Self-Neglect and Alcohol and Substance Misuse -7 Minute Briefing

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This briefing is part of a series on self-neglect. Each briefing should be read alongside your Safeguarding Adults Board multi-agency policy, procedures, and practice guidance.

Overview

The Issue

  • Self-neglect can impact on an adult’s wellbeing but the cause of this is not directly a result of physical or mental impairment or illness but arises from acts of their own, such as drug and alcohol misuse and risks associated with this.
  • Attachment to their substance of choice and prioritising this above all else, can impact on their relationship with others.
  • Definition of addiction is the loss of the ability to make choices.  The Latin meaning for addiction implies enslavement.

Links to Abuse and Neglect

  • Increased risk of deterioration in physical and mental health.
  • Risk of overdose or contaminated substances if drugs purchased on the street.
  • Risk of engaging in criminal activity to fund drug or alcohol use.
  • Increased risk of violence from others.
  • Exploitation by others, including sexual exploitation.
  • Increased risk of domestic abuse.
  • Increased risk of suicide or misadventure.
  • Financial difficulties can occur due to expenditure on drugs/alcohol resulting in debts and inability to pay for basic needs.
  • Increased risk of homelessness if unable to adhere to tenancy agreements.
  • Emotional or psychological harm due to increased social isolation.

A Multi-Agency Response

Self-neglect cases involving drug and alcohol misuse require a multi-agency response, whether this is under safeguarding adults’ procedures or as part of multi-disciplinary working more generally.  There needs to be a clear understanding of the person’s needs as a whole (not just in relation to their substance misuse).  A multi-agency approach often works well, with a core group of professionals established to closely monitor risks and the plans to manage risks.

Mental Capacity

Learning from Safeguarding Adults Reviews (SARs) involving alcohol and substance misuse often focuses upon the lack of practical application of the Mental Capacity Act. Understanding the mental capacity of the person is crucial to managing risks associated with drug and alcohol misuse.  This will often require a Mental Capacity Assessment. 

Practitioners should ensure that the risks around a particular decision are clearly and honestly explained to allow the person to make an informed choice. This might involve telling someone that they are putting their life at risk.  Learning from cases has also highlighted the need to consider executive functioning – a person’s ability to implement a decision they have made.

A group of people with a person pointing at a graphKey Learning

Key Points to Consider

  • Alcohol and drug misuse can sometimes play a significant role in the lives of adults with care and support needs.
  • Alcohol is a causal factor in more than 60 medical conditions (Alcohol Change UK).
  • Whilst domestic abuse can be associated with drug and alcohol misuse there could also be other underlying issues for example controlling and coercive behaviour, the normalisation of abuse and social isolation etc.
  • Learning from alcohol related Safeguarding Adults Reviews identified 45% had self-neglect as a type of abuse. In 25% of these the principal focus was on a person with alcohol related concerns.

Engagement

  • Implementing change can be difficult due to other risks associated with drug and alcohol.
  • Peer groups can impact on a person’s engagement with services.
  • Non-engagement with services may result in increased risks associated with substance misuse e.g. the type of substance used, quantity of substance, how substance is taken.  
  • It is widely recognised that cases involving those who misuse drugs and alcohol must often be dealt with outside usual prescribed timescales of the safeguarding adults processes.
  • Professionals must work to forge relationships with individuals to gain their trust and confidence – consider key worker(s) / advocacy.
  • Several attempts at engagement may be necessary before an individual begins to engage. It is important not to sever contact with an individual who is displaying self-neglect/risk taking behaviour based on their refusal to engage with services, regardless of their mental capacity.
  • Consider Carer Assessments

Know when to seek Support/ Escalate

Where concerns persist and/or risks increase, there may be a need to seek additional advice and support.

This might be from legal services, senior managers and/or safeguarding/MCA specialists.

Missing Persons

Consideration should always be given as to whether the person is missing, at risk of or has been missing in the past. Those with Substance Misuse and Alcohol issues or those who are homeless have increased vulnerability – is their history always considered as much as it should be and are there cross boundary conversations which promote due diligence around safeguarding? Refer to your own local protocols around Missing Adults and the appropriate response pathway.

Questions for you to Consider

  • Do you understand the causes of the person’s addiction to alcohol and drug use and their lived experience?
  • Have you communicated and shared information with professionals in other agencies, in particular those working in drug and alcohol services and safeguarding specialists.
  • Are you clear about any informal carer arrangements? Have informal carers been offered support in their caring role?
  • Have you assessed the person’s mental capacity in relation to the risks they are taking? Has this been done recently, and has it been formally recorded?
  • Have there been full and frank conversations with the person about the impact drug and alcohol misuse is having on their own wellbeing?
  • Do they fully understand the steps involved to access the support they need?

Links to further Information

Produced by the North East SAR Champions

v2 June 2025