Implementing and delivering personalised budgets for drug and alcohol users: A narrative systematic review

Personalised budgets have historically been provided to groups of people with varying long-term health and social care needs. Since 2010, there has been increasing interest in providing personal budgets (PBs) to individuals with a history of drug and alcohol use in the UK, reflecting the policy and practice shift towards whole person recovery from substance use. However, information on implementing, delivering, and receiving such initiatives with this group is limited. This systematic review was conducted to identify and collate the existing experiences of providing personalised budgets to drug and alcohol users. Between March and April 2017, we searched six electronic and 11 grey literature databases for English language studies published between 1990 and April 2017 which described the implementation and delivery of personalised budget initiatives with drug and alcohol users. Search results (n = 6,749) were screened against inclusion and exclusion criteria; six records met the inclusion criteria. Across the studies, staff reported specific moral, ethical, and practical issues which affected the implementation and delivery of personalised budgets to drug and alcohol users. Staff working with drug and alcohol users with PBs reported greater job satisfaction due to having greater flexibility and autonomy but they had increased workloads and additional responsibilities beyond their remit and training. Drug and alcohol users' experiences of receiving personalised budgets included varying levels of awareness, knowledge, and control of their budgets, and difficulties in understanding what the budgets could be used for. Nevertheless, personalised budgets had been used to purchase various services and items beyond traditional drug and alcohol treatment. Outcomes for drug and alcohol users included reduced drug use, improved relationships, improved mental and physical well-being, and better daily structure. Although the review suggests that providing personalised budgets to drug and alcohol users presents unique implementation and delivery challenges, these were not insurmountable.