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 D2 about?

As well as concrete things like staff, management committees, resources, and an institutional structure, organisations have links with other organisations, histories, values, priorities, and an ethos, determining whether they offer an environment in which staff and patients/clients can maximise their potential. For these and other reasons, agencies differ in how keenly and effectively they seek and incorporate knowledge and implement evidence-based practices. The best might, for example, have effective procedures for monitoring performance and identifying where improvements are needed, facilitate staff learning from research and from each other, and forge learning or service-provision links with other organisations. Openness to change and encouraging sources of change such as research and feedback from staff and patients emerge (eg, see our commentary on study listed above) as key attributes.

In the treatment of conditions affected by thoughts and emotions, it is “the meaning the client gives to the experience of therapy that is important,” and that meaning is constructed from the context within which an intervention is delivered. Forming part of that context is the setting provided by the organisation, its administrative procedures, and its clinicians, whose intervention style, optimism and expectations of treatment will be affected by the organisation within which they work. “Patients may improve simply because they are placed in places that are symbols of competent care,” reviewers have concluded. Rather than seeing the intervention as the treatment, arguably it is more realistic to see treatment as a package of interacting elements including (among other factors) the intervention, the way the therapist relates to the patient, the patient’s predispositions, responses and how they manage their condition, and the credibility of the context as a healing environment.

Defining the treatment package in this way means that each of these factors affects not just how the patient feels about their treatment, but the impact it has on the condition being treated. Research cited in this cell is about the impact of these attributes at the level of the organisation. At this distance from the preoccupation with intervention effectiveness, research is scarce, and generic sources beyond the scope of the matrices become more important.