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 E3 about?

The roles of medical services and interventions within treatment systems for problem drinking implemented across an administrative area. In particular, their role in creating an effective and cost-effective mix of services offering attractive access points and appropriate options for moving between services or using them in parallel. Involves commissioning, contracting and purchasing decisions to meet local needs in the context of resource constraints and national policy. Activities include: assessing the need for different kinds of services; restructuring or re-tendering services; contractual requirements on services to demonstrate evidence-based practice, meet standards, and implement performance monitoring; and financial or other rewards/sanctions linked to activity, quality or outcomes.

A particular challenge is to create systems which can respond to the substantial overlap between substance use and mental health problems, avoiding patients being turned away from either sector’s service because of their other needs, and coordinating care or possibly offering fully integrated care. Below we offer a substantial discussion of these issues in the UK context.

Research on treatment systems is rarely of the ‘gold standard’ randomised-controlled-trial format, and work focusing on medical services is rare, but we can fall back on the studies and reviews in cell E2, which deal with the same topics across alcohol treatment systems as a whole.