Alcohol Treatment Matrix cell E3: Treatment systems; 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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Treatment systems; Medical treatment

Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing medical interventions and treatment in medical settings. Includes discussions of what a good quality alcohol service would look like and whether the UK is making progress on systems for treating the overlap between substance use and mental health problems.


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 Workplace culture key to broadening treatment opportunities (1980). Commissioners are encouraged to make every service contact an opportunity to tackle problem drinking and its consequences, but influential English studies showed that training will not substantially engage staff in this work unless they feel drinking is a legitimate priority back at work.

K Missed opportunities to prevent deaths from alcohol-related liver disease in UK (National Confidential Enquiry into Patient Outcome and Death, 2013). Based on 594 relevant deaths in the first half of 2011 identified by hospitals in the UK other than in Scotland. Most patients had recently attended hospital but there was a failure to screen adequately for harmful drinking, and even when this was identified, patients were not referred for support. See also an in-depth analysis (2012) revealing missed opportunities to prevent alcohol-related deaths in 2003 in the Glasgow region.

K Hospital alcohol teams spreading but underpowered (Public Health England, 2014). Survey results documented the spread of alcohol services to all but a few hospitals in England, but fewer than a quarter took the form of multidisciplinary teams or could implement the assertive outreach recommended for patients with multiple and severe difficulties. Recommends which types of services should be commissioned in different categories of hospitals.

K Case management links detoxification to treatment (2006). Siting case managers at detoxification services transformed them into gateways to longer term treatment. They targeted patients with a history of multiple detoxifications, motivating them to complete the process and arranging support and follow-on treatment – one element of a broader ‘recovery revolution’ in Philadelphia. For discussion click and scroll down to highlighted heading.

K Don’t assume you know what characterises an effective service – find out! (2009). That’s what the US health service for former military personnel did by testing the relationship between possible indicators of a treatment service’s quality and the degree to which in practice it fostered remission in problem drinking. The strongest indicator of the best average outcomes was the proportion of a service’s patients who had attended it at least three times during the first month of treatment. For discussion click and scroll down to highlighted heading.

K ‘Dual diagnosis’ provision falls short in England ([UK] Care Services Improvement Partnership, 2008). First national assessment of progress towards implementing government good practice guidelines issued in 2002 (listed below) revealed there remained “a long way to go to genuinely meet the complex and changing needs of people with dual diagnosis”. Regional reports also available. See also Effectiveness Bank hot topic on ‘dual diagnosis’. For discussion click and scroll down to highlighted heading.

K Caring at the overlap between substance use and mental illness; more nobody’s job than everybody’s ([UK] Institute of Alcohol Studies, 2018). Entry title refers to Public Health England’s insistence in guidance listed below that caring for people with both substance use and mental health problems should be seen as “everyone’s job”. Instead a survey and seminar involving people working in these sectors found that “too many people are bounced between services despite being highly vulnerable. Too often, instead of being everybody’s business, comorbidity is nobody’s business.” See also Effectiveness Bank hot topic on ‘dual diagnosis’. For discussion click and scroll down to highlighted heading.

Reduction in psychiatric admissions from before to the year after allocation to integrated versus parallel care; shows reduction was much greater when substance use and mental health care were integrated

Psychiatric admissions in the years before and after allocation to integrated versus parallel care

K Integrated dual diagnosis teams help prevent crises (2006). From Texas, a rare (largely) randomised trial of truly integrated care for people suffering severe mental illness complicated by substance use found these arrangements reduced the frequency of psychiatric and legal crises chart. Related review and guidance below. See also Effectiveness Bank hot topic on ‘dual diagnosis’. For related discussion click and scroll down to highlighted heading.

R Evidence weak for integrating addiction and mental health treatment (2013; free summary and commentary from the US Centre for Reviews and Dissemination). Synthesis of research finds some evidence that integrating treatment for substance use and mental health problems improves psychiatric symptoms and (in residential settings) reduces drinking more than non-integrated care, but none of the slight advantages approached statistical significance, and only one of the studies assessed whether treatment truly was integrated. See also study not included in this review above, related guidance below, and Effectiveness Bank hot topic on ‘dual diagnosis’. For discussion click and scroll down to highlighted heading.

