Alcohol Treatment Matrix cell E4: Treatment systems; 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

Includes brief interventions

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Includes harm reduction

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Treatment systems; Psychosocial therapies

Key studies on local, regional and national systems for effectively and cost-effectively providing psychosocial therapies, and the roles of those therapies within the overall systems. Focus is on the potential of mutual aid to bridge the gap between diminished resources and heightened recovery ambitions.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Systematic facilitation transforms zero mutual aid group attendance into 100% (1981). Randomised trial with just 20 participants pioneered linking alcohol patients to mutual aid groups. After typical information and encouragement none went in the following week, but all did whose attendance had also been systematically facilitated by procedures which included a phone call during a counselling session to a group member, who accompanied the client to their first meeting. Similar contemporary trials from the UK and USA below. For related discussion click and scroll down to highlighted heading.

K In UK active referral significantly promotes NA/AA attendance but not abstinence (2012). Tested how to extend the recovery process beyond formal treatment by systematically linking patients to mutual aid groups. Being encouraged by a doctor or peer (especially the latter) substantially improved attendance at 12-step groups, but impacts on abstinence were much smaller and not statistically significant. Seminal study above and similar US study below. For discussion click and scroll down to highlighted heading.

K In USA post-treatment substance use reduced by actively linking patients to mutual aid groups (2007). Among patients treated by the US medical service for ex-military personnel, persistent and practical efforts strengthened 12-step group involvement after treatment and modestly improved substance use outcomes. Seminal study and similar UK study above. For discussion click and scroll down to highlighted heading.

K Promoting SMART mutual aid (2010). Analyses the facilitators and obstacles to establishing a cognitive-behavioural alternative (SMART Recovery) to 12-step mutual aid at six sites in England. Prominent theme was the tension between being mutual aid being supported by treatment services versus being co-opted. For related discussions click here and here and scroll down to highlighted headings.

K Forging inter-service links to promote patient transition and aftercare (2012). Implementing psychosocial approaches to promoting patient transition between US services involved analysing how organisations relate to each other and how they deliver their services, in order to forge stronger service networks and identify gaps in the continuum of care. Discussed in cell E3, siting case managers at detoxification services has been (2006) one successful transition tactic.

K Determining who needs residential care (2001). US study’s criteria and the methods used to develop them offer a way to reserve residential rehabilitation for those who need it, improving treatment completion rates for both residential and non-residential options. For about 1 in 5 of the patients alcohol was their primary substance.

K Text chat therapy (2011). Dutch trial of internet-based therapy for problem drinking via text-chat conversations with a real therapist found this improved on an automated self-help option. Impacts were included in a simulation study (2011) which suggested health would improve and/or costs reduce if across a country on-line interventions supplemented or replaced conventional care. See also hot topic on computerised therapy and advice.

R What promotes longer term care and aftercare (2011). Includes the implementation of psychosocial strategies to help ensure patients who need it receive long-term care or aftercare; discussion in cell D2.

R Peer-based support for recovery from problem substance use (2009). Compendious review from leading authority on recovery systems based on mutual aid. Remit is any form of recovery-oriented mutual assistance involving people whose credentials rest on personal experience, whether offered informally or as part of a service. For discussion click and scroll down to highlighted heading. Will inform planners and commissioners of services aiming to improve linkage to peer-based recovery support; for related discussion click and scroll down to highlighted heading. Also reviews literature on peer-based support itself; for related discussion click and scroll down to highlighted heading.

R Attending AA meetings after treatment helps sustain drinking reductions (2014). That was the implication of what the authors believed was “the most rigorous assessment yet of a 70-year old mutual help organization”. Our commentary discusses whether these results mean treatment services will further prevent heavy drinking or its consequences by promoting participation in 12-step fellowships. For related discussions click here and here and scroll down to highlighted headings.

R Varieties and impacts of case management (2019). An expert Euro-US collaboration examines the most common mechanism for transforming isolated treatment episodes into coherently staged and holistic recovery programmes – the appointment of a ‘case manager’ who remains a stable hub orchestrating service delivery. From some of the same team see earlier review (2006) published by Findings. Related guidance below. For related discussion click and scroll down to highlighted heading.

R Severe cases differentially benefit from residential care (2003). Notes from Drug and Alcohol Findings on studies comparing residential with non-residential treatment. Concludes that for patients who accept and can safely be sent to either, there is little to choose between them. Severe cases may however differentially benefit from residential care. See also a review (2006) limited to randomised trials of therapeutic communities and mainly concerned with use of illicit drugs.

G Commissioning an alcohol intervention and treatment system ([UK] National Institute for Health and Care Excellence, 2011). Authoritative guidance from England’s gatekeeper to the public provision of health services on how commissioners should organise and procure treatment services across an area which implement national guidance and satisfy policy requirements. On psychosocial interventions, NICE took its lead from associated clinical guidelines ([UK] National Institute for Health and Care Excellence, 2011). For discussion click here and for related discussions here, here and here, and scroll down to highlighted headings.

G Setting up a local treatment system ([UK] Department of Health and National Treatment Agency for Substance Misuse, 2006). Guidance for local health organisations in England and their partners on delivering a planned and integrated treatment system for adults with drinking problems.

G Organising integrated and holistic care (Report Produced for the Scottish Advisory Committee on Drug Misuse, 2008). Treatment system guidance for Scotland on an “an approach that aims to combine and co-ordinate all the services required to meet the assessed needs of the individual,” requiring “collaborative working between agencies and service providers” to address the multiple difficulties often found among people who have drug or alcohol use problems.

G Case management ([US] Substance Abuse and Mental Health Services Administration, 1998). Based on research and experience indicating that “substance abusers have better treatment outcomes if their other problems are addressed concurrently,” US consensus guidance on case management to orchestrate the range of services often needed to promote lasting and multi-faceted recovery. Related review above. For related discussion click and scroll down to highlighted heading.

more Retrieve all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topics on computerised therapy and advice, residential rehabilitation, 12-step mutual aid groups, and commissioning treatment systems.

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