Randomised breathalysing in an inpatient alcohol treatment setting: staff and service users’ perceptions
Pelma McCullagh, Shane Kirwan, Gráinne Donohue, Damien Lanigan, Brian KeoghBackground/aims
Monitoring alcohol use during inpatient treatment is essential for relapse prevention and medication safety. However, there is limited research examining how service users and staff experience randomised breathalysing within addiction units. Therefore, this study aimed to explore perceptions of random alcohol breath testing in an open inpatient alcohol treatment service.
Methods
A qualitative descriptive design was used. Semi-structured interviews were conducted with mental health nursing staff ( n =6) who have experience administering a breathalyser test and service users ( n =5) who had experience receiving a randomised breathalyser test. Interviews were transcribed verbatim and analysed using Braun and Clarke’s six-phase thematic analysis. Ethical approval was obtained, and participants provided written informed consent.
Results
Three themes were identified: safety vs surveillance, the impact of randomised breathalysing, and the therapeutic milieu. Breathalysing was generally viewed as promoting safety, although some service users initially perceived it as surveillance. Participants reported reduced relapse behaviour, improved adherence and greater acceptance of testing over time, which helped to reduce concerns about stigma. Testing was also perceived to support ward cohesion and maintain boundaries, although sensitive implementation was necessary to protect the therapeutic alliance.
Conclusions
Randomised breathalysing was generally experienced as acceptable, clinically useful and supportive of abstinence when delivered within a person-centred framework. Clear communication, transparency and supportive nurse-service user relationships were critical in preventing perceptions of coercion. Findings highlight the importance of monitoring approaches that maintain safety while preserving therapeutic trust.
Implications for practice
Randomised breathalysing may be a useful relapse-prevention strategy in inpatient settings when integrated sensitively into routine care. Training in communication and stigma-aware practice is essential for effective implementation.