One of 25 cells in the Alcohol Treatment Matrix
Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing psychosocial therapies and the role of those therapies within the same systems.
S Seminal studies K Key studies R Reviews G Guidance more Search for more studies
Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text
S 0% mutual aid group attendance with usual procedures, 100% with systematic encouragement (1981). Early and tiny trial pioneered procedures to link alcohol treatment patients to mutual aid groups. None offered just information attended in the following week, but everyone systematically encouraged by procedures which included a phone call with an existing member, who accompanied the patient to their first meeting. Similar procedures have been trialled in contemporary UK and US studies. Discussion in bite’s Issues section.
K Difficult, but system change can be engineered and extend service delivery (2012). Results in US states included extending anti-relapse alcohol medication to more clinics and the implementation of psychosocial approaches which promoted continuing care by facilitating the transfer of patients between services. Siting case managers at detoxification services has been (2006) one successful transfer tactic, discussed in cell E3’s bite.
K De-individualisation forced by cost-containment associated with worse treatment outcomes (2008). Advanced US analysis of comprehensive data from a national treatment study found substance use outcomes were relatively poor after treatment at centres constrained by funders in the services they could offer and in their ability to individualise treatment, but relatively good in services subject to quality accreditation.
K Promoting SMART Recovery mutual aid (2010). What worked in disseminating a cognitive-behavioural alternative to 12-step mutual aid in England. Key theme was the tension between being supported versus being co-opted by treatment services. Much of the research relates to 12-step groups but may also apply to other mutual aid approaches. For this work see bite’s Issues sections (1 2).
K Active referral promotes NA/AA attendance in UK but abstinence not significantly improved (2012). Systematic encouragement from either a doctor or a peer (especially the latter) substantially improved attendance at 12-step groups, but impacts on abstinence were smaller and not statistically significant. Corresponding US study below. Discussion in bite’s Issues section.
K In USA active and persistent attempts to link patients to mutual aid groups helps reduce substance use (2007). Among patients treated by the US medical service for ex-military personnel (the Veterans Affairs Health Care System), persistent and practical efforts strengthened 12-step group involvement after treatment and modestly improved substance use outcomes. Corresponding British study above. Discussion in bite’s Issues section.
K Text chat therapy (2011). Dutch trial of internet-based therapy for problem drinking via text-chat conversations found this improved on an automated self-help option. Impacts of this programme were included in a simulation study (2011) which suggested health would improve and/or costs reduce if across a country on-line interventions supplemented or replaced conventional care.
R Peer-based recovery support services (2009). Compendious review discussed in bite’s Highlighted study section. Will inform (among others) planners and commissioners of services aiming to improve linkage to mutual aid groups and other peer-based recovery support resources, interventions discussed in bite’s Issues section. Also reviews literature on peer-based support itself, for which see discussion in bite’s Issues section.
R Attending AA meetings after treatment helps sustain drinking reductions (2014). That was the implication of this innovative analysis, but does that mean treatment services improve drinking outcomes by actively promoting participation in 12-step fellowships? Our commentary tackles this issue head on and finds the evidence equivocal. Relevant discussions in bite’s Issues sections (1 2).
R Varieties and impacts of case management (2006). An expert Euro-US collaboration examines a core mechanism for transforming isolated episodes of care into coherently staged and comprehensive reintegration programmes – a ‘case manager’ who remains a stable hub orchestrating different phases of service delivery. See also US guidance below. Discussion in bite’s Issues section.
R Severe cases differentially benefit from residential care (2003). Notes from Drug and Alcohol Findings on studies comparing residential with non-residential treatment. Concludes that for patients who accept and can safely be sent to either, there is little to choose between them. Severe cases may however differentially benefit from residential care. See also a review (2006) limited to randomised trials of therapeutic communities.
G Commissioning an alcohol intervention and treatment system ([UK] National Institute for Health and Care Excellence, 2011). UK’s official health advisory body on how commissioners should organise and procure treatment services across an area which implement related national guidance and satisfy policy requirements. On psychosocial interventions NICE took its lead from associated clinical guidelines ([UK] National Institute for Health and Care Excellence, 2011). Discussion in bite’s Where should I start? and Issues (1 2) sections.
G Setting up a local treatment system ([UK] Department of Health and National Treatment Agency for Substance Misuse, 2006). Guidance for local health organisations and their partners on delivering a planned and integrated treatment system for adult problem drinkers.
G Integrated care for drug and alcohol users (Report Produced for the Scottish Advisory Committee on Drug Misuse, 2008). Treatment system guidance for Scotland.
G Organising holistic and continuing care ([US] Substance Abuse and Mental Health Services Administration, 1998). US consensus guidance on case management to orchestrate the range of services often needed to promote lasting and multi-faceted recovery. Related review above and discussion in bite’s Issues section.
more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page and hot topics on computerised therapy and advice, residential rehabilitation and commissioning.