Alcohol-related hospital admissions are rising annually, putting pressure on NHS services. People with serious alcohol problems often turn to A&E because they struggle to engage with traditional addiction services for physical, practical or psychological reasons. Only 6%-20% of people with alcohol dependence in England access community alcohol services.
Our researchers conducted a trial of Alcohol Assertive Outreach Treatment (AAOT) in Lambeth and Southwark, with health professionals supporting patients at home and in their neighbourhood. Findings showed AAOT is highly cost-effective, improves quality of life and reduces hospital admissions.
Alcohol addiction affects more than 600,000 people across England who have severe alcohol-use disorder (OHID, 2024). Yet only 6%-20% of those who need help access traditional community treatment services. Meanwhile, alcohol-related hospital admissions continue to rise each year, putting increasing pressure on NHS services.
People with serious alcohol problems often turn to hospital A&E for help because they struggle to engage with traditional addiction services for physical, practical or psychological reasons. Many face significant social exclusion and receive care that does not address their complex needs around mental health, addiction and managing their lives.
The ARC’s researchers developed and tested a new Alcohol Assertive Outreach Treatment (AAOT) service designed to provide more integrated community-based support for people with alcohol dependence. Instead of expecting people with serious alcohol problems to go to clinics or hospitals, health professionals go to patients, supporting them at home and in their neighbourhood.
AAOT services are provided by a multidisciplinary team that can include outreach practitioners, psychiatrists, psychologists, specialist nurses, occupational therapists, as well as housing support workers, social services and addiction and adult mental health services. The team takes a proactive approach, developing and maintaining lasting, supportive relationships with service users and their carers.
Yes, it’s alcohol support but not just alcohol support, it’s support for yourself, as in being a person
Our clinical trial of AAOT in Lambeth and Southwark showed highly promising results. AAOT improves patient outcomes, reduces hospital readmissions and costs, when compared with usual care:
AAOT was identified as a priority intervention by the NIHR Mental Health Implementation Network (MHIN), which aims to drive national improvements in mental health practice.
Our study found that there was significant reduction in A&E attendances and a 50% reduction in hospital admissions in the groups supported with AAOT. There was resoundingly positive feedback on the high-quality alcohol assertive outreach facilitated by collaboration between the research team and the multidisciplinary team
AAOT teams have been rolled out in some of the most deprived communities in England, which have the most deaths from alcohol liver disease and the least access to specialist treatment.
I wanted a bottle, you know. Alcohol, alcohol, alcohol. But [my key worker's] perseverance in a kind way, she got me out of bed. She got me downstairs and said. 'Right I’m going to make you a cup of tea.' So she made me a cup of tea and that was the start of it, that was the beginning of somebody caring enough to get me out of bed
My case worker came to me see me once a week and with her support and encouragement I got help physically and mental health support. I joined groups and met other service users in recovery. Now I do some voluntary work with a lived experience team and highlight the stigma of addiction and support needed for people with unmet needs
Findings from the trial have informed national guidance and improved access to suitable person-centred care for a vulnerable group of people, while reducing pressure on the NHS. The research shows how more integrated, person-centred care, can benefit patients and the health system – improving lives while also using resources efficiently.