Alcohol Treatment Matrix cell B3: Practitioners; 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

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Practitioners; Medical treatment

The most important seminal and key studies and reviews shedding light on the impact of the practitioner in medical interventions and treatment for alcohol problems in medical settings.


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 Patients engage better with treatment when clinicians are committed to working with them (1996). See also related paper from same study (1996). Assessment staff at an English alcohol treatment clinic differed greatly in how many of their patients went on to engage with treatment; how committed the staff were to working with a client (‘therapeutic commitment’) was related to both therapeutic relationships and engagement, probably because clients experienced uncommitted workers as ‘cold’ and the committed as ‘warm’. Later studies (1980) from the same team found commitment depended on workplace support for dealing with drink problems. Related study below. For discussions click here and here and scroll down to highlighted headings.

S It’s the way you say it (1970). Final step of a remarkable series of studies from the late 1950s found that the warmth and concern a doctor expressed towards alcoholics in general was strongly related to whether at a US emergency department a year before their patients had followed through on the same doctor’s referral to the hospital’s alcohol treatment clinic. Related study above. For discussions click here and here and scroll down to highlighted headings.

K Patients progress better with optimistic doctors who flexibly respond to their needs (2008). Analysis confined to the arms of the US COMBINE alcohol treatment trial providing medical care which included medications but not psychosocial therapy. What made the difference to patients’ drinking and clinical progress seemed to be how far the clinician maintained confident optimism and responded to the patient rather than strictly adhering to a treatment manual. For discussions click here and here and scroll down to highlighted headings.

K Patients do best when they feel GPs know them and communicate well (2007; free source at time of writing). US patients referred to primary care after detoxification reduced alcohol problems most when they saw doctors they trusted, they felt knew them as a whole person, and who probed/communicated thoroughly and well. For discussion click and scroll down to highlighted heading.

R Ability to forge positive relationships with patients accounts for clinicians’ impact on treatment quality (2000; free source at the time of writing). Assessed whether retention and substance use were related to the clinician’s professional status, personal experience of addiction, adherence to protocols, relationships with patients, personality, beliefs about treatment, and professional practice issues. Found clinicians vary greatly in their performance but that “past assumptions that levels of training, experience, or other simple therapist variables could account for such differences does not hold”. More important were ability to build positive relationships with patients. For discussion click and scroll down to highlighted heading.

R Above all, don’t do the wrong thing (2015; free source at the time of writing). Across health care in general, doctor-patient interactions that are invalidating (do not successfully communicate acceptance and understanding) damage relationships more powerfully than positive communications cement them. More on the importance of not doing the wrong things in cell B2. For discussion click here and scroll down to highlighted heading.

G What UK doctors should do and be able to do ([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 such as doctors in emergency departments and general practitioners to addiction specialists. For related discussion click and scroll down to highlighted heading.

G What UK specialist addiction doctors should do and be able to do ([UK] Public Health England, Royal College of Psychiatrists and Royal College of General Practitioners, 2014). Guidance from body overseeing addiction treatment in England and from professional associations for GPs and for psychiatrists on the “essential functions which can usually only be carried out by addiction specialist doctors” and the importance of retaining their expertise in the sector.

G What US specialist addiction doctors should do and be able to do ([US] American Society of Addiction Medicine, 2014). Consensus guidelines from the US professional association for doctors who specialise in treating addiction on what they are expected to do and the standards they should meet throughout treatment from assessment to aftercare. For related discussion click and scroll down to highlighted heading.

G Competencies for working with co-occurring substance use and mental health problems (2019). From Clinks, a national charity supporting voluntary organisations in the criminal justice system in England and Wales, and developed through Public Health England based on their related guidance. Advice on the values, knowledge and skills required for effective care of people whose substance use problems are complicated by poor mental health. Informed by patients who emphasised the “importance of workers’ personal qualities and behaviour and how vital the workers’ characteristics were to an individual’s recovery journey”.

Search for all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topic on the influence of treatment staff.

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