2019/20 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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Interventions; Safeguarding the community

Seminal and key studies on the impact of alcohol treatment on the community including the safety and welfare of families and effects on crime and antisocial behaviour.

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 No use ordering ‘chronic drunks’ to AA or treatment (1967). Identified by reviews (1; below) as one of just three randomised trials of self-help groups. It found that a court order to attend an alcohol clinic or AA meetings did not reduce arrests compared to no treatment – if anything, the reverse. The authors’, originally optimistic about the interventions, ended by concluding that their findings “offer no support for a general policy of forced referrals to brief treatment.” Related review below. Discussion in bite’s Issues section.

S Disulfiram backed by sanctions helps reform repeat alcohol-related offenders (1966). In the early ’60s in Atlanta in the USA, a pioneering trial tested whether faced with another spell in jail, ‘skid-row’ repeat drunkenness offenders would instead take a drug which generates deterrent physical reactions to alcohol. Most did, belying their supposedly hopeless condition. The Effectiveness Bank commentary describes an early trial (1983) in London which tested a similar programme with similar results. Discussion in bite’s Issues section.

K No significant benefits from court-ordered treatment in England (2011). In the English Midlands introduction of court-ordered treatment for problem-drinking offenders on probation could not be shown to have reduced re-offending more (though the reductions were substantial) than previous probation arrangements. Similar evaluations in Lancashire (2010), West Yorkshire (2011) and nationally ([UK] Ministry of Justice, 2009) also found considerable improvements but did not benchmark these against any, or any adequate, comparison groups. Discussion in bite’s Issues section.

K Anti-offending programme did not cut crime (2011). The main cognitive-behavioural group therapy programme (ASRO) for problem substance users on probation in the UK could not be shown to have affected reconviction rates. See also similar UK findings (2012) from the same cognitive-behavioural family of interventions applied to drink-driving. Discussion in bite’s Issues section.

K No crime-reduction dividend from offering brief counselling to drunk arrestees ([UK] Home Office, 2012). UK government-funded pilot schemes found no crime-reduction benefits from brief alcohol counselling for arrestees under the influence of drink, confounding hopes that these ‘arrest referral” schemes would help quell late-night alcohol-related disorder. The schemes did however uncover many dependent drinkers. Discussion in bite’s Issues section.

K Minimal ‘drinking too much’ warning works as well as brief interventions in UK probation services (2014). Largest alcohol screening and brief intervention evaluation yet conducted in Britain found risky drinking rates fell as much after the most minimal intervention as after more sophisticated and longer alternatives, but these might have impacted more on recidivism. A similar Scottish study did not directly test effectiveness. Discussion in bite’s Highlighted study and Issues sections.

Families with children initially at risk of being taken in to public care and actually taken in during follow-up period

K Intensive support for problem drinking parents enabled children to stay at home (Welsh Assembly Government, 2008). Found that a service which worked intensively over a few weeks with substance using parents (their problems mainly involved alcohol) whose children faced imminent care proceedings forestalled their removal from the home. Later evaluation (2012) of the same service confirmed this was not at the expense of the children’s welfare chart. Similar schemes were implemented across Wales and have been evaluated (2014). Related guidance below. Discussion in bite’s Issues section.

K No demonstrable benefits from intensive support for “troubled families’ ([UK] Department for Education, 2011). Evaluation of national payment-by-results scheme to ’turn round’ troubled families in England found substantial remission in substance use problems, but could not attribute these to the interventions. Final evaluation report (2016) found that relative to comparison families, there were no significant impacts on substance use or outcomes related to employment, job-seeking, school attendance and anti-social behaviour. Related guidance below. Related discussion in bite’s Issues section.

K Therapeutic orientation improves outcomes of child care proceedings in London (2016). First UK family drug and alcohol court achieved lastingly better parental and child outcomes at lower cost ([UK] Home Office, 2012). The authors said “there was a sound basis for comparing outcomes” but the families allocated to the family drug and alcohol court versus usual care proceedings derived from different boroughs and were not randomly assigned. Related guidance below. Discussion in bite’s Issues section.

K Support the relatives too (2011). Brief primary care counselling seemed to help relatives in England cope with living with a problem drinker, but without a control group against whom to benchmark the outcomes the study could not be sure the outcomes were due to the interventions.

Improvements in violence in the family and child welfare after treatment for drinking problems

K Patient-focused treatment aids wives and children too (2003 and 2006). Even when treatment is focused on the individual problem drinker, families benefit from reduced violence and improved child welfare chart. Discussion in bite’s Issues section.

K Most impact from (when feasible) couples therapy (2009). Anti-violence benefits for partners greatest when they join with the dependent drinker in couples-based therapy which addresses relationships as well as drinking. See also other couples-therapy reports focused on male (2004) or female (2009) drinkers and British advice (2007) on how to avoid the risk that couples therapies might provoke partner abuse. Related review below.

R Routine alcohol treatment can reduce domestic violence (2009; free version at time of writing). When successful, alcohol treatment in general results in reduced violence between sexual partners; couples therapy has yet greater impacts, but is not always (2007) safe or feasible. Related studies above. Discussion in bite’s Issues sections (1 2).

R Family programmes can improve prospects of children of problem substance users (2012) Of the reviewed programmes, most effective were those which involved both parents and children, particularly the Strengthening Families Programme (2004). Related guidance below. Discussion in bite’s Issues section.

R Alcohol treatment prevents injuries (2004) ... and also causes of injury such as violence and accidents; same lead author was responsible for an earlier review (1999) analysed for the Effectiveness Bank. Similar message tentatively emerged from another review analysed (2000) for the Effectiveness Bank. Discussion in bite’s Issues section.

R Is therapy undermined by a punishment context? (2005). Asks whether in criminal justice settings, the contradictions of helping and punishing at the same time (‘motivational arm-twisting’) undermine interventions which might work elsewhere – in particular, the client-centred motivational interviewing style of counselling.

R How to stop drink-drivers reoffending (2006). Includes the “encouraging” results from rehabilitation programmes. Related guidance below.

R Encourage but don’t coerce AA attendance (1999) Synthesis of studies concludes that people forced to attend AA do worse than when coerced instead into professionally run treatments or left to their own devices, but when AA is chosen it records statistically significant advantages over alternatives. Related seminal study above.

G Offender management guidance for England and Wales ([UK] National Offender Management Service, 2010); Treating prisoners in Scotland (Scottish Prison Service, 2011). Official guidance on the commissioning, management and delivery of interventions for alcohol misusing offenders, dating from before the transfer of responsibility for treatment in prison to the NHS. Discussion in bite’s Highlighted study section.

G Managing alcohol problems in prisoners (World Health Organization, 2012). Based on UK experience, offers an integrated model of best practice in care for problem-drinking prisoners, including a consideration of specific types of treatments. Discussion in bite’s Where should I start? section.

G Developing and providing effective services for the children of problem drinkers (accessed 2017). Funded by the UK charity Comic Relief, a web resource to help managers, commissioners and practitioners develop and provide effective services for children whose parents misuse alcohol.

G Treating the drink-driver (Health Canada, 2004). Authors reviewed evidence and consulted experts to arrive at recommended education and treatment and rehabilitation approaches to alcohol/drug impaired driving. Related review above.

more Search for all relevant analyses or for subtopics go to the subject search page or hot topics on supporting families, testing and sanctions and protecting children.

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