Alcohol Treatment Matrix cell C3: Management/supervision; Medical treatment

2020/21 update funded by

Alcohol Change UK web site. Opens new Window

Alcohol Change UK

Previously also funded by

Society for the Study of Addiction web site Society for the Study of Addiction

Developed with

Skills Consortium web site. Opens new window

Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

Drug Treatment Matrix

Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Alcohol Treatment Matrix cell C3 Matrix cell logo

Management/supervision; Medical treatment

Seminal and key studies on the impact of management on medical interventions and treatment for problem drinking in medical settings. Asks how we can identify effective clinicians and effective medications, and highlights the remarkable transformation brought about in the 1950s at a US clinic which few referred patients attended and fewer still engaged with.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S Impact of training depends on workplace support and experience (1980). English study found that if post-training experience in working with problem drinkers and support from experienced colleagues were lacking, six months later the trainees (mainly from specialist alcohol services) were barely more committed to and confident about working with drinkers than before being trained.

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 listens to the patients and systematically ensures they are treated with warmth and respect. More in presentation which ends by focusing on the studies. For discussion click and scroll down to highlighted heading.

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. Related study below. For related discussion click and scroll down to highlighted heading.

S Written test for therapy-related social skills helps identify effective counsellors (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 how many of their patients relapsed after treatment. Replication study below. For discussion click and scroll down to highlighted heading.

The better the rapport between patient and counsellor, the less likely was the patient to drop out of treatment

K How to identify rapport- and retention-generating counsellors (2002). Replication at a Finnish outpatient alcohol clinic of US study above, which used the same system to identify counsellors who would generate the mutual client–counsellor rapport associated with retention in treatment chart. For discussion click and scroll down to highlighted heading.

K Trainees already best at client-centred counselling gain most from training (2004). Highlighting the importance of staff recruitment, US study at a medical centre’s 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. Simple indices of experience and qualifications did not identify proficient clinicians. Related study above. For related discussion click and scroll down to highlighted heading.

K Practice (and coaching) makes perfect; motivational counselling in primary care (2015). Focused on smoking cessation, a half-day workshop was not enough to develop the motivational interviewing skills of primary care doctors, nurses and pharmacists. Skills were sustained and improved only when the workshop was bolstered by expert coaching based on practice with simulated patients. These findings from a randomised trial are in line with those for therapists and counsellors discussed in cell C4. Related study above.

K Stepping up intensity of care costs more without improving outcomes (1999). From Canada the first evaluation of ‘stepped care’ for heavy drinkers found no added benefit from offering further treatment to patients who did not respond to initial therapy, but the study was not a definitive refutation of this potentially cost-saving strategy. Related guidelines below. For discussion click and scroll down to highlighted heading.

K Group-based medication management gives more patients the chance to benefit (2013; free source at time of writing). Common in psychosocial therapy, a US treatment centre extended the group format to medication-based treatment for alcohol dependence, considering, reviewing and adjusting medication and discussing treatment issues with other patients also taking or considering pharmacotherapy. Results included slashed waiting times and a threefold increase in patients on medication due to more starting treatment.

R Strategies for incorporating 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, clinicians who adopt a motivational interviewing style achieve significantly better outcomes than those who offer usual care, and training clinicians in motivational interviewing improves (2013) their skills, especially when reinforced by supervision or coaching based on feedback on trainees’ actual performance. For related discussion click and scroll down to highlighted heading.

G Roles and benefits of employing nurses in specialist substance use treatment services (Public Health England and [UK] Royal College of Nursing, 2017). Describes the potential roles of nurses in alcohol and drug treatment in England. Aims to help commissioners and providers of specialist services recruit the right workforce and maintain and develop their competence.

G What managers should expect of doctors treating problem substance use ([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 to addiction specialists. Other UK (Public Health England, [UK] Royal College of Psychiatrists, Royal College of General Practitioners, 2014) and US ([US] American Society of Addiction Medicine, 2014) guides focus on specialists.

G Staff development toolkit ([UK] National Treatment Agency for Substance Misuse, 2003). Workforce development guidance for managers in drug and alcohol services from what was the special health authority responsible for promoting addiction treatment in England, now absorbed into Public Health England.

G NICE advises stepped care ([UK] National Institute for Health and Clinical Excellence, 2011). Britain’s official health intervention assessor endorses trying the least intensive potentially appropriate treatment and only ‘stepping up’ to more intensive and costly approaches if the initial attempt fails. Related evaluation above. For discussion click and scroll down to highlighted heading.

G K Failings of detoxification procedures in the independent sector ([UK] Care Quality Commission, 2017). Official regulator of health and adult social care in England sums up results of inspections of services offering residential care to people undergoing detoxification from drugs and alcohol, often preparatory to residential rehabilitation. Poor management was a major underlying cause of the failings which risked safety and effectiveness at almost two-thirds of services. Flip side of the failings constitute good practice recommendations.

G How to assess the performance of specialist doctors ([US] American Society of Addiction Medicine, 2014). Indices designed to evaluate an individual doctor’s performance against US ([US] American Society of Addiction Medicine, 2014) for specialist addiction physicians.

G Models of care for alcohol misusers ([UK] Department of Health and National Treatment Agency for Substance Misuse, 2006). From the special health authority responsible for promoting addiction treatment in England, now absorbed into Public Health England. Guidance for health organisations and their partners on delivering an integrated local treatment system for problem drinkers. Includes (from page 74) quality criteria for managing alcohol services. For discussion click and scroll down to highlighted heading.

G Competencies for working with co-occurring substance use and mental health problems (2019). “Developed through” Public Health England by Clinks, a charity supporting voluntary organisations in the criminal justice system in England and Wales. Based on PHE’s related guidance. Describes the values, knowledge and skills required for effective care of people with substance use plus mental health problems. Designed as an individual development tool, but “can also be used and modified by any service provider for workforce development. For example, when describing the specific capabilities required in job descriptions, for training curricula and for performance, development and appraisal systems.”

G Treating substance use service clients with mental health problems ([Australian] National Drug and Alcohol Research Centre, 2016). Funded by the Australian government. Recommends services screen all patients for the full range of mental health problems and that mental illness should not be a barrier to treating substance use problems. Says research shows these patients can benefit as much as others from routine substance use treatments. UK guidelines ([UK] National Institute for Health and Care Excellence, 2016) on managing substance use plus severe mental illness says mental health services should take the lead.

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