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Supported by  Alcohol Research UK web site Society for the Study of Addiction web site Skills Consortium web site. Opens new window
Matrix Row logo Alcohol Treatment Matrix row 5: Safeguarding the community
Row 5 is about treatment intended to safeguard the community. A common theme is the contradiction between treatment centred on the patient’s welfare, yet offered within a system which prioritises the wider community, and sees the patient essentially as a threat. That divide is regularly and productively bridged, but not without difficulty, and sometimes not well enough for research to discern the intended benefits.


Cell A5 Treatment not for the patient, but for the community
A core contradiction is illustrated by the cover of guidance from the World Health Organization on treating problem-drinking prisoners. Its subtitle, An opportunity for intervention, is belied by the barbed wire-topped wall. How could such an environment host productive intervention? Yet those same walls create the ‘dry space’ in which change seems possible.

Cell B5 What if the therapist … is also the jailer?
Title poses the dilemma for treatment staff who may be (seen as) allied with authorities which control or punish the ‘client’, or threaten to remove their children. Explores whether in these situations exceptional abilities are needed to forge therapeutic relationships, and invites you to ‘stress test’ a proposed universal rule: The trickier the situation, the more the worker matters.

Cell C5 The most difficult management task in the addictions field?
Asked of managing ‘wet’ centres where street drinkers can continue to drink, the title question could have been asked of managing treatment generally when controlling the ‘patient’ is high on the agenda. Discusses a rare trial of the influential ‘risk-need-responsivity’ model, and asks whether cognitive-behavioural approaches are the way to go.

Cell D5 When it comes to treatment for offenders, is small beautiful?
Explores the influence of an organisation’s structures and processes on how well it delivers treatment in criminal justice and allied settings. In the context of a market which drives treatment organisations to grow ever bigger, on the basis of US research we ask, “Is small beautiful?”. Coercive contexts enable the imposition of treatment contacts, but do they also undermine the quality of those contacts?

Cell E5 The right ingredients for criminal justice/health collaboration?
Last cell explores systems for treating problem drinking offenders and parents. We invite you to benchmark your own systems against a review’s key ingredients for partnership working, to ponder why drinking is prominent in sending thousands to prison, yet not in services provided in prison, and to question how far collaboration should go: do ‘shared goals’ in practice become those of the criminal justice system?