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Practitioners; Medical treatment

The most important seminal and key studies and reviews shedding light on the impact of the practitioner in medical interventions and treatment for alcohol problems in medical settings.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Commitment to working with problem drinkers affects engagement (1996). See also related paper from same study (1996). At an English alcohol treatment clinic assessment workers differed greatly in how many of their patients went on to engage with treatment; how committed they were to working with a client (‘therapeutic commitment’) affected both therapeutic relationships and engagement. Later studies (1980) from the same team found therapeutic commitment depended on workplace support for dealing with drink problems. Discussion in bite’s Highlighted study and Issues sections.

S It’s the way you say it (1970). Final step of a remarkable series of studies from the late 1950s found that the warmth and concern a doctor expressed towards alcoholics in general was strongly related to whether at a US emergency department a year before their patients had followed through on the same doctor’s referral to the hospital’s alcohol treatment clinic. Discussion in bite’s Highlighted study and Issues sections.

K Doctor’s optimism and flexibility improve outcomes (2008). In the arms of the US COMBINE alcohol treatment trial which evaluated medical care with medications but without psychosocial therapy, what made the difference to patients’ drinking and clinical progress seemed to be how far the clinician maintained confident optimism and responded to the patient rather than strictly adhering to a treatment manual. Discussion in bite’s Issues section.

K Patients do best when they feel GPs know them and communicate well (2007). Free source at time of writing. US patients referred to primary care after detoxification reduced alcohol problems most when they saw doctors they trusted, they felt knew them as a whole person, and who probed/communicated thoroughly and well. Discussion in bite’s Issues section.

R Clinicians’ impact on treatment quality (2000). Free source at the time of writing. Impacts on retention and outcome related to professional characteristics, recovery status, adherence to protocols, countertransference, alliance, personality, beliefs about treatment, and professional practice issues. Concludes that “clinicians’ actual record of work with patients (eg., retention and outcome within their caseload) varies greatly between clinicians. Moreover, past assumptions that levels of training, experience, or other simple therapist variables could account for such differences does not hold.” Discussion in bite’s Where should I start? section.

G What UK doctors should do and be able to do ([UK] Royal College of Psychiatrists and Royal College of General Practitioners, 2012). Guidance from UK professional associations for GPs and for psychiatrists on the competencies, training and qualifications expected of doctors involved in caring for substance users, from generalists such as doctors in emergency departments to general practitioners and addiction specialists.

G What UK specialist addiction doctors should do and be able to do ([UK] Public Health England, Royal College of Psychiatrists and Royal College of General Practitioners, 2014). Guidance from body overseeing addiction treatment in England and from professional associations for GPs and for psychiatrists on the “essential functions which can usually only be carried out by addiction specialist doctors”, and the importance of retaining their expertise in the sector.

G What US specialist addiction doctors should do and be able to do ([US] American Society of Addiction Medicine, 2014). Consensus guidelines from the US professional association for doctors specialising in treating addiction on what they are expected to do and the standards they should meet at stages in the addiction care process from assessment to aftercare.

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