Seminal and key studies on the impact of management in medical interventions and treatment in medical settings. Asks how we can identify effective clinicians and effective medications, and highlights the remarkable transformation brought about in the 1950s at a Massachusetts clinic.
S Seminal studies K Key studies R Reviews G Guidance more Search for more studies
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S Impact of training depends on workplace support and experience (1980). English study of trainees mainly from specialist alcohol services found that when experience in working with problem drinkers and support from experienced colleagues were lacking, six months after a week-long residential course trainees were barely more committed to and confident about working with drinkers than before.
S Listening management transforms alcohol clinic (1970). Remarkable series of US studies from the late 1950s proved that an alcohol clinic’s intake and attendance can be transformed by a management which listens to the patients and systematically ensures they are treated with warmth and respect. More in presentation and video, which end by focusing on the studies. Discussion in bite’s Highlighted study section.
S Some counsellors inspire retention, others rapid drop-out (1976). Turning the spotlight on recruitment, at a US alcohol treatment clinic trainee counsellors differed greatly in patient retention. Neither experience of alcoholism treatment nor further on-the-job training greatly affected performance.
S Written test reveals effective interpersonal therapy skills (1981). US study in a hospital alcohol clinic used a simple written method to score the therapy-related social skills of counsellors, which were strongly related to their patients’ post-treatment relapse. Replication study below. Discussion in bite’s Issues section.
K How to identify rapport- and retention- generating counsellors (2002). Replication at a Finnish outpatient alcohol clinic of study above which used the same system to identify counsellors who would generate the mutual client/counsellor rapport associated with retention chart. Discussion in bite’s Issues section.
K Training in client-centred approach needs receptive trainees (2004). US study at medical centre’s addictions programme suggests that recruiting the ‘right’ clinicians who have not been trained in motivational interviewing would be better than choosing the ‘wrong’ ones who have been, and the former gain most from training. Simple indices of experience and qualifications did not identify proficient clinicians.
K Stepping up intensity of care spends more without improving outcomes (1999). From Canada the first evaluation of ‘stepped care’ for heavy drinkers found no added benefit from offering further treatment to patients who did not respond to initial therapy, but the study was not a definitive refutation of this potentially cost-saving strategy. Discussion in bite’s Issues section. Related guidelines below.
K Group-based medication management gives more patients the chance to benefit (2013). Free source at time of writing. Common in psychosocial therapy, a US treatment centre extended the group format to initiating and managing medication-based treatment for alcohol dependence. Results included slashed waiting times and a threefold increase in patients on medication due to more starting the treatments.
R Strategies for incorporating evidence into practice ([Australian] National Centre for Education and Training on Addiction, 2008). Lessons from health promotion and medical care on how to improve addiction treatment practice by introducing research-based innovations, including common medical education and training strategies.
R Worth training clinicians in motivational interviewing (2013). Free source at time of writing. Across medical care including treatment and brief intervention for drinking problems, clinicians who adopt a motivational interviewing style achieve significantly better outcomes than those who offer usual care, and training clinicians in motivational interviewing improves motivational skills.
G What should managers expect of doctors caring for substance users? ([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. See also a guide ([UK] Public Health England, Royal College of Psychiatrists and Royal College of General Practitioners, 2014) for more on the roles and competencies expected of specialists and the importance of retaining their expertise in the sector.
G Staff development toolkit ([UK] National Treatment Agency for Substance Misuse, 2003). Guidance for managers in all drug and alcohol services from what was the special health authority responsible for promoting addiction treatment in England.
G How to assess the performance of specialist doctors ([US] American Society of Addiction Medicine, 2014). Indices designed to evaluate an individual doctor’s performance against standards of care ([US] American Society of Addiction Medicine, 2014) for specialist addiction physicians.
G NICE advises stepped care ([UK] National Institute for Health and Clinical Excellence, 2011). Britain’s official health intervention assessor endorses trying the least intensive potentially appropriate treatment and only ‘stepping up’ to more intensive and costly approaches if the initial attempt fails. Discussion in bite’s Issues section. Related evaluation above.
G Models of care for alcohol misusers ([UK] Department of Health and National Treatment Agency for Substance Misuse, 2006). Includes (from page 74) quality criteria for managing alcohol services. Discussion in bite’s Issues section.
G Effective substance use service provision for clients with mental health problems ([Australian] National Drug and Alcohol Research Centre, 2016). Funded by the Australian government. Recommends services screen all patients for mental health problems and that mental illness should not be a barrier to treating substance use problems. Research shows these patients can benefit as much as others from routine treatments for problem substance use.