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

Katherine Jackson, Eileen Kaner, Barbara Hanratty, Eilish Gilvarry, Lucy Yardley, Amy O'Donnell*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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.

Original languageEnglish
Pages (from-to)268-280
Number of pages13
Issue number2
Early online date1 Oct 2023
Publication statusPublished - 10 Jan 2024

Bibliographical note

Funding Information:
The ADEPT Study is funded by a National Institute for Health and Care Research (NIHR) Advanced Fellowship (ADEPT: Alcohol use disorder and DEpression Prevention and Treatment, Grant: NIHR300616). The NIHR have not had any role in the design, implementation, analysis, write‐up and/or dissemination of the research. L.Y. is an NIHR Senior Investigator, and her research programme is partly supported by NIHR Applied Research Collaboration (ARC) West and NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation. E.K. is supported by an NIHR Senior Investigator award and is Director of the NIHR Applied Research Collaboration North East and North Cumbria. Thanks to our Study Patient and Public Involvement Group for their ongoing and invaluable input into this research. Finally, we would also like to express our gratitude to the 39 people who took part in the study and to those who helped with study recruitment across the NENC region.

Publisher Copyright:
© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Structured keywords

  • Health and Wellbeing (Psychological Science)


  • Male
  • Humans
  • Female
  • Depression
  • Alcoholism/therapy
  • Relational Autonomy
  • Qualitative Research
  • Social Support


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