2019/20 update funded by

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Previously also funded by

Society for the Study of Addiction web site Society for the Study of Addiction

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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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Interventions; Generic and cross-cutting issues

Seminal and key studies shedding light on aspects of the treatment of problem drinking relevant both to psychosocial and medical approaches.

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

S Shock to the system: handing patients responsibility matches extended treatment (1999). Describes study in London (1977) which questioned the orthodoxy that alcoholism requires intensive treatment. After thorough assessment, a single brief session handing responsibility to the couple to cure the husband’s alcoholism worked as well as the extended treatment of the time. See also commentary (2015) around four decades later from a study researcher dicusssed in bite’s Highlighted study section. The trial was broadly replicated (1988) at a Scottish alcohol clinic, where there was more evidence that extended treatment led to some (but still generally insignificant) further improvements.

S Empathy and organisation transform alcohol clinic (1970). Remarkable series of US studies from the late 1950s proved that an alcohol clinic’s intake and attendance can be transformed by systematically treating patients with warmth and respect. See also slide presentation and video, which end by focusing on the featured studies. Discussion in bite’s Where should I start? section

S Pioneering insight into common factors in therapy (1991). First published in 1961 and culminating in a third edition in 1991, Jerome D. Frank’s book Persuasion and Healing was a pioneering insight into the important features shared by effective therapies in mental health including the addictions, features now widely acknowledged as more influential than the specific theories and methods of different approaches. Discussion in bite’s What are these ‘common factors’? section.

K Treatment entry often the key event (2005). Reanalysis of data from the multi-million dollar US Project MATCH trial showed treatment entry was associated with major drinking reductions even before any or much treatment had been delivered, suggesting to the analysts “current treatments are not effective”. See the rejoinder (2005) from a MATCH researcher, and an informal commentary (2008) from Drug and Alcohol Findings on the implications of this and similar findings. Discussion in bite’s Highlighted study section.

K Non-residential rehabilitation usually matches residential ... but not always (2007). 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.

K Motivating aftercare (2007). US inpatient treatment centre systematically applied simple prompts and motivators to substantially improve aftercare attendance and sustain recovery. See also later report from same study.

K Remission is the norm, but some take longer to get there (2011). US national survey found just a third of all formerly dependent drinkers remained dependent three years later, but among the most severely affected drinkers with multiple psychological problems, the proportion was twice as high despite more extensive treatment. Three-quarters of dependent drinker remitted without any treatment.

R Half of all problem substance users recover (2010). In the general population and in treatment samples, on average studies have found half (or more in recent studies) of all problem substance users were later in remission. After treatment, six out of ten remitted by becoming abstinent, but among general population samples, six out of ten continued to use.

R Engaging the treatment-resistant (2010). Shock-tactic confrontation and tough-love disengagement found less likely to persuade dependent users in the family to enter treatment than a ‘community reinforcement’ approach aimed at engaging them in fulfilling activities incompatible with continued substance use.

R Tailor induction (2005). Some patients need motivation bolstered and options explored, for others this is not just unnecessary but counterproductive.

R All well-structured therapies work equally well (2008). After combining results from relevant alcohol studies, this ingenious analysis found any structured approach grounded in an explicit model as good as any other.

R Effective ways to relate to clients (American Psychological Association, 2011). Effective ways to relate to psychotherapy clients (and by extension, other clients and patients) like forming a therapeutic alliance, being empathic, and appropriately adjusting to the individual. Also, what to avoid.

R Continuing care does help (2014). Synthesis of research built on an previous review (2009) by adding 13 studies to the 20 identified earlier and aggregating all substance use outcomes reported in the trials. Finding was that patients allocated effectively at random to aftercare/continuing care engaged in slightly but significantly less substance use at follow-up.

G Official British guidance on how to assess and treat problem drinking (National Institute for Health and Care Excellence, 2011). Recommendations from Britain’s health technology advisers on overall principles and particular interventions. Among the former are that therapeutic staff should aim to build a trusting relationship with clients and work in a supportive, empathic and non-judgmental manner.

G Principles of effective treatment (2006). Based on reviews commissioned by the American Psychological Association, tries to take the therapist as far along the road as possible to evidence-informed practice, acknowledging that “There is no empirically complete formula to allow clinicians to plan and deliver with complete confidence the right treatment for any incoming client with a substance use disorder.”

G US guidance on matching patients to intensity and type of care (American Society of Addiction Medicine, 2013). From the professional body for US addiction clinicians, world’s most widely used criteria for deciding what kind of treatment to start with or move on to for different kinds of patients.

G Strategies to promote continuing care (2009). Expert US consensus on practical strategies to promote aftercare/continuing care based on review of principles of addiction treatment.

G Crucial case management role (Association of Alcohol and Other Drugs Agencies Northern Territory, 2015). Australian state ‘peak’ body for non-governmental drug and alcohol services offers guidance on the important and widely implemented (but barely researched) role of the case manager in integrating and coordinating service delivery.

more Search for all relevant Effectiveness Bank analyses or for subtopics go to the subject search or hot topics on promoting recovery through employment, mutual aid and user-involvement, the need for residential care, individualising treatment, and matching alcohol treatments to the patient. See also the collection of analyses indexed on ‘common factors’.

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