Beyond the Bottle: A digital lifeline, trauma, stigma, and the team changing the face of addiction
The eCIWA tool
CIWA stands for the Clinical Institute Withdrawal Assessment for Alcohol. It assesses how severe a person's alcohol withdrawal is, combining what the clinician observes with what the patient reports. Withdrawal can be dangerous and in some cases life-threatening, so assessing it properly and consistently matters a great deal.
The assessment itself is not new. What is new is that it is now electronic, known locally as eCIWA, and available across the whole hospital. It went live to coincide with Alcohol Awareness Week, after several years of development.
“A paper chart can be mislaid or take time to find in a set of notes. The electronic version is always there, for whoever is caring for the patient, wherever they are in the hospital.”
The assessment now travels with the patient between wards, so care continues without information being lost. Neighbouring hospitals do not yet have a digital version, so a copy is printed if a patient needs to be transferred.
It also lets the Trust see how consistently the assessment is being used across wards and identify where further training may be needed. Ultimately, it is about people receiving the standard of care they should be able to expect.
Rolling it out was a substantial piece of work. Every ward in the hospital had to be trained and moved from paper to the digital system.
Who the team supports
The Assertive Outreach Alcohol Team works with people who experience high-intensity use of hospital services. That is rarely because of alcohol alone.
“It is rarely just about the drinking. It is often about how people experience life, their relationships and the stigma they face.”
For most, alcohol sits within a wider picture of severe multiple disadvantage. That means several serious problems at once, typically mental ill health and housing difficulties alongside alcohol or other drug use. Health inequalities run through all of it.
People come to the team's attention in three ways: a daily report of admissions where alcohol features; electronic alcohol screening using eAUDIT, an electronic version of the Alcohol Use Disorders Identification Test, which means everyone admitted to hospital is asked about their alcohol use; and notification of anyone prescribed medication for alcohol withdrawal.
From there, the team reviews anyone who has attended five or more times over a rolling twelve months. That is the threshold the team uses to identify high-intensity use and to decide who the outreach service works with.
“It is a simple service to describe and a hard one to do well. It comes down to having the right people, with the right skills and the right approach, and giving them the time to work alongside someone at a pace set by that person and their needs.”
The team works with partner agencies to support people in their own communities. That is often what makes the difference between someone coming back to hospital and someone staying well at home.
What still needs to change
Rates of liver disease in parts of Dorset are above the national average. A significant number of people do not engage with addiction services at all. Some need more than a brief conversation and instead move between mental health services, the criminal justice system, emergency departments and social care.
“Where is their voice in all of this? Although Dorset has a positive track record with patient and public involvement, there is so much services can learn by listening to those with lived and living experience and co-producing services with patients.”
Community-based treatment is valuable and works well for many people. What is missing is a responsive service that can hold the people with the most complex needs, working alongside existing services rather than separately from them. Closing that gap means services working far more closely together, and it means breaking down the stigma this group experiences every day.
Stigma and health inequalities
“Reducing stigma has to be a major priority, because when all is said and done, stigma kills.”
Someone who is dependent on alcohol and also has a mental health condition is likely to die younger and is likely to find it harder to get access to primary care.
Services need to become trauma-informed, and that means more than adopting the term. It requires a real understanding of trauma and its effects and a change in culture and mindset across services.
Breaking the habit, breaking the shame
Lucy also chatted to John, who is a former patient of the Assertive Outreach Alcohol Team. Here's what John told us.
I hit a turning point when I was admitted to Poole Hospital (now UHD) after frequent hospitalisations for alcohol-related heart and breathing complications. I desperately wanted to stop drinking but couldn't sustain it on my own. That changed when I met the Assertive Outreach team.
Their approach was entirely non-judgmental, blunt, and practical. Instead of lecturing me, their support focused on holistic recovery and daily habit-breaking, even suggesting I rearrange my furniture to disrupt physical routines, like sitting in my usual drinking chair.
I met them as an inpatient, but their vital reassurance followed me home for a full 12 months post-discharge. I stopped drinking the day I left and have remained sober ever since. They also seamlessly transitioned me into the local drug and alcohol service, even physically accompanying me to my first appointment.
Looking back, a major hurdle was simply not knowing this specialist service existed. Back then, Bournemouth and Poole hospitals hadn't yet merged into UHD, making the service heavily siloed; you had to already be deeply entrenched 'in the system' to find them. While the team now operates across the entire unified Trust, it highlights a lasting need for better public awareness.
Beyond navigating the system, the deepest barrier was shame. With my professional background, I felt an overwhelming guilt that ‘I should have known better.' I isolated myself, believing my flaw was uniquely worse than anyone else's.
The turning point came when the service provided a safe space to open up. Entering treatment helped me realise I wasn't alone, dismantling the isolation of addiction. Overcoming that internal stigma is an immense challenge, but it is precisely where the outreach team excelled. Today, progress is clearly being made, Emergency Department nurses can now automatically refer patients straight to the service, making life-saving intervention much more integrated.
Where to find help
John's biggest hurdle was not knowing the service existed. If you are worried about your own drinking, or someone else's, you do not need to wait until things reach a crisis.
In Bournemouth, Christchurch and Poole, With You provides free and confidential drug and alcohol support for adults.
In the Dorset Council area, REACH provides free and confidential drug and alcohol support.
Your GP can also refer you, and NHS 111 can help if you are unsure where to start.
If you are admitted to hospital at University Hospitals Dorset, you can ask any member of staff to refer you to the addiction care and treatment service if you have not already been referred.
