13. Community alcohol treatment and recovery services
Source: gov.uk (2025-11-28)

How community alcohol treatment and recovery services can provide accessible, trauma-informed, inclusive care. This includes how they work with health, care and recovery services to develop personalised treatment plans and deliver evidence-based interventions.

13.1 Main points

Community alcohol treatment services should:
- provide a positive experience of care for people who are stigmatised and disadvantaged
- promote a trauma-informed therapeutic environment that can help engage and involve people in their treatment and recovery
- make sure the service is accessible to anyone who needs alcohol treatment
- promote equitable access and personalised treatment that meets the diverse needs of the local population, including people with protected characteristics, socially excluded groups and those with specific needs such as very poor health
- implement a quality governance framework informed by strong clinical leadership to help deliver safe, appropriate care and evidence-based treatment
- make sure that integrated drug and alcohol treatment services are inclusive for people whose main or only substance problem is alcohol
- be part of a recovery-oriented system of care which offers alcohol treatment integrated with longer-term recovery support
- involve peer support networks and organisations in service feedback, design, monitoring and in delivering recovery support
- work in partnership with the wider health and social care system, criminal justice system and community services at a strategic and a service level
- develop service level agreements and information sharing arrangements with partner services to provide integrated care to people with multiple needs and support transitions from one service to another
- have competent, caring staff who are well-trained and supervised and have appropriate caseloads
- provide quick and easy access to initial assessment, urgent treatment and risk management, and comprehensive assessment
- offer a named keyworker, personalised, collaborative treatment and recovery planning and structured support for each person in treatment
- offer evidence-based alcohol focused psychosocial, recovery support, pharmacological and harm reduction interventions
13.2 Introduction

In every local area there should be community alcohol treatment and recovery services for adults and for young people. These services should:
- provide a positive experience of care
- be designed to meet the alcohol treatment needs of the local community
- be easy to access
- provide evidence-based interventions
Most people access alcohol treatment in community services and those who need planned inpatient or residential treatment can access this through referral from community services.

Most of these clinical guidelines are relevant for community alcohol treatment and recovery services. So, this chapter summarises the main elements of adult community alcohol treatment and recovery services and directs you to other sections in the guidelines that provide more detailed guidance on each element.

Chapter 23 provides guidance on community alcohol treatment and support for young people.

You should also read this chapter together with chapter 25, which provides guidance on developing inclusive alcohol treatment services.

13.3 Core elements of community alcohol treatment

13.3.1 Principles of care

You should read guidance on principles of care in chapter 2.

These principles should form the foundation of a community alcohol treatment and recovery service.

They include service and system arrangements and clinical practice that contribute to:
- a positive experience of care
- equality, diversity and inclusion
- quality governance
- recovery-oriented care and systems of care
- local strategic partnerships
13.3.2 Designing services to meet the alcohol treatment needs of the local community

Community alcohol treatment services should be based on the unique needs of the local area they serve.

While the form of local strategic partnerships vary across the UK, there should be a local strategic partnership that commissions and plans alcohol and drug treatment for their area. Each local strategic partnership should co-produce an assessment of local need involving local people and communities in the process, including those with lived and living experience of alcohol problems. If community services are combined alcohol and drug treatment services, the distinct needs of people with problem alcohol use, people with problem drug use and people with both alcohol and drug problem use should be identified. The community alcohol treatment and recovery service should be aware of the local needs assessment and of any changing local needs.

Service providers should design services so that they are accessible to everyone in their local area. They should work with people with protected characteristics and socially excluded groups to identify their needs and co-produce plans to target and tailor services to those groups.

You can read more about targeting and tailoring services in:
- chapter 25 on developing inclusive services
- chapter 9 on alcohol assertive outreach and a multi-agency team around the person
- chapters 18 to 24, 26 and 27 on specific populations
13.3.3 Service ethos

Creating a positive service ethos

Service ethos describes the culture and feel of a service. There are a number of things that a service can do to make sure they have a positive ethos, including having:
- strong clinical leadership
- engaged staff
- clear and supportive management direction
- a service framework based on the principles of care outlined in chapter 2
Making good first impressions

First impressions of a treatment service can have a lasting impact on a person. These impressions can affect their experience of assessment, how they engage with the treatment process and ultimately affect their treatment outcomes.

