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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 C3: Management/supervision; Medical treatment

S Trainingineffective without post-training support and experience (1980). English study of trainees mainly from specialist alcohol services found that without either high base levels of experience in working with problem drinkers support from experienced colleagues, or the opportunity to gain further support and experience, six months after a week-long residential course the trainees were barely more committed to and confident about working with drinkers than they had been before the course.

S Listening management transforms alcohol clinic (1970). Remarkable series of US studies from the late 1950s proved that an alcohol clinic’s intake and attendance can be transformed by a management which listened to the patients and systematically ensured they were treated with warmth and respect. More in this slide presentation and video, which end by focusing on the studies.

S Some counsellors inspire retention, others rapid drop-out (1976). Turning the spotlight on recruitment, at a US alcohol treatment clinic trainee counsellors differed greatly in patient retention. Neither experience of alcoholism treatment nor further on-the-job training greatly affected performance.

S Interpersonal functioning can be measured (1981). US study in a hospital alcohol clinic used a simple written method to score the therapy-related social skills of counsellors, which were strongly related to their patients’ post-treatment relapse.

K How to identify rapport- and retention- generating counsellors (2002). Replication of above seminal study at a Finnish outpatient alcohol clinic used the same system to identify which counsellors would generate the mutual client/counsellor rapport associated with retention.

K Receptive trainees make training work (2004). US study at medical centre addictions programme suggests that recruiting the ‘right’ clinicians who have not been trained in motivational interviewing would be better than choosing the ‘wrong’ ones who have been, and the former gain most from training.

K Stepping up intensity of care does not help (1999). From Canada the first evaluation of ‘stepped care’ for heavy drinkers found no added benefit from offering further treatment only to those who did not respond to initial therapy, but the study was not a definitive refutation of this cost-saving strategy.

K Group medication management extends treatment to more patients (2013). Free source at time of writing. Common in psychosocial therapy, a US substance use treatment centre extended the group format to initiating and managing medication-based treatment for alcohol dependence. Result was to slash waiting lists and generate a threefold increase in numbers on medication due to more patients starting the treatments.

R Strategies for integrating evidence into practice ([Australian] National Centre for Education and Training on Addiction, 2008). Lessons from health promotion and medical care on how to improve addiction treatment practice by introducing research-based innovations, including common medical education and training strategies.

R Worth training clinicians in motivational interviewing (2013). Free source at time of writing. Across medical care, including treatment and brief intervention for drinking problems, clinicians who adopt a motivational interviewing style achieve significantly better outcomes than those who offer usual care, and training clinicians in motivational interviewing does change their behaviour in the direction of improved motivational skills.

G What UK doctors should do and be able to do ([UK] Royal College of Psychiatrists and Royal College of General Practitioners, 2012). Guidance from UK professional associations for GPs and for psychiatrists on the competencies, training and qualifications expected of doctors involved in caring for substance users, from generalists such as doctors in emergency departments, to general practitioners and addiction specialists. See also this guide ([UK] Public Health England, Royal College of Psychiatrists and Royal College of General Practitioners, 2014) for more on the roles and competencies expected of doctors specialising in addiction.

G Staff development toolkit ([UK] National Treatment Agency for Substance Misuse, 2003).

G How to assess the performance of specialist doctors ([US] American Society of Addiction Medicine, 2014). Performance measures designed to evaluate performance against standards of care for specialist addiction physicians ([US] American Society of Addiction Medicine, 2014).

G NICE advises stepped care ([UK] National Institute for Health and Clinical Excellence, 2011). Endorses trying the least intensive potentially appropriate treatment and only ‘stepping up’ to more intensive and costly approaches if the initial attempt does not work.

G Models of care for alcohol misusers ([UK] Department of Health and National Treatment Agency for Substance Misuse, 2006). Includes (from page 74) quality criteria for managing alcohol services.

G Effective substance use service for clients with mental health problems ([Australian] National Drug and Alcohol Research Centre, 2016). Funded by the Australian government. Though aimed at frontline substance use treatment clinicians, also acts as a guide to what managers could so to make their service more effective at identifying and responding to the mental illnesses common among their clients.

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