Introduction

We know that dependence on, and inappropriate use of, alcohol is now widely seen as a global social problem. It is closely associated with crime and violence. It is a major contributory factor to road traffic and other accidents, resulting in countless deaths and serious injuries. It creates massive costs in terms of both personal and familial unhappiness and distress, it creates economic inefficiency and it imposes a massive burden on healthcare through reducing life expectancy and increasing morbidity (Heather et al, 2001). For some discussants, its costs far outweigh those associated with the use of illegal drugs, yet still it is essentially conceived of and treated in the same old individualised terms that would have been familiar in societies much more than a century ago. In the United Kingdom (UK), radical social policies in response to tobacco smoking have resulted in unprecedented reductions in the proportion of people smoking and the damage done. Yet over the same period, we have seen public policies that have increased access to alcohol and rising concerns about serious increases in alcohol-related problems.

At the same time, the dominant model of treatment for alcohol problems continues to be the ‘12-step’ model with its talk of reliance on a ‘higher power’. There can be few social or medical issues in the West in the 21st century that are still framed in such individualised, quasi theological or metaphysical terms. This is a wake-up call for a radical rethink of alcohol and alcohol dependence, building on more recent understandings. That is why this book is so important, because it offers a space to develop such a discussion, which determinedly seeks to move from medicalised, individual, to more social understandings, particularly in relation to a group who have historically received different and inferior treatment in relation to alcohol use – women.

In addition, if we are seeking new and different understandings that may be helpful in reconceiving alcohol problems and the responses made to them, then a particularly fertile field is likely to be the lived experience and experiential knowledge of service users themselves. For this reason, this chapter is concerned with ideas that have been developed by service user movements, particularly the movements of disabled people and mental health service users/survivors.