R Pay-for-performance systems an evidential leap in the dark (Cochrane review, 2011). Overview of reviews on financial incentives for healthcare professionals in general could find no evaluations which reported on patient outcomes. Also conducted under rigorous Cochrane procedures, a similar review (2011) but of individual studies found “insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care”. A review (2014) specific to drug and alcohol treatment could find “no peer-reviewed evidence that [pay-for-performance] … improves client outcomes post-treatment”. For related discussion click and scroll down to highlighted heading.

G NICE synthesises official guidance on the organisation and procurement of alcohol treatment and brief intervention services ([UK] National Institute for Health and Care Excellence, 2011). England’s gatekeeper to the public provision of health care interventions extracts the messages for commissioners from its own and other official guidance and distils these into a single document to guide the organisation and procurement of treatment and brief intervention services in an area. Also offers reasons for organisations responsible for spending health service resources to devote these to alcohol services.

G NICE alcohol use disorders treatment and care pathways ([UK] National Institute for Health and Care Excellence, accessed 2020). From England’s gatekeeper to the public provision of health care interventions, care pathways and associated resources and guidance relating to the prevention, diagnosis and management of alcohol-related disorders. See also earlier guidance ([UK] Department of Health, 2009) on alcohol treatment pathways and current substance use guidance collated by Public Health England (2019). For related discussion click and scroll down to highlighted heading.

G Integrated care for substance users in Scotland (Report produced for the Scottish Advisory Committee on Drug Misuse, 2008). Guidance on how to construct a treatment system that combines and coordinates all the services required to meet the assessed needs of the individual. Includes care pathways and responding to patients with mental illnesses.

G Expert advice on commissioning substance use treatment ([UK] Joint Commissioning Panel for Mental Health, 2013). Co-chaired by the Royal College of General Practitioners and the Royal College of Psychiatrists, a collaboration of organisations and individuals with an interest in commissioning mental health services explains the rationale for commissioning effective services and offers practical advice. For discussions click here and here and scroll down to highlighted headings.

G NICE advises against specialist ‘dual diagnosis’ services ([UK] National Institute for Health and Care Excellence, 2016). England’s gatekeeper to the public provision of health interventions says that rather than creating specialist services, health and social care (including substance use) services should adapt to people whose substance use is accompanied by mental illness, and in severe cases care should be led by mental health services. Another NICE guideline (2011) deals specifically with psychosis and substance use. Guidance is reflected in NICE quality standards (2019). See also earlier dual diagnosis good practice guide ([UK] Department of Health, 2002) and Effectiveness Bank hot topic. Related review and study above. For discussion click and scroll down to highlighted heading.

G “No wrong door” for patients with mental health and substance use problems (Public Health England, 2017). Authority overseeing substance use treatment in England calls for commissioners to organise compassionate and non-judgemental care for patients with mental health problems centred on their needs and accessible at every entry point to health and social care systems. Stressed that caring for these patients is “everyone’s job” and there should be “no wrong door” to accessing help. See also Effectiveness Bank hot topic on ‘dual diagnosis’. For discussion click and scroll down to highlighted heading.

G What specialist addiction doctors should do and be able to do ([UK] Public Health England, Royal College of Psychiatrists, Royal College of General Practitioners, 2014). From the authority overseeing addiction treatment in England and UK professional bodies, guidance for commissioners on the part doctors who specialise in addiction are expected to play in promoting recovery, and the importance of retaining their expertise in the sector.

G Organising to address problem drinking in NHS hospitals (undated). Guidance and advocacy from London’s Health Innovation Network on the steps that need to be taken in NHS hospitals to tackle alcohol-related harm, including commissioning and models for service delivery systems.

G How to assess the performance of specialist doctors ([US] American Society of Addiction Medicine, 2014). Criteria designed to be used as the basis for local reimbursement and quality-control systems which evaluate performance against the standards ([US] American Society of Addiction Medicine, 2014) expected of specialist addiction physicians. For discussion click and scroll down to highlighted heading.

more Search for all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topics on commissioning and dual diagnosis.

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