The Alcohol Treatment Matrix is concerned with the treatment of alcohol-related problems among adults (another deals with drug-related problems). It maps the treatment universe and for each sub-territory (a cell) lists the most important UK-relevant research and guidance. Across the top, columns move from specific interventions through how their impacts are affected by the widening contexts of practitioners, management, the organisation, and whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. Inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level. 

What is cell C3 about?

About the treatment of alcohol dependence in a medical context and/or involving medical care, typically by GPs or at alcohol treatment or psychiatric units in hospitals. Clinical staff are responsible for medications, so the centrality of these to an intervention distinguishes it most clearly as medical. However, medications are never all there is to medical care and most treatments do not feature them. Though almost universally used to ease withdrawal in inpatient units, in 2018/19 in England just 19% of the 73,556 ‘alcohol-only’ patients being treated in the community were prescribed an anti-alcohol medication. Narrowing in on primary care – the only identifiably medical setting – it was 47%, still just under half. Guidelines typically see psychosocial support as an essential component of treatment, and ‘medical’ treatment may consist entirely of advice and psychosocial support from clinicians. Apparent also in the studies listed in cell B2, how clinicians relate to patients affects whether they enter (study listed above) and engage in treatment. The clinician-patient relationship may also be a therapeutic influence in its own right.

This cell focuses on how these processes are affected by the management functions of selecting, training and managing staff, and managing the intervention programme. In highly controlled studies, it may be possible to divorce the impact of interventions from the management of the service delivering them, but in everyday practice, whether interventions (cell A3) get adopted and adequately implemented, and whether practitioners (cell B3) are able to develop and maintain recovery-generating attitudes and knowledge, depend on management and supervision.