Alcohol Matrix cell D3: Organisational functioning; Medical treatment
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Alcohol Treatment Matrix cell D3

Organisational functioning; Medical treatment

One of 25 cells in the Alcohol Treatment Matrix Matrix cell logo

Selected studies and reviews on how treatment organisations affect the implementation and effectiveness of medical interventions and treatment in medical settings. One of 25 cells in the alcohol matrix.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Workplace support and experience needed for training to be effective (1986). In England specialist centres including alcohol treatment clinics offered the most favourable post-training environments for training to generate a positive attitude to working with drinkers. The reason was that they provide opportunities to gain support and experience on return to work. This study was discussed in cell D2’s bite and related studies were discussed in cell B3’s bite.

K High quality primary care helps sustain recovery after detoxification (2007). Free source at the time of writing. The alcohol problems and substance use of US patients referred to primary care after detoxification were related to a recognised measure of the general quality of primary care. Discussion in bite’s Highlighted study section.

K Integrate addiction treatment with medical care for its consequences (2001). That was the message of a US trial which randomly allocated patients (most dependent on alcohol) at a substance use clinic to primary care integrated into the work of the clinic or referral to an external service. Only patients with complaints associated with substance use gained from integration. A similar study focused on dependent drinkers suffering alcohol-related physical illnesses. Discussion in bite’s Issues section.

K Integrated ‘chronic disease management’ model does not improve on usual primary care (2013). Chronic conditions like diabetes requiring long-term behaviour change respond well to chronic disease management models based in primary care but integrated with specialised services, which support the patient in managing their illness. Expectations (free source at time of writing) that the same would apply to addiction were confounded when researchers found little or no extra benefit compared to usual primary care, and no sign (free source at time of writing) that increasing the quality of, or engagement with, the intervention would improve things. Discussion in bite’s Issues section.

R Implementing evidence-based innovations ([Australian] National Centre for Education and Training on Addiction, 2008). Lessons from health promotion and medical care on how to improve addiction treatment practice including organisational and administrative strategies. Discussion in bite’s Where should I start? section.

R Weak evidence for integrating addiction and mental health treatment (2013). Synthesis of research findings finds some evidence that treatment which integrates substance use and mental health strands improves psychiatric symptoms and (in residential settings) drinking more than non-integrated care, but none of the slight advantages approached statistical significance. See also Effectiveness Bank hot topic on ‘dual diagnosis’. Related guidance below.

G Getting your organisation fit to implement change ([US] Substance Abuse and Mental Health Services Administration, 2009). How to assess an organisation’s capacity to identify priorities, implement changes, evaluate progress, and sustain effective programmes, and how to actually implement these changes: “If your organization is troubled, you need to build a healthier work culture before change will be possible.” Discussion in bite’s Issues section.

G Theory into practice strategies ([Australian] National Centre for Education and Training on Addiction, 2005). Chapter on managing organisational change includes the organisational factors which impede or promote change and how to manage them. Discussion in bite’s Issues section.

G NICE advises against specialist ‘dual diagnosis’ services ([UK] National Institute for Health and Care Excellence, 2016). The UK’s official health intervention assessors says that rather than creating specialist ‘dual diagnosis’ services, health and social care (including substance misuse) services should adapt to mentally ill substance users, and their care should be led by the mental health service. Another NICE guideline (2011) has dealt specifically with psychosis and coexisting substance use problems. Related review above.

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For subtopics go to the subject search page. Also see hot topic on why some treatment services are more effective than others.

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