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 E4 about?

The roles of the ‘psychosocial’ therapies introduced in cell A4 in building a cost-effective mix of services across an administrative area which offers people with alcohol use problems attractive access points, appropriate options for moving between services or using them in parallel, and which promotes the integration of services to achieved holistic and lasting recovery.

In this endeavour, psychosocial therapies are critical. Though medication use has been increasing, treatment usually still consists entirely of advice and support. Medications are almost universally used to ease withdrawal in inpatient units, but in itself this is not a treatment for the dependency which gave rise to the need for managed withdrawal. Treatment for alcohol dependence mainly occurs in non-residential community settings or primary care. In those settings in 2018/19 in England, of the 73,556 drinkers not also being treated for drug dependence, just 19% were prescribed a medication to treat their dependency; specifically in primary care, the only identifiably medical setting, it was 47%, still under half.

Creating a local treatment system involves commissioning, contracting and purchasing decisions to meet local needs in the context of resource constraints and national policy. At this level, research is rarely of the ‘gold standard’ randomised-controlled-trial format. Unlike intervention programmes, whole treatment systems are not easily manipulated by researchers into one sort versus another based on the equivalent of a toss of a coin, leaving us largely reliant on studies of how things work out in the ‘messier’ world of everyday practice. These studies have to try to adjust for the multiple influences and differences between areas which obscure the impacts of the features researchers are attempting to assess. Such studies will often include but not focus on psychosocial services, making the corresponding cell on treatment systems as a whole of relevance also to this cell.