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S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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Alcohol Matrix cell A4: Interventions; Psychosocial therapies

S Single session equals extended treatment (1977). For couples at a London alcohol treatment clinic a single 'It's up to you' session led to no worse drinking outcomes than the usual extended treatment of the time. See "The alcohol clinic" on p. 1 of linked PDF file.

S Confrontation provokes resistance (1993). Among US heavy drinkers motivational interviewing's non-confrontational style reduced both resistance and drinking compared to an explicitly challenging approach; click the ‘alternative source’ link in the Findings analysis for a free copy of the original article. See also this review of the positive role of subtle forms of ‘confrontation’ in motivational interviewing.

S Client-centred group therapy works best (1957). Well-controlled study found a Rogerian client-centred approach beneficially changed self-perceptions of alcoholic patients and reduced relapse compared to learning theory or analytic approaches.

K UK trial finds therapies equivalent (2008). Results of largest UK alcohol treatment trial confounded expectations that a motivational approach would best suit unmotivated or hostile clients, and that clients lacking social supports would do best when this was explicitly addressed. Overall, too, neither therapy significantly bettered the other.

K Project MATCH confounds expectations (1999). Landmark US trial designed as a definitive test of matching different types of clients to different therapies instead confirmed the importance of the ‘common factors’ underlying seemingly distinct approaches; for more see book (2002) of the project.

K In relapse prevention, practice makes (more) perfect (1997 and 2000). Practising relapse prevention skills rather than just discussing them boosted confidence and helped newly detoxified Scottish patients stay sober longer.

R All bona fide ‘talking therapies’ work equally well (2008). After combining results from relevant alcohol studies, this ingenious analysis To estimate the relative efficacy of alcohol use disorder treatments, the authors used meta-analysis techniques to aggregate the outcomes of studies which directly compared two bona fide psychological treatments. They faced the problem of how to combine a study where for example treatment A was better than B, with another where A was worse than C. To overcome this they randomly assigned a positive or negative sign to an effect size expressing the magnitude of the difference between any two treatments. Then they estimated how far the distribution of effect sizes conformed to the shape expected if in reality there were no differences. A highly variable distribution would indicate that differences in the effectiveness of the treatments were not due simply to sampling error. A smoother distribution would suggest that differences in effectiveness were at most minor, and that studies which found differences did so largely due to chance variations. found any structured approach grounded in an explicit model as good as any other. We have, it was argued, been looking in the wrong direction for therapy’s active ingredients. See these reviews for similar verdicts on motivational interviewing (Cochrane review, 2011) and cognitive-behavioural therapy (2009).

R Common relationship factors (American Psychological Association, 2011). Introduces reviews based on the understanding that treatment methods are not simply technical interventions, but ways client and therapist relate, so cannot be divorced from the general relationship between client and therapist. From here you can find the component reviews and the overall conclusions reached by the task force.

R Motivational starts to treatment (2005). Findings review discovers that manualised motivational interviewing is not always a positive alternative to more directive approaches.

R Peer-based addiction recovery (2009). Includes chapter on the evidence for AA and allied mutual support networks and treatments based on the same principles and networks. See also this review (2004) of how treatment services can promote mutual aid and this synthesis of studies (1999) of AA-based versus other approaches.

R Some patients get worse (2005). Salutary reminder that after psychosocial therapy up to 15% of clients end up worse than before; some of the reasons are to do with poor therapy including a weak relationship, failing to assess how clients are doing, being confrontational or critical, low or inappropriate expectations, and lack of challenge.

R If patient is in suitable couple, work with both (2011). Problem drinkers in a stable relationship do better when the focus is at least partly shifted to working with the couple to foster sobriety-encouraging interactions.

G NICE guidance on treating problem drinking (NICE, 2011). Britain's official health advisory body recommends overall principles and particular interventions.

G Treatment principles (2006). Based on reviews commissioned by the American Psychological Association; reviews evidence and offers guidance on how to relate to clients and what to do.

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For subtopics go to the subject search page or hot topics on contingency management, residential rehabilitation, 12-step mutual aid, and motivational interviewing.

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