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Matrix row

Alcohol Change UK The national charity working to end alcohol harm through evidence-driven change

Alcohol Matrix, row 5: Safeguarding the community

Defocuses from the patient to ask what treatment can do for the rest of us in the form of reducing crime and safeguarding families and communities. Core theme is the playing out of the contradictions between segregation and punishment and reintegration and rehabilitation, explored at the level of interventions, client/offender-worker relationships, service management, treatment organisations, and treatment systems.

Cell A5 The interventions: why is the record so poor?

Asks whether the conflict between centring on the patient’s welfare versus controlling them to safeguard family and community is why the record of criminal justice interventions is so poor, highlights the most robust test yet of brief alcohol counselling in probation, and explores whether it can ever be safe to leave children with severely dependent drinkers.

Cell B5 What if the therapist works for the jailer?

The title poses the dilemma for alcohol treatment staff (seen as) working for authorities controlling or punishing the ‘client’ or deciding on removing their children. Argues that in these situations exceptional abilities are needed to forge productive relationships, asks if it’s best to divorce therapy from supervision, and invites you to ‘stress test’ a proposed universal rule: The trickier the situation, the more the worker matters.

Cell C5 Managing to extract therapy from punishment

A rare review specific to the treatment of problem drinking in criminal justice settings argues that “the justice system usually communicates to the offender that treatment is punishment,” making staff competence and the managers who sustain that competence critical. Highlights the first trial of the influential ‘risk-need-responsivity’ model for matching intervention to offender, queries whether cognitive-behavioural approaches are the way forward, and asks how managers can prioritise the child when the parent is the patient.

Cell D5 Organisations set the context for crime-reducing treatment

Studies teasing out organisational-level influences on treatment for drinking problems which aims to reduce crime and safeguard family and community. In the context of a market which drives treatment organisations to expand, asks, “Is small beautiful?”, explores how supervision responsibilities might undermine therapy, and pursues the implications of transitioning to family- rather than patient-focused treatment.

Cell E5 How far should collaboration go?

An Australian review argues that despite radically different starting points, criminal justice and treatment systems must collaborate to deliver treatment. How far should collaboration go? Where do we draw the line between the confidentiality of the consulting room versus sharing information with criminal justice and child protection? And why is drinking so prominent among prisoners, but not in prison services?