A realist inspired evaluation of a Salvation Army community programme for people with problematic alcohol use and cognitive impairment

Abstract

People with experience of problematic alcohol use (PAU), cognitive impairment and alcohol-related brain damage (ARBD) seek help at Salvation Army community programmes. Realist evaluation, which inspired this research, encourages exploration of people’s reasoning when resources are introduced into their lives. Realists anticipate varying intervention outcomes, expected and unexpected. Research findings may challenge but also provide evidence to create or strengthen interventions. This research sought evidence about ‘what works for which people with PAU, cognitive impairment and ARBD in what circumstances in Salvation Army community programmes, how and why?’ Findings related to micro-actions and outcomes, small steps rather than giant leaps, creating opportunities for salutogenic flow in the midst of rippling complexities associated with PAU and cognitive impairment. Flow arose in the non-judgemental intervention context where people repeatedly accessed basic need resources. Their generalised resistance resources strengthened and recovery-orientated sense of coherence grew. As recovery resources to others, peer credence was given to those who had “worn the T-shirt”. The Salvation Army crucially provided the physical and social context where individuals seeking help could access core resources, provided by peers, staff and volunteers whose approach extoled, ‘Three strikes and you’re welcome’. People were offered realistic hope, with acknowledgement that though life’s whirlpools could draw them back into PAU’s depths, others could share experiences offering encouragement towards sustained recovery. Hope extended to people whose recovery seemed remote, their aspirations focusing on avoiding withdrawals and maintaining alcohol intake. Their hopes received daily fulfilment. Alcohol consumption continued through individual and peer group resourcefulness. Basic needs were met by staff, volunteers and peers offering stigma-free affirmation of worth. While not reaching the ‘ease’ end of the salutogenic continuum, the pull of the ‘dis-ease’ end precipice appeared held back. Supported by people to whom they mattered, those facing that precipice did not do so in isolation.