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Matrix Row logo Alcohol Matrix row 3: Medical treatment
Time to consolidate the lessons of the course’s last five instalments, all on the treatment of alcohol dependence in a medical context or involving medical care. The centrality of medications most clearly marks an intervention as medical. But for this ‘disease’, medications do not have reliable, mechanical effect. The evidence challenges us to place drugs in the context of the practitioners delivering them, managements and organisations which shape the therapeutic environment, and the local treatment system which provides preparatory, supportive and follow-on care.

Cell A3 Medical interventions
Research shows medications are generally minor aids to recovery driven by the patient’s impetus to overcome their drink problem and influenced by their life circumstances and resources. Invites you to consider whether NICE was right to relegate disulfiram to a second-line option, and whether the placebo effect is pharmacotherapy’s main active ingredient.

Cell B3 The influence of the practitioner
Moving on from the medications, this bite looks at the clinicians who prescribe them. Argues that bedside manner is not just a conduit for treatment; to a large extent, it is the treatment. Ends by inviting you to weigh the evidence on what makes for an effective clinician.

Cell C3 Managing alcohol treatment services
Highlights the remarkable transformation brought about in the 1950s by an open-minded management at a Massachusetts clinic. Asks how managers can identify effective clinicians, set guidelines for choosing medications, and whether their services should ‘step up’ to more intensive treatment if initial treatment fails.

Cell D3 How the provider organisation influences treatment
Clinicians deliver interventions in a context which more or less legitimises and supports their work. This cell focuses on that context at the level of the treatment or healthcare organisation, asking whether the quality of a primary care practice affects treatment effectiveness and whether ‘continuous improvement’ is always a good thing.

Cell E3 Getting the (treatment) system right
Moves to the level of commissioning whole treatment systems. Highlights the US trial which transformed detoxification recyclers into typical patients, asks if you agree with an expert group’s vision of what constitutes a good quality alcohol service, and questions whether the UK is making progress on care for mentally ill problem drinkers.