The Drug Matrix is concerned with the treatment of problems related to the use of illegal drugs by adults (another deals with alcohol-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 staff, the management of the service, and the nature of the organisation, to the impact of local area treatment systems. Down the rows are the major intervention types implemented at these levels.

What is cell B4 about?

What is this cell about? Every treatment involves direct or indirect human interaction, but this cell is about treatments in which interaction is intended to be the main active ingredient – ‘psychosocial’, or more colloquially, ‘talking’ therapies. They attempt to change the patient’s behaviour directly by ‘shaping’ it through rewards and sanctions, or indirectly via their beliefs and attitudes, how they relate to others, and how others relate to them. Interventions vary in type, intensity and duration; see cell A4 for more on these variations.

Of course, what is done in therapy matters, but as long as this is a well structured, bona fide treatment which ‘makes sense’, the ‘common factors’ shared by different therapies seem more critical to their success. For the patient, the main embodiment of these factors is how the therapist relates to them, the influence of which is apparent in substance use treatment generally and in respect of medical treatments. Unsurprisingly, the evidence is stronger still when the structured enactment of that relationship is the treatment. In this cell we focus on the client-worker relationship, and on whether some therapists are more successful because they more strongly forge the right kind of relationships – ‘therapeutic’ relationships.