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Home > Alcohol treatment matrix cell A3: Interventions - medical treatment.

Drug and Alcohol Findings. (2020) Alcohol treatment matrix cell A3: Interventions - medical treatment. Drug and Alcohol Findings Alcohol Treatment Matrix .

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URL: https://findings.org.uk/PHP/dl.php?file=Matrix/Alc...


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 B3 about?

About the treatment of alcohol dependence in a