Effectiveness Bank Alcohol Treatment Matrix row 2. Generic and cross-cutting issues

Matrix row

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

Alcohol Matrix row 2: Generic and cross-cutting issues

Explores key research on the shared elements of effective treatment. Driven by the ‘negative’ findings of a huge US trial, a pivotal moment was the (re)recognition that interventions work partly because their cultural fit bequeaths them this power. Moving out from interventions to practitioners, the way they are managed, the host organisation, and the treatment systems enfolding them all, the matrix exposes the interdependencies between these layers. When these mesh, they can generate solutions which make sense to patients and clinicians, delivered in environments and ways which promote optimism and desired change. If this makes treatment seem little more than a placebo, try reframing that, and seeing the ‘placebo effect’ as the major active ingredient.

Cell A2 The ‘common factors’ at the heart of treatment

Prompted by the ‘failure’ of their multi-million dollar project, researchers on the US Project MATCH trial were driven to the recognition that treatment is closer to “a culturally appropriate solution to a socially defined problem” than a technical fix to a medical dysfunction.

Cell B2 At the crux: the encounter between clinician and client

Influences explored across the matrix come to a head in the encounter between clinician and client. Take a step back and (in the words of one of this cell’s reviews) you will see that therapies may be the “trees”, but the “forest” is the client-therapist relationship.

Cell C2 The transformational potential of management

Interventions and practitioners operate in services shaped by leaders. At this level, whole services can be transformed from ‘going through the motions’ into effective client-engagers. Along the way, learn the fascinating history of the most controversial issue in alcohol treatment: whether to insist that dependent drinkers try for abstinence.

Cell D2 The organisation is the healing context

Introduces the freely available resource which has done most to promote evidence-based improvements in treatment organisations, highlights “Exceptionally seminal” British studies from the ’70s, then asks what characterises an engaging and effective service and whether these qualities can be engineered.

Cell E2 Getting the (treatment) system right

With the central reins relaxed, local commissioning has become key to establishing recovery-generating treatment systems with diminished resources. Payment-by-results schemes were meant to lead the way, but have they led us backwards instead? Explores the surprising results of a rare randomised trial of service-improvement mechanisms, and finds no simple answer to how many drinkers should be in treatment.