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Understanding people's experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study

Lookup NU author(s): Dr Katherine Jackson, Professor Eileen KanerORCiD, Professor Barbara Hanratty, Dr Eilish Gilvarry, Professor Amy O'DonnellORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. Background and Aims: Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice. Design: Semi-structured qualitative interviews underpinned by the methodology of interpretive description. Setting: North East and North Cumbria, UK. Participants: Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score). Measurements: Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression. Findings: Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) ‘lack of recognition’ of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having ‘nowhere to go’ to access relevant treatment and care and (3) ‘supporting relational autonomy’ as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals’ differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation. Conclusions: Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship between alcohol use and depression and formal care provision that does not acknowledge people's social and economic context, including their intrinsic need for relational support, may contribute to distress and limit their capacity to get well.

Publication metadata

Author(s): Jackson K, Kaner E, Hanratty B, Gilvarry E, Yardley L, O'Donnell A

Publication type: Article

Publication status: Published

Journal: Addiction

Year: 2024

Volume: 119

Issue: 2

Pages: 268-280

Print publication date: 01/02/2024

Online publication date: 01/10/2023

Acceptance date: 23/08/2023

Date deposited: 26/10/2023

ISSN (print): 0965-2140

ISSN (electronic): 1360-0443

Publisher: John Wiley and Sons Inc.


DOI: 10.1111/add.16350


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Funder referenceFunder name
National Institute for Health and Care Research (NIHR) Advanced Fellowship