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 A4 about?

 Every treatment involves direct or indirect human interaction, but this cell is about therapies in which interaction is intended to be the main active ingredient. Colloquially referred to as ‘talking therapies’, these are formally designated ‘psychosocial’ approaches. They attempt to change how the patient behaves either directly, or via their beliefs and attitudes, how they relate to others, and how others relate to them. For an ‘alcoholic’ or ‘addict’, simply being related to and valued in a caring context centred on your aspirations, needs and welfare may be a live-changing experience in itself, but usually there are also specific techniques or strategies derived from different understandings of how dependence arises and how it can be reversed.

Interventions vary in type and in intensity and duration. They range from brief advice and counselling to extended therapies based on psychological theories, and all-embracing residential communities where clients stay for several months.

Techniques and strategies might include: rewards and punishments contingent on client behaviour (contingency management); leading the client to see their substance use as contrary to desired self-images or objectives (as in motivational interviewing); harnessing social influences (as in group and family therapies and community living arrangements); identifying with the client what triggers their undesired substance use and training them how to manage or avoid those triggers (as in cognitive-behavioural therapies); ways to manage thoughts and moods which otherwise might precipitate relapse (as in mindfulness approaches); and more practical elements, such as those intended to upgrade the patient’s employability.

Whether based on research, theory, religion, morals or experience, belief systems underlie these approaches. Most prominent in the research are the 12 steps of Alcoholics Anonymous and allied fellowships, and the understanding that addiction can be learnt and unlearnt, which underpins major psychological therapies, including those recommended by the UK’s official health advisory body, the National Institute for Health and Care Excellence (NICE).