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Treatment systems; Generic and cross-cutting issues

The most important studies on local, regional and national systems for effectively and cost-effectively providing treatment. One of 25 cells in the alcohol matrix. Also highlights the most useful reviews and practice guidelines and offers a customised one-click search for more on the Effectiveness Bank database.

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

K Local area strategies in England lack vision, clarity and commitment ([UK] Department of Health, 2011). When from 2006 to 2011 government alcohol policy support teams made more than 480 visits to local strategic partnerships, they found improving but often muddled and uncoordinated attempts to improve public health through alcohol-related interventions, which lacked consistent commitment.

K What the local treatment system feels like for the patient (2015). Interviews with alcohol patients at an NHS addiction service in England revealed that for them the treatment journey was often “fragmented, with input from a number of different staff in different settings and an overall lack of clarity around the role and remit of each”.

K Adequacy of service provision in Scotland (NHS Health Scotland, 2014). Evidence that in 2012 Scotland’s alcohol treatment caseload equated to about 1 in 4 of the country’s alcohol-dependent adults – better than in England. Evidence too of a peer-based recovery orientation taking root. Discussion in bite’s Issues section.

K Systems change helped improve access to and retention in treatment (2008). US NIATx programme halved waiting times and extended retention partly by fostering a self-sustaining inter-service improvement network and a performance analysis system linked to funding. See also this later extension (2012) to the programme. Related NIATx study and web site listed below.

K Expert coaching helps services improve patient access and retention (2013). Randomised trial tested the improvement collaborative model developed by the US NIATx quality improvement resource. Arrangements for services to learn from each other were less effective and less cost effective at improving patient access and retention than assigning each clinic a quality improvement expert to ‘coach’ a service through the process. Related NIATx study listed above and web site below. Discussion in bite’s Highlighted study section.

K Disappointing early results from English payment-by-results schemes ([UK] Department of Health, 2013). Among the 3081 alcohol patients treated in the pilot schemes there was no indication of elevated abstinence rates and the proportion exiting treatment free of dependence was lower than in the rest of England and lower than in the same areas before the pilots. Discussion in bite’s Issues section.

K In Delaware paying for results led to rapid increase in drug-free treatment exits (2008). Rather than specifying treatment inputs like numbers of counselling sessions, the US state of Delaware incentivised patient recruitment, engagement, and drug- and alcohol-free treatment completions; the result was more patients, more engaging treatment, and a rapid increase in satisfactory treatment completions. But there were signs too that services focused on doing enough to earn the rewards without seeking to excel in these or in other ways. Discussion in bite’s Issues section.

K How much should treatment systems rely on residential rehabilitation? (2007). Rare randomised trial confirmed that unless there are pressing contraindications, intensive day options deliver outcomes equivalent to residential care. Often of course, there are pressing contraindications. See also this informal Findings review.

R Recovery-oriented systems of care (2008). Creating a recovery-friendly environment is the best way to sustain resolution of substance use problems argues this (as we described it) “sweeping, learned but practice-oriented tour-de-force”. Discussion in bite’s Where should I start? section.

R Research supporting components of a recovery system ([US] Substance Abuse and Mental Health Services Administration, 2009). Evidence for key elements of recovery-oriented systems of care such as continuity of care anchored in the community and delivered by integrated services on the basis of system-wide education and training. See also associated implementation case studies.

R Policy strategies for improving outcomes (2011). Two of the world’s most respected addiction researchers also with top-level policymaking experience set out the options for improving treatment systems.

R Funding mechanisms for substance use treatment (Report for the Australian Department of Health, 2014). Chapter 6 comprehensively reviews funding mechanisms including payment by results, for which it finds no peer-reviewed evidence that it has improved post-treatment alcohol or drug client outcomes. Part 2 of the report makes recommendations for Australian service planning and commissioning which may in parts be applicable to the UK. Discussion in bite’s Issues section.

G Commissioning alcohol treatment systems in England (National Institute for Health and Care Excellence, 2011). UK’s official health advisory body on organising and procuring treatment services across an area which implement national guidance and satisfy policy requirements. Incorporated in broader commissioning guidance from Public Health England. Expected impacts on drinking built into a spreadsheet (NICE, accessed 2016) enabling commissioners to estimate health gains from a portfolio of interventions.

G Commissioning integrated alcohol harm-reduction systems in England (Public Health England, 2016). Key principles and associated action-prompts for developing an integrated local system to reduce alcohol-related harm, including treatment services which meet NICE standards. One of a suite of commissioning guidance and resources. Supported by a spreadsheet (Public Health England, accessed 2018) enabling commissioners to estimate social benefits and effects on performance indicators.

G Scotland’s vision of a high quality treatment system (Scottish Government and Convention of Scottish Local Authorities, 2014). What for the Scottish Government ‘quality’ consists of in substance use services. Intended to ensure commissioning of the quality of treatment and support services needed to meet the needs and aspirations of a local population. Builds on report (2011 ) on commissioning alcohol services. See also more provider-oriented English guidance.

G Integrated care for drug or alcohol users (Report Produced for the Scottish Advisory Committee on Drug Misuse, 2008). Guidance for Scotland on implementing a treatment system which aims to combine and coordinate all the services required to meet the assessed needs of the patient.

G US NIATx system change resources ([US] NIATx, accessed 2016). Web-based service provided by the University of Wisconsin and supported by US government, offering practical strategies for commissioners and planners to promote change across a treatment system including engaging services in mutual leaning and support, tested in a study listed above. Specific aims include reducing waiting times and improving retention (see this example), and increasing admissions and reducing no-shows (see this study). For discussion click and scroll down to highlighted heading.

more This search retrieves all relevant analyses.
For subtopics go to the subject search page and hot topic on evidence-based commissioning; see also this on-line library of papers related to recovery-oriented systems of care.

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