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

Background
Dependence on alcohol and other substances contributes significantly to poor health globally. Deaths associated with substance use have increased since the COVID-19 pandemic and providing effective support for recovery is critical. The pandemic required an unprecedented change to recovery services for substance use, from in-person care to mainly telephone and online support. The 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 multi-method 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 group, including people with experience of substance use, supported 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
Most participants wanted to retain remote services alongside in-person provision, post-pandemic. Remote delivery was not appropriate for everyone however, and not all aspects of service delivery work remotely. Findings are organized under two main themes. Within the first, Finding the Right Balance, factors contributing to an improved service experience for some are contrasted with reduced information on which staff can base judgements and other risks to service user wellbeing. Within the second, Resourcing Hybrid, some of the resource implications for providers, (e.g. hybrid optimised service hubs), and users (e.g. digital access) are drawn out.
Conclusions
Drug and alcohol services should include remote support options for some service users where that is likely to be safe and enhance their care. In-person and outreach or home-visiting will be more appropriate for some. Services may need to invest in training and resourcing for a hybrid offer to operate effectively. Service user preferences and their personal resources, health and wellbeing, and whether they are able to engage with the service as offered should be central to how their care is planned.