Alcohol Treatment Matrix cell D4: Organisational functioning; Psychosocial therapies

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

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Effectiveness Bank Drug Treatment Matrix

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Organisational functioning; Psychosocial therapies

Key studies on how treatment organisations affect implementation and effectiveness of psychosocial therapies. Explores the effects of high staff turnover, how to reduce it, and the importance of services being ready for change, and asks whether change driven by money rather than humanitarian mission is just as good for patients.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Organisational factors affect willingness to address problem drinking (1980). Involving mainly non-medical alcohol counselling and treatment centre staff, an English study turned the spotlight on organisational factors in the development of a positive attitude to working with problem drinking patients – in particular, the support of experienced colleagues and the availability of experience in working with these patients. Later the same lead researcher was able to add (1986) time pressures, case priorities, departmental policy, and other workplace constraints. For discussion click and scroll down to highlighted heading

K Organisational health associated with engagement in treatment (2009). In England engagement with treatment and rapport with counsellors were strongest when services fostered communication, participation and trust among counselling staff, and had a clear mission but were open to new ideas. Related US study from the same research stable below. For discussion click and scroll down to highlighted heading.

K Workplace ethos sets context for adopting new counselling methods (2012). Workplace climate including strength of mission, staff cohesion, communications, professional autonomy, lack of stress, and receptiveness to change “underlies the entire process” of ‘bottom up’ innovation initiated by counsellors. Related UK study from the same research stable above. For discussion click and scroll down to highlighted heading.

K Human relations environment related to patients’ substance use (2011; free source at time of writing). Uniquely this study integrated analyses of the links between patient substance use and the contributions made by patients, counsellors, and services to the development of therapeutic relationships. Teasing out these influences revealed that rather than resources, training or equipment, it was the human relations environment of US substance use counselling centres which was related to a centre’s outcomes. Services also differed in the strength of the therapeutic relationships patients reported with counsellors, differences also related to outcomes. Implications were that “assuming causality … better outcomes could be achieved by both improving … organizational functioning [and] the alliance of counsellors with their patients”. For related discussion click and scroll down to highlighted heading.

K Organisational context is key to implementing new ways of working (2012; free source or original article at time of writing). Compelling account of what it takes in the real world (where implementation staff have to grapple with counsellors and organisations over which they have no control) to introduce a new treatment approach. Key lesson is that each organisation is different; being there, learning about that unique context, and taking it into account, are needed to give implementation a chance. For discussion click and scroll down to highlighted heading.

K Autonomy and justice retain counselling staff (2008). Organisations which do not offer autonomy to substance use counsellors, foster a sense of being treated fairly, or promote mutual support between workers, risk generating the high staff turnover which undermines workforce development initiatives. For discussion click and scroll down to highlighted heading.

R Involve the whole organisation in implementing psychosocial treatment programmes (2011). Successful implementation is most likely when the entire agency is the target of the implementation effort rather than individual therapists. For related discussion click and scroll down to highlighted heading.

G English drug services define their own quality standards (2016). From bodies representing the addictions treatment sector in England, standards developed after consultation and piloting with services. Designed to guide services in assessing how they support people into and through recovery and the quality of vital aspects of their organisations. Includes standards for non-residential and residential rehabilitation services and an implementation guide for the non-residential standards.

G Is your service even ready to improve? ([US] Substance Abuse and Mental Health Services Administration, 2009). How to assess an organisation’s capacity to identify priorities, implement changes, evaluate progress, and sustain effective programmes, plus how to implement innovations. For discussions click here and here and scroll down to highlighted headings.

G Simple ways to improve an organisation’s performance. Helpful web site from the USA’s University of Wisconsin, providing research findings, promising practices, and toolkits, all geared to encouraging and supporting administrative and therapeutic improvements in addiction and mental health services.

G Theory into practice strategies ([Australian] National Centre for Education and Training on Addiction, 2005). From one of the world’s major workforce development agencies for the addictions field. Chapter on managing organisational change includes the organisational factors which impede or promote change and how to manage them. For related discussions click here and here and scroll down to highlighted headings.

more Search for all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topics on why some treatment services are more effective and on individualising treatment.

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