Services can avoid or limit stigmatising and stereotyping people with problem alcohol use by paying attention to:
- how staff interact with people on the phone or online
- how staff interact with people face-to-face at reception or in clinical interactions
- how the service ethos is portrayed in its information about itself
- the environment in which assessment and treatment take place
This applies to people who need alcohol treatment, as well as their family or carers.

13.3.4 Meeting the needs of people with primary problem alcohol use in integrated drug and alcohol treatment services

Integrated drug and alcohol services should be organised so that people whose main substance problem is alcohol:
- feel they are in the right place to seek help
- get a treatment offer that is tailored to their alcohol treatment needs
- feel safe and supported
To make integrated drug and alcohol services more inclusive to people with problem alcohol use, the services should make sure that:
- the service name is inclusive (not called a drug treatment service)
- there is visible information on site specifically for people with problem alcohol use
- the service is promoted to people whose main substance problem is alcohol, using targeted service information
- they offer evidence-based alcohol-focused interventions
- they have a dedicated alcohol team or staff with alcohol specific competences
- they have information about alcohol and alcohol treatment options available and staff are competent to discuss these options with people
- it’s clear that people can make their own choices about treatment options
- they offer to host peer support organisations and mutual aid groups such as Alcoholics Anonymous on the service site
13.4 Partnership working

Community alcohol treatment and recovery services provide specialist alcohol treatment and recovery support, but they cannot meet all the needs of people with problem alcohol use or their families. So, it’s essential that they work in partnership with other local services and with peer support organisations to meet those needs. Community alcohol treatment and recovery services have a vital role to play in the wider partnership approach. Local strategic partnerships should support local services to develop and maintain effective partnerships and play a role in addressing any difficulties in partnership working at service level.

13.4.1 Working with peer support organisations

In some areas, peer support networks are closely linked to the community alcohol treatment service and in others they are independent lived experience recovery organisations. Community alcohol treatment services should involve peer support organisations or networks in the service.

You can read more about working with peer support organisations in section 2.6.5 in chapter 2 on principles of care.

You can read more keyworkers helping people to access peer support organisations and mutual aid as part of the structured support they offer in section 5.5.4 in chapter 5 on psychosocial interventions.

You can read guidance on recovery support services, including more on peer support organisations, in chapter 6.

13.4.2 Integrated care pathways with partner services

Local strategic partnerships should agree how local systems will work together to meet the needs of people with problem alcohol use. The community alcohol treatment and recovery service has an important role in making and maintaining service level agreements to support integrated care pathways.

With each partner service, community alcohol services should agree:
- clear referral pathways into the community alcohol treatment and recovery service
- how the alcohol service can refer people to the partner service
- joint working arrangements, setting out who is responsible for what
- information sharing agreements and mechanisms
- to attend and contribute to multi-agency case conferences and care planning reviews
Effective partnership working at service level requires support from local strategic partnerships. So, commissioners and leaders in local strategic partnerships should support local services to:
- develop and maintain effective partnerships
- address any difficulties they have integrating pathways with partner services
Commissioners and service managers need to allocate time and provide training for staff to work in partnership with other services. Where possible it is helpful for a named staff member in the community alcohol service and in each partner service to lead on partnership working.

Services should make sure that all their staff are aware of and updated on the pathways and related information sharing arrangements.

