Finding the Right Balance: A Framework analysis of staff and service user experiences of moving to remote drug and alcohol support during the COVID-19 pandemic

Abstract

Background Dependence on alcohol and other substances contributes significantly to poor health globally. Deaths associated with substance misuse have increased since the COVID-19 pandemic period and providing effective support for recovery is critical. The pandemic required an unprecedented change to recovery services for substance misuse, from in-person care to mainly telephone and online support. The qualitative study described here forms part of a wider evaluation and was one of the first to explore the move to remote models of recovery services. Methods This was a mixed-methods qualitative study, employing in-depth interviews, focus groups, text-based asynchronous interviews, digital timelines and creative vignettes. Framework analysis was undertaken, with focus on service user out-of-pocket expenses as part of a health economic evaluation. A Public Involvement in Research group, including people with lived experience, was involved in study design and analysis. Staff (N=36) and drug and alcohol service users (N=28) in an English city participated in one or more of the data collection methods. Findings were shared with staff and service users and their input shaped the final analysis. Results There was a strong desire to retain remote service delivery alongside the return of in-person provision, post-pandemic. Remote service delivery was not appropriate for everyone however, and not all aspects of service delivery work well remotely. Findings are organized under two main themes: Finding the Right Balance and Resourcing Hybrid. Four sub-themes sit within Finding the Right Balance. These are: Lockdown and remote services: from supportive context to excuse to ‘go wild’; Maintaining therapeutic effects remotely: trust, rapport and motivation; Characteristics of people and components of service delivery; and Efficiency and convenience of remote. Two sub-themes sit within Resourcing Hybrid. These are: Investing in Hybrid; and Service users’ resource needs. Conclusions Optimal delivery of drug and alcohol services should include remote support options, alongside in-person and outreach or home-visiting, where needed. Services may need to invest in training and resourcing for a hybrid offer. Service user preferences and characteristics including their personal resources, health and wellbeing, and readiness to address substance misuse should be central to deciding to whom remote care should be offered. Study registration ISRTCN50804656 https://doi.org/10.1186/ISRCTN50804656