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Title and link for copying Comment/query to editor Drug Matrix Alcohol Matrix

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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Alcohol Matrix cell E3: Treatment systems; Medical treatment

S Workplace culture key to broadening treatment opportunities (1980). Commissioners are encouraged to make every welfare, medical and social service contact in their area an opportunity to tackle problem drinking and its consequences, but these influential English studies showed that training will not substantially engage staff in this work unless trainees feel drinking is a legitimate priority in their work environments.

K Reports on treatment in England rise concerns over referral numbers (Public Health England, 2014). The last report on the alcohol treatment caseload in England before the reports combined alcohol and drugs gives cause for concern over low numbers referred by GPs and emergency departments relative to their potential. From the latest combined report (Public Health England, 2016) it seems there remains at least as much reason for concern, with 9,952 alcohol-only clients (just over one a year per practice) coming via GPs and 695 via emergency departments.

K Missed opportunities to prevent deaths from alcohol-related liver disease in UK (National Confidential Enquiry into Patient Outcome and Death, 2013). Based on 594 relevant deaths in the first half of 2011 identified by hospitals in the UK other than in Scotland. Most patients had recently attended hospital but there was a failure to screen adequately for harmful drinking, and even when this was identified, patients were not referred for support. See also an in-depth analysis (2012) revealing missed opportunities to prevent alcohol-related deaths in 2003 in the Glasgow region.

K Hospital alcohol teams spreading but underpowered (Public Health England, 2014). Survey documents the spread of alcohol services to all but a few hospitals in England but under a quarter took the form of multidisciplinary teams or could implement the assertive outreach recommended for the most severely and multiply affected patients. Recommends the types of services which should be commissioned in different categories of hospitals.

K Case management links detoxification to treatment (2006). Siting case managers at detoxification services transformed them in to gateways to longer term treatment. The managers targeted patients with a history of multiple detoxifications, motivating them to complete the process and arranging support and follow-on treatment. The initiative was part of a broader ‘recovery revolution’ in Philadelphia. The link is to the Effectiveness Bank analysis; the original article is also freely available. Discussion in bite’s Highlighted study section.

K Don’t assume – find out which service features relate to better outcomes (2009). That’s what the US health service for former military personnel did by testing the relationship between candidate quality indicators and the degree of remission in problem drinking. The strongest indicator of which agencies had the best average outcomes was the proportion of their patients who attended at least three times in the first month of treatment. Discussion in bite’s Issues section.

K Dual diagnosis provision in England ([UK] Care Services Improvement Partnership, 2008). First national assessment for England of progress towards implementing the good practice set out by government in 2002.

K Integrated dual diagnosis teams generate extra improvements (2006). Rare (partly) randomised trial of truly integrated substance use and mental health care for severely mentally ill problem substance users found these arrangements reduced the frequency of psychiatric and legal crises. Related review and guidance below.

R Weak evidence for integrating addiction and mental health treatment (2013). Synthesis of research finds some evidence that treatment which integrates substance use and mental health strands improves psychiatric symptoms and (in residential settings) drinking more than non-integrated care, but none of the slight advantages approached statistical significance. See also Effectiveness Bank hot topic on ‘dual diagnosis’. Related guidance below. Discussion in bite’s Issues section.

R Pay for performance systems an evidential leap in the dark (2011). Overview of reviews on financial incentives for healthcare professionals in general could find no evaluations which reported on patient outcomes. Also conducted under rigorous Cochrane procedures, a similar review (2011) but of individual studies found “insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care”. A review (2014) specific to drug and alcohol treatment could find “no peer-reviewed evidence that [pay-for-performance] ... improves client outcomes post-treatment”.

G Organisation and procurement of treatment and brief intervention services ([UK] National Institute for Health and Care Excellence, 2011). From Britain’s health service standard-setting authority, guidance for commissioners on how to organise and procure services in an area which implement national clinical guidance and satisfy policy requirements.

G NICE alcohol use disorders treatment and care pathways ([UK] National Institute for Health and Care Excellence, accessed 2017). From Britain’s official health advisory body, care pathways and associated resources and guidance relating to the prevention, diagnosis and management of alcohol-related disorders. See also related presentation (Public Health England, 2010) and earlier guidance ([UK] Department of Health, 2009) on alcohol treatment pathways.

G Integrated care for drug or alcohol users in Scotland (Report Produced for the Scottish Advisory Committee on Drug Misuse, 2008). Treatment system guidance including care pathways and dual diagnosis.

G Expert advice on commissioning drug and alcohol treatment ([UK] Joint Commissioning Panel for Mental Health, 2013). Co-chaired by the Royal College of General Practitioners and the Royal College of Psychiatrists, a collaboration of leading organisations and individuals with an interest in mental health service commissioning offers practical advice on how and why to commission effective treatment services. Discussion in bite’s Where should I start? and Issues sections.

G Alcohol primary care service framework ([UK] Primary Care Commissioning, 2009). Guidance for commissioning and resourcing primary care practices to treat hazardous, harmful and dependent drinkers.

G NICE advises against specialist ‘dual diagnosis’ services ([UK] National Institute for Health and Care Excellence, 2016). The UK’s official health intervention assessors says that rather than creating specialist ‘dual diagnosis’ services, health and social care (including substance misuse) services should adapt to mentally ill substance users, and their care should be led by the mental health service. Another NICE guideline has dealt specifically with psychosis and coexisting substance use problems. See also earlier guidance ([UK] Department of Health, 2002). Related review above. Discussion in bite’s Issues section.

G What UK specialist addiction doctors should do and be able to do ([UK] Public Health England, Royal College of Psychiatrists and Royal College of General Practitioners, 2014). Guidance for commissioners and others from body overseeing addiction treatment in England and from UK professional bodies on the part addiction specialists are expected to play in promoting recovery and the importance of retaining their expertise in the sector.

G How to assess the performance of specialist doctors ([US] American Society of Addiction Medicine, 2014). Criteria designed to be used as the basis for local reimbursement and quality control systems which need to evaluate performance against the standards ([US] American Society of Addiction Medicine, 2014) expected of specialist addiction physicians. Discussion in bite’s Issues section.

more This search retrieves all relevant analyses.
For subtopics go to the subject search page and hot topics on evidence-based commissioning and ‘dual diagnosis’.

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