Alcohol Matrix cell D3: Organisational functioning; 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

Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

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Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Organisational functioning; Medical treatment

Selected studies and reviews on how treatment organisations affect the implementation and effectiveness of medical interventions and treatment in medical settings. Asks whether evidence-based innovation is always a good thing, and explores the evidence for and against integrating substance use treatment with medical or psychiatric care.

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 environments for training to generate positive attitudes to working with problem drinking because they provided opportunities to gain support and experience on return to work. This study was discussed in cell D2 and related studies from the same team in cell B3.

K High quality primary care helps sustain recovery after detoxification (2007; free source at the time of writing). The substance use of US patients (most with both drug and alcohol problems) referred to primary care after detoxification was found to be related to the general quality of their care. Organisational factors associated with greater alcohol problem reduction included how easy the practice made it for the patient to get in touch and visit and whether they saw the same doctor each time. For discussion click and scroll down to highlighted heading.

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 clinic, or to a service run by the same provider but which worked independently. Patients whose medical complaints were associated with substance use (the majority) further reduced their drinking and other substance use when allocated to integrated care. Findings confirmed those of a similar study (1999) focused on dependent drinkers with alcohol-related physical illnesses. For discussion click and scroll down to highlighted heading.

K Integrated ‘chronic disease management’ model not found to improve on usual primary care (2013; alternative free source at time of writing). Generally, chronic illnesses requiring long-term behaviour change respond well to disease management models based in primary care but integrated with specialised services, supporting the patient in managing their illness. Expectations (2008; 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 (2012; free source at time of writing) that a higher quality or more engaging disease management intervention would improve things. For discussion click and scroll down to highlighted heading.

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, including the use of organisational and administrative quality-improvement strategies. For discussion click and scroll down to highlighted heading.

R Evidence weak for integrating addiction and mental health treatment (2013; free summary and commentary from the US Centre for Reviews and Dissemination). Synthesis of research findings finds some evidence that integrated treatment for substance use and mental health problems improves psychiatric symptoms and (in residential settings) reduces 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 Is 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 improvement programmes, and how to actually implement these programmes: “If your organization is troubled, you need to build a healthier work culture before change will be possible.” For discussion click and scroll down to highlighted heading.

G Strategies to translate theory into practice ([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. For discussion click and scroll down to highlighted heading.

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

more Search for all relevant Effectiveness Bank analyses or search more specifically at the subject search page. Also see hot topic on why some treatment services are more effective than others.

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