13.4.3 Co-ordinating care with partner services

Service level agreements with partner systems and services should include agreements between the community alcohol treatment and recovery services and a wide range of other services, including:
- GPs and local primary care networks, including pharmacy teams
- liver screening and liver departments in hospitals
- alcohol care teams in local acute hospitals
- community, inpatient and crisis mental health services
- neuropsychology and services for cognitive impairment (for alcohol related brain damage)
- occupational therapy services
- antenatal and maternity services
- early help and child safeguarding services
- adult social care and safeguarding services
- criminal justice services including police custody suites, courts and prisons
- homelessness and housing services
- domestic abuse services
- community services working with people with protected characteristics or socially excluded groups, including people experiencing severe and multiple disadvantage
You can read more guidance on partnership working with these services in the relevant chapters on specific settings and specific populations in part 2 of the guidelines.

13.4.4 Continuity of care and transitions

Transitions from one service to another, or one setting to another, are often vulnerable times for people, even when transitions are about making progress in recovery. Services need to work in partnership so that people:
- stay engaged with services throughout the transition and settle into the new service
- get the level of support they need to manage the transition (which can mean a temporary increase in support)
Adult community alcohol treatment services should have ongoing agreed continuity of care arrangements with several services. These services include:
- young people’s community alcohol treatment service
- specialist inpatient medically assisted withdrawal
- residential rehabilitation
- liver departments in acute hospitals, including liver transplant specialists
- hospital alcohol care teams
- prison substance use or healthcare services and probation services
When a person makes one of these transitions, both (or all) services involved and the person should agree an individually tailored transition plan. This should be agreed well ahead of the transition, so the person is appropriately supported at a vulnerable time.

You can read more guidance on these transitions in other parts of the guidelines, including:
- sections 9.8.7 and 9.8.8 in chapter 9 on alcohol assertive outreach and a team around the person
- section 12.7.2 in chapter 12 on specialist inpatient medically assisted withdrawal
- section 14.4 in chapter 14 on residential treatment and intensive structured day treatment
- section 16.10 in chapter 16 on discharging patients from acute hospitals to ongoing treatment and care
- sections 17.5.6 and 17.6 in chapter 17 on alcohol treatment in criminal justice settings
- section 18.7.3 in chapter 18 on people with co-occurring mental health conditions
- sections 23.8 in chapter 23 on alcohol treatment and support for young people
13.5 Caring and competent staff

Community alcohol treatment and recovery services should be staffed with a multidisciplinary team that includes:
- doctors
- nurses
- psychologists
- social workers
- family support workers
- peer support workers
- other practitioners
Caring and competent staff are vital to an effective community alcohol treatment and recovery service. Staff should be able to form therapeutic alliances with people who are stigmatised, often marginalised and with high levels of trauma. This requires care and skill.

Staff also need alcohol specific competences. In integrated drug and alcohol services there should be enough staff with alcohol specific competences and specialist expertise to meet alcohol treatment need.

You can read guidance on staff competences in section 2.5 on a skilled and competence workforce.

13.6 Assessment

The community alcohol service should provide quick and easy access to:
- initial assessment
- urgent treatment and risk management
- comprehensive assessment including risk assessment
Assessment involves the person choosing an alcohol use goal. Severity of dependence and complexity of need provide broad indicators for appropriate alcohol use goals, but these should always be mutually agreed between the person and the assessor.

You can find detailed guidance on assessment in chapter 4 on assessment and treatment and recovery planning.

13.7 Personalised treatment and recovery planning

Based on assessment, formulation (see the glossary) and discussion of available treatment and recovery support interventions, the assessor or allocated keyworker should agree a treatment and recovery plan with each person.

Care should always be personalised and plans should be regularly reviewed. Personalised care should take into account important aspects of a person’s identity and experience, including any protected characteristics.

Each person should also have a risk management (safety) plan that is regularly reviewed.

You can find guidance on treatment and recovery planning, including risk management (safety) planning in section 4.10 in chapter 4 on assessment and treatment and recovery planning.

You can find guidance on formulation in section 5.4 in chapter 5 on psychosocial interventions.

