Most staff and service users who transitioned to remote substance use support during the COVID-19 pandemic expressed a clear preference to retain remote service options alongside traditional in-person provision, according to a qualitative evaluation conducted in an English city. The findings, published as part of an investigation into post-pandemic service models, indicate that while remote delivery improved the service experience for many clients, it remains fundamentally inappropriate for certain individuals and cannot effectively accommodate every aspect of drug and alcohol support. Instead of replacing face-to-face services entirely, the qualitative evidence points toward a balanced hybrid model where remote tools complement established direct clinical and community interventions.

The investigation emerged in response to urgent global challenges, as dependence on alcohol and other substances contributes significantly to poor health outcomes worldwide. Mortality and deaths associated with substance use escalated following the onset of the COVID-19 pandemic, rendering the provision of effective, accessible recovery support increasingly critical. As one of the earliest studies dedicated to examining this remote transition, the current project forms an integral component of a wider evaluation into recovery service adaptations.

To examine the practical complexities of this service transformation, the research team deployed a multi-method qualitative framework that utilized diverse data collection approaches across the participant cohort. The investigative methods comprised in-depth interviews, focus groups, and text-based asynchronous interviews, complemented by qualitative tools including digital timelines and creative vignettes. The collected qualitative material was systematically evaluated using framework analysis, which integrated a specific focus on service users’ out-of-pocket expenses to provide empirical data for an accompanying health economic evaluation of remote substance use care.

The empirical study sample was drawn from an English city and comprised 36 staff members and 28 drug and alcohol service users, each of whom participated in one or more of the qualitative data collection exercises. A notable feature of the study’s methodological design was the central involvement of a dedicated Public Involvement group, which included individuals possessing lived experience of substance use. This stakeholder group actively supported both the initial study design and the subsequent analytical phases. Furthermore, preliminary findings were systematically shared back with participating staff and service users, allowing their direct reflections and critical input to shape and refine the structure of the final analysis.

The core findings of the evaluation were categorized under two primary analytical themes, the first of which was identified as Finding the Right Balance. Within this theme, the researchers contrasted positive elements that enhanced the care experience for some individuals with substantial operational and clinical drawbacks.

The second primary theme, titled Resourcing Hybrid, articulated the distinct resource demands that both healthcare providers and service users face when maintaining dual delivery pathways. For treatment provider organisations, operating an effective hybrid delivery system necessitates dedicated capital and logistical investments, such as designing and equipping hybrid-optimised service hubs capable of managing blended care operations.

Reflecting on these findings, the authors concluded that modern drug and alcohol support services should integrate remote options for service users whenever remote delivery is clinically safe and likely to enhance overall care. To deliver an effective hybrid offer, service providers must be prepared to invest in targeted staff training and organizational resources, ensuring that treatment planning remains anchored to individual client preferences, personal health and wellbeing, financial resources, and direct engagement capacity.

Subject of Research: Remote and hybrid models in drug and alcohol recovery services

Article Title: Finding the right balance: a framework analysis of staff and service user experiences of moving to remote drug and alcohol support during the COVID-19 pandemic

Article References: Brown, K. E., MA, N. L., Fakoya, O., Freethy, I., Bontoft, C., Garcia-Iglesias, J., MA, A. W., Wagner, A. P., Miners, L., Jackson, J., Dennington-Price, A., Simmons, I., Cowe, M., Greco, H.-A., Newby, K., Howlett, N., Wellsted, D., Bartington, S., Breslin, G., … Wills, W. (2026). Finding the right balance: a framework analysis of staff and service user experiences of moving to remote drug and alcohol support during the COVID-19 pandemic. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15844-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15844-w

Keywords: substance use recovery, remote health services, drug and alcohol support, hybrid service delivery, telehealth, qualitative framework analysis, service user experiences, healthcare staff perspectives, public involvement, COVID-19 pandemic, digital health access, health economic evaluation, out-of-pocket expenses, creative vignettes, digital timelines, asynchronous interviews, focus groups, service user wellbeing