Alcohol Treatment Matrix cell A4: Interventions; Psychosocial therapies

2020/21 update funded by

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Alcohol Change UK

Previously also funded by

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

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Includes brief interventions

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Interventions; Psychosocial therapies

The most important seminal and key studies on the general principles underpinning psychosocial therapies and the effectiveness specific approaches. 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

S Confrontation provokes resistance (1993). Among US heavy drinkers motivational interviewing’s non-confrontational style reduced both resistance and drinking compared to an explicitly challenging approach. See also this review (free source at time of writing) of the positive role of subtle forms of ‘confrontation’ in motivational interviewing. Discussion in bite’s Issues section.

S Treatment services can radically affect access to mutual aid (1981). Direct contact with 12-step group members during treatment who then helped patients to meetings created a 100% turn-round in attendance compared to usual encouragement and information. Just 20 patients were allocated to these alternative referral procedures by a toss of a coin, but this early study was a convincing demonstration that treatment services can radically affect access to mutual aid.

S Client-centred group therapy works best (1957). For its time methodologically advanced, this US study found the Rogerian, client-centred approach characterised by non-directive, empathic listening (for which see cell B4) which underpins motivational interviewing generated healthier self-perceptions among alcohol-dependent patients and reduced relapse compared to approaches based on learning theory or psychoanalysis. Discussion in bite’s Where should I start? section.

K No added value from motivational interviewing (2012). Other than fleetingly and non-significantly, motivational interviewing’s change-promoting strategies did not seem to promote extra change among the stable, moderately dependent drinkers recruited to this US trial. If anything, non-directive Rogerian therapy stripped of motivational interviewing’s ‘active’ ingredients worked best, and a ‘self-change’ option was almost as effective as both. Discussion in this cell’s Issues section and also in cell B4.

K Expected differences between therapies not found in UK (2008). Results of the largest yet UK alcohol treatment trial confounded expectations that a motivational approach would best suit unmotivated or hostile clients, and that clients lacking social supports would do best when this was explicitly addressed. Overall too, neither therapy significantly bettered the other. Discussion in bite’s Where should I start? and Highlighted study sections.

K Project MATCH confounds expectations (1999). Landmark US trial designed as a definitive test of matching different types of clients to different therapies instead confirmed the importance of the ‘common factors’ underlying seemingly distinct approaches; for more see the book (2002) of the project. Discussion in bite’s Where should I start? section.

K In relapse prevention, practice makes (more) perfect (1997 and 2000). Practising relapse prevention skills rather than just discussing them boosted confidence and helped newly detoxified Scottish patients stay sober longer.

K 12-step group attendance boosted in London but not abstinence (2012). Tested the ambition to extend recovery beyond formal treatment by systematically linking patients to mutual aid groups. Most patients had just been detoxified from alcohol. Attendance at 12-step groups was substantially boosted but not abstinence from the primary problem drug, a pattern not unusual in similar US studies. Relative to alternatives, treatment based on encouraging AA involvement has generally not further reduced heavy drinking or drink-related consequences. See also this review (2004) of how treatment services can promote mutual aid.

R All bona fide ‘talking 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. We have, it was argued, been looking in the wrong direction for therapy’s active ingredients. See these reviews for similar verdicts on motivational interviewing (2011) and cognitive-behavioural therapy (2009). Discussion in bite’s Where should I start? section.

R Common relationship factors (American Psychological Association, 2011). Introduces reviews based on the understanding that treatment methods are not simply technical interventions, but ways client and therapist relate, so cannot be divorced from the general relationship between client and therapist. From here you can find the component reviews and the overall conclusions (2011) reached by the American Psychological Association’s task force. Discussion in bite’s Where should I start? section.

R Motivational starts to treatment better without the manual (2005). Findings review discovered that motivational interviewing is not always a positive alternative to more directive approaches, and that motivational interviewing has worked best when the therapist is not constrained to a manual. Latter conclusion confirmed by a synthesis (2005) of research findings (free source at time of writing). Discussion in bite’s Issues section (1 2).

R Directiveness is a key difference between therapies (2006). Rather than specific techniques, the interpersonal style (eg, directive v. patient-led) associated with different therapies is why some work better with some clients than others. Discussion in bite’s Where should I start? and Issues sections.

R Peer-based addiction recovery (2009). Includes chapter on the evidence for AA and allied mutual support networks and treatments based on the same principles and networks. See also a review (2004) of how treatment services can promote mutual aid and a synthesis of studies (1999) of approaches based on AA/NA’s 12-steps versus alternative treatments.

R Some patients get worse (2005). Reminder that after psychosocial therapy up to 15% of clients end up worse than before. Some of the reasons are thought to be a weak client-therapist relationship, failing to assess how clients are doing, being confrontational or critical, low or inappropriate expectations, and lack of challenge. Discussion in bite’s Issues section.

R If patient is in suitable couple, work with both (2011). Problem drinkers in a stable relationship do better when the focus is at least partly shifted to working with the couple to foster sobriety-encouraging interactions.

R How lasting are the effects of offering prizes for abstinence? (2014). Free source at time of writing. Systematically giving substance use patients a chance to win valuable prizes if they test abstinent offers a lower-cost alternative to other ‘contingency management’ systems which provide rewards each time. Research synthesis shows that in the short term it works, but effects soon fade.

G NICE guidance on treating problem drinking (National Institute for Health and Care Excellence, 2011). UK’s official health advisory body recommends overall principles and particular interventions. Discussions in bite’s Issues section (1 2).

G Principles for how to relate to counselling/therapy clients and the content of sessions (2006). Free source at time of writing. Based on reviews commissioned by the American Psychological Association. Reviews evidence and offers in-principle guidance on how to relate to clients and the content of sessions. Argues that these principles “provide a more research-informed and potentially effective approach to treatment than either the application of a one-size-fits-all standard treatment protocol or the use of idiosyncratically selected interventions”. Free source available at time of writing. Discussion in bite’s Where should I start? and Issues sections.

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page or hot topics on contingency management, residential rehabilitation, motivational interviewing.

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