Constructing alcohol screening and counselling: the attitudes of social work professionals and their clients

Background and Aims: Social work professionals frequently encounter clients with alcohol-related problems and are well-placed to play a central role in early identification. However, social work professionals often do not feel well-equipped for work with alcohol-related problems and perceive a lack of role confidence, knowledge and skills in this aspect of their practice. This may depend on the attitudes toward alcohol screening and counselling. This study presents a qualitative analysis of attitudes toward alcohol screening and counselling and is unique in its inclusion of attitudes from both social work professionals and their clients. The analytical focus is on the ways the two parties constructed alcohol screening and counselling in their attitudes, and whether professionals and clients did this the same way or whether there were differences between them.

Methods: Social work professionals (N=14) and their clients (N=14) were asked to comment on eight statements concerning alcohol screening and counselling. The qualitative attitude approach was used to explore attitudes as argumentative phenomena; attitudes consist of a stand people take and justifications people use to support the taken stand. The analysis was performed in two stages. First, classifying analysis was used to identify different types of stands and justifications towards each statement. Then, interpretative analysis brought the categories into a conceptual dialogue with relevant theoretical concepts and discussions. Taking a stand is an evaluative act that contextualises and constructs an attitude object in a particular way. Here, the primary objective is to explore how alcohol screening and counselling were constructed as attitude objects.

Results: Both professionals and clients constructed alcohol screening and counselling in three different ways. (1) Self-evident parts of social work. This construction was based on the shared understanding that alcohol screening and counselling belong to social work. Besides, the professionals associated screening and counselling closely with the client’s fulfilment of responsibilities and the ability to function well. (2) Tools for discussing sensitive topics. This construction highlights the possibility of a different understanding of the aims of alcohol screening and counselling (e.g. a professional interprets screening as a routine assessment, whereas a client interprets it as doubt about his/her ability to control alcohol consumption). The clients connected screening and counselling closely with privacy-threatening interaction. (3) Useful tools for motivation. Here, both clients and professionals agreed that screening and counselling should be built on motivational interaction that is sensible, client-oriented and neutral.

Conclusions: The professionals and their clients had fairly similar ways of constructing alcohol screening and counselling. However, the professionals focused more on the clients’ responsibilities and well-being, whereas the clients placed the same emphasis on interaction and discussion about privacy-threatening topics. The results shed light on different versions of constructing alcohol screening and counselling. The findings may help clients and professionals understand each other better and can be used to improve acceptability of alcohol screening and counselling.