What were we trying to do?

Alcohol Assertive Outreach Treatment (AAOT) is a community, or ‘place-based’ service aimed at a group of people with alcohol dependence who have high levels of unplanned alcohol-related hospital attendance and who struggle to engage with traditional health and other services. Typically, people in this group have multiple long-term conditions and experience high levels of socioeconomic deprivation, so AAOT offers a way to reduce the high levels of morbidity and mortality they experience, through increasing engagement in treatment.

 

The overall aim of this study was to evaluate the implementation of the AAOT model to create a framework explaining the barriers and enablers to its implementation, but also its sustainability and potential for wider use. This was done by:

 

1. A mixed-methods study using routinely collected clinical AAOT data and semi-structured interviews.  
2. Exploring the longer-term clinical- and cost-effectiveness of AAOT.
3. Developing best practice and sharing the findings with service-users, practitioners and policymakers.

 

 

Why was this important?

Worldwide, alcohol misuse is the biggest factor for death, ill-health and disability among 15-49 year olds. In 2021 in the UK, there were 9,641 alcohol-specific deaths, which was an increase of almost 20% from 2019. Alcohol-related harm costs the NHS £3.5 billion each year, so decreasing harm for patients as well as reducing costs to the NHS are key aims in government policy.

 

 

How did we do it?

We did an evaluation of how and when AAOT services are used and the outcomes before and after AAOT involvement. We also explored the barriers and facilitators of AAOT implementation. This took place over two studies:

 

• Study 1: Analysis of Routine Clinical Data (this was a quantitative, or data-based study)
• Study 2: Analysis of barriers and facilitators to the implementation of AAOT in clinical services (this was a qualitative, or interview-based, study)

 

We assessed the engagement and incorporation of AAOT services into routine care by examining the services in use, which included:

• Assertive outreach services (Big Life in Bolton and Salford, and the High Impact Substance Misuse Team in Salford)
• Structured community alcohol care teams (GMMH Achieve in Salford and Bolton)

 

A PPI advisory panel was set up to generate outcomes and co-develop the interview schedules that were used to gather information about service-user experience. Patient and Public Involvement (PPI) members were integrated into the study team and met with researchers regularly to give feedback on recruitment and research materials, and to provide feedback on the analysis and interpretation of the data that was gathered.

 

 

Who did we work with?

 

Dr Stephen Kaar, Consultant Addictions Psychiatrist in Greater Manchester Mental Health NHS Foundation Trust, was the Principal Investigator (PI) of this project. 

 

We worked with:

• GMMH Achieve (Salford and Bolton)
• Big Life (Salford and Bolton)

 

 

Findings

Research in Manchester and Hull both found that high-quality AAOT led to reduced emergency hospital admissions. In the paper 'Treatment Engagement and Healthcare Utilization Outcomes from a Mixed Methods Study of the Implementation of Alcohol Assertive Outreach in the North West of England', findings showed that:

• there was a reduction in total Emergency Department (ED) attendance of 14.67% in the 12 months after AAOT compared to the 12 months before.
• in the 12 months after AAOT, there was a reduction of 25.21% in unplanned ward admissions.
• there was a 15.13% increase in total bed nights following AAOT - however, this was not statistically significant.

 

 A qualitative evaluation by the University of Hull highlighted the importance of the relationship between the patient and keyworker to deliver effective AAOT. Assertive advocacy (when the key workers repeatedly and persistently advocate for better care for their service users with other services who are involved in their care) was a key feature of successful implementation of AAOT. 

 

Patient and public involvement was a successful element of this project which was underpinned by a partnership between academic experts and experts by experience. Patients and the public were involved in co-facilitating workshops, co-authorship of publications, co-facilitation and presenting at commissioner events and disseminating research findings. 

 

Findings and learning from the project have been shared in over nine regional, one national and one international events over the past two years. An Alcohol Assertive Outreach Toolkit is also in development to support implementing and sustaining high-quality AAOT.

 

In the below Mental Health Implementation Network (MHIN) webinar, experts explored how Alcohol Assertive Outreach Treatment (AAOT) offered a creative and flexible approach to engagement and treating patients who might otherwise be readmitted to an acute hospital.

 

 

 

 

Resources

• Publications
  • Mylonas N, Scoles LH, Priyam A, Butterworth C, Blood S, O'Donnell A, Drummond C, Lovell K, Kaar SJ. (5 May 2025). Treatment Engagement and Healthcare Utilization Outcomes from a Mixed Methods Study of the Implementation of Alcohol Assertive Outreach in the North West of England. Substance Use & Misuse
  • Scoles LH, Mylonas N, Priyam A, Blood S, O'Donnell A, Drummond C, Lovell K, Kaar SJ. (3 Feb 2025). A qualitative exploration of the barriers and facilitators to the implementation of the alcohol assertive outreach model. Alcohol and Alcoholism 
• News story
  • Webinar shares learning on the implementation and evaluation of alcohol assertive outreach treatment (AAOT) in England (3 March 2025)

 

Funding information

This work was funded by the NIHR Mental Health Implementation Network.