13.8 Evidence-based alcohol interventions

Community alcohol treatment and recovery services should offer evidence-based alcohol interventions. These should include:
- psychosocial interventions
- access to recovery support interventions
- pharmacological interventions
- harm reduction interventions
The choice of treatment options (in-house or through referral) should be clear to the person when they enter treatment and during their assessment.

Clinicians and other practitioners should provide accessible information on the risks, benefits for the person and on known outcomes of interventions, so the person can make informed decisions about their choice of treatment.

13.8.1 Psychosocial interventions

Psychosocial interventions are an essential part of treatment for everyone. They should always take place in the context of a broader personalised treatment and recovery plan.

The service should offer everyone in treatment a named keyworker who provides structured support. Structured support involves using specific psychosocial interventions that are common to evidence-based psychological treatments for alcohol and drug use.

Services should also offer formal psychological treatments focused specifically on alcohol-related problems according to individual need. These treatments are generally provided by a specialist member of the multidisciplinary team alongside a keyworker who provides structured support.

You can find guidance on structured support in section 5.5 and formal psychological treatments in section 5. 7 in chapter 5 on psychosocial interventions.

13.8.2 Recovery support interventions

Keyworkers should help people to set recovery goals in their treatment and recovery plan and help them to access appropriate recovery support interventions. Recovery support is important from the beginning and throughout treatment and especially after the person has left structured treatment.

Recovery support interventions can include:
- involvement in recovery-oriented peer support activities and mutual aid
- employment support
- education, training and volunteering
- involvement in supportive family and social networks
- involvement in cultural and community networks
- support for health and wellbeing
- recovery check-ups after the person has left structured alcohol treatment and re-engagement plans
Alcohol treatment and recovery services should have pathways and joint working arrangements with recovery support services including peer support organisations so they can help people access emotional and practical support for their ongoing recovery from alcohol dependence.

You can read about the keyworker’s role in providing recovery interventions as part of the structured support they offer in section 5.5 3 and 5.5.4 in structured support in chapter 5 on psychosocial interventions.

You can read more about recovery support services in chapter 6 on recovery support services and in chapter 7 on employment support.

13.8.3 Pharmacological interventions

Pharmacological interventions are used:
- for medically assisted withdrawal from alcohol
- to prevent and manage specific complications of withdrawal from alcohol
- to prevent Wernicke-Korsakoff syndrome in people at high-risk who continue to drink alcohol, as well as those undergoing withdrawal
- to reduce craving, prevent relapse and promote abstinence
- to reduce alcohol consumption in specific groups of people who have a high drinking risk level
You can read more guidance in:
- chapter 10 on pharmacological interventions
- chapter 11 on community based medically assisted withdrawal
13.8.4 Harm reduction interventions

A goal of abstinence is usually recommended for people with moderate or severe dependence and practitioners should give people information about the risk of harm associated with their level of alcohol use. If a person understands the recommendation but is not ready or chooses not to consider abstinence or, where appropriate, low risk drinking, this should not be a reason to deny them support from the alcohol treatment service. The practitioner can agree an initial goal of harm reduction with the person and they can regularly review this. For people with severe dependence or complex co-occurring physical and mental health conditions, the practitioner should ultimately encourage a goal of abstinence.

You can read guidance on alcohol use goals in section 4.7 of chapter 4 on assessment and treatment and recovery planning.

You can read guidance on harm reduction in chapter 8.

13.9 Commissioning and contracting community alcohol treatment services

Commissioning and contracting arrangements vary across the UK. These processes play an important role in shaping community alcohol treatment and recovery services.

Where services are integrated alcohol and drug services, service specifications should set out distinct requirements for alcohol treatment and for drug treatment and monitor effectiveness of their delivery. These guidelines focus on service delivery rather than commissioning and contracting but the Office for Health Improvement and Disparities’ Commissioning quality standard (https://www.gov.uk/government/publications/commissioning-quality-standard-alcohol-and-drug-services) provides guidance on commissioning drug and alcohol treatment services. The standard applies to England but some of the content may be useful for other UK nations.