? ) Some turn to the internet and the anonymity of chatrooms to explore whether there is help available, but only under pseudonyms. There they find support from others in the same situation, and the peer-to-peer advice, while powerful, is sometimes contrary to what we know is helpful.
There is an argument often put forward that this group of women do not need as much help as women whose alcohol problems have developed into something more serious, but I would argue that we need to take a both/and approach. Treatment is absolutely vital for women who need it, but earlier action to help women on a pathway to serious problems would mean less reach the stage where treatment is necessary. If we could find a way to reach these women and offer them support and anonymity, we could make a difference. Perhaps this is an area where official bodies should be looking at a way to work with that powerful peer-to-peer mechanism to get the right advice and support out there, with respect for anonymity.
It’s a hugely problematic question – do you guarantee anonymity and reach many more people but perhaps miss instances of child neglect, or do you carry on as is, with social service involvement and child protection taking centre stage, but perhaps miss different instances of child neglect?
I don’t know where I stand on this one. We simply don’t know how much harm stays hidden because we don’t provide anonymous help, but nor do we know whether more harm would be caused if we did.