Effectiveness Bank web site Matrix row
Supported by Alcohol Change UK web site. The national UK charity that aims to create evidence-driven change to reduce alcohol-related harm Alcohol Change UK
The national charity working
to end alcohol harm through
evidence-driven change

Matrix Row logo Alcohol Matrix row 3: Medical treatment
Row 3 of the Alcohol Treatment Matrix explored the treatment of alcohol dependence in a medical context or involving medical care. The centrality of medications most clearly marks an intervention as medical, but for this ‘disease’, medications do not have reliable, mechanical effects. The evidence challenges us to place drugs in the context of the practitioners delivering them, managements and organisations which shape the therapeutic environment, and the local treatment system’s preparatory, supportive and follow-on care.

Cell A3 Doctors and drugs; medical interventions
Starts with the study which questioned the orthodoxy that ‘alcoholism’ demands intensive treatment, highlights trials of the UK’s three approved medications, then explores how to enable or encourage patients to take the pills, the status of disulfiram, most controversial of the mainstream pharmacotherapies, and the importance of the wrongly disparaged ‘placebo effect’.

Cell B3 ‘Bedside manner’ matters; focus on the practitioner
Bedside manner is not just a conduit for treatment: to a substantial degree, it is the treatment. Learn from seminal studies that patients “sensitized to rejection” assess their clinicians as much as the reverse, and investigate what research can tell us about what makes a clinician ‘good’.

Cell C3 Managing to make the most of medical care
Key research on the management of medical interventions and treatments. Highlights the remarkable transformation of a US clinic in the 1950s by an open-minded manager, then addresses three key management issues: How do you identify effective clinicians? Worth ‘stepping up’ to more intensive treatment if initial treatment fails? Can research tell us which patients do best on which medication?

Cell D3 The organisation is the healing context
How treatment organisations affect the implementation and effectiveness of medical treatments. Asks whether evidence-based innovation is always a good thing, explores the evidence for and against integrating medical care with the treatment of alcohol dependence, and investigates the impact of quality in primary care practices.

Cell E3 Treatment systems transcend individual services
Moves out to the level of whole treatment systems, highlighting the simple US innovation which routed detoxification recyclers into longer term remission. See if your vision of a ‘good’ service corresponds with that of an expert group, and explore whether Britain is making progress on organising care at the substantial overlap between problem drinking and mental illness.