Effectiveness Bank web site Matrix row
Alcohol Research UK web site Society for the Study of Addiction web site Skills Consortium web site. Opens new window  Federation of Drug and Alcohol Professionals web site. Opens a new window
Matrix Row logo Alcohol Matrix Bites row 2: Generic and cross-cutting issues
Prompted by the ‘failure’ of the US Project MATCH trial, pivotal to this row was the re-recognition (cell A2) that treatment is closer to “a culturally appropriate solution to a socially defined problem” than a technical fix to a medical dysfunction. It means interventions only act as solutions because their fit with the culture bequeaths them this power. Moving out from the intervention, to the practitioner, the way they are managed, the organisation in which manager and staff work, and the treatment systems enfolding them all, the matrix exposes the interdependencies between these layers. If these mesh, they generate solutions which make sense to patients and practitioners, delivered in environments and ways which promote optimism and positive change.

If this makes treatment sound like a huge placebo effect, try reframing that, and seeing the ‘placebo effect’ as the major active ingredient. Then you can understand why the supposedly untreated or poorly treated control groups in trials often improve so much that an expertly crafted intervention makes no further difference. But no story is ever complete – and this story may be as incomplete as the ‘technical fix’ paradigm, perhaps resting on exclusion from research of the most needy patients, whom no amount of optimism alone could project into lasting recovery.

Cell A2 Generic factors in the effectiveness of treatment
Is treatment a socially endorsed way to get better, which works because we believe it works? Or have we been misled by studies which exclude the most needy patients? How should we conceive of treatment? A technical fix forged by experts to key in to a specific disorder, or an authoritative-looking offer of concern, hope and understanding to ‘demoralised’ people?

Cell B2 The influence of the practitioner
Ask patients what helped and many highlight not pills or cognitive-behavioural exercises but the practitioner – what they said and how they validated and inspired – yet research commonly seeks to eliminate these influences in order to focus on the intervention. Step back and (in the words of one of the cell’s reviews) you will see that interventions are the trees, but the forest is the client-therapist relationship.

Cell C2 Managing alcohol treatment services
Interventions and practitioners operate in services shaped by leaders. At this level, whole services can be transformed from ‘going through the motions’ to effective client-engagers. Introduces the Manners Matter series on the importance of organised, personal and persistent caring, highlights the critical missing link of staff recruitment, and details the fascinating history of the most controversial issue in alcohol treatment: whether services should insist dependent drinkers try for abstinence.

Cell D2 How the provider organisation influences alcohol treatment
Spotlights the freely available resources of the US NIATx collaboration, helping addiction treatment organisations become receptive to improvements and successfully implement them. Asks what characterises an engaging and effective service, whether these qualities can be engineered, and whether services should gear up for long-term care/aftercare.

Cell E2 Getting the (treatment) system right
With the central reins relaxed, local commissioning has become key to establishing recovery-generating treatment systems with diminished resources. Payment-by-results schemes were intended to lead the way, but do they counter-productively stifle patient-centred practice? Explores the surprising results of a rare randomised trial of service-improvement mechanisms, and finds no simple answer to how many drinkers should be in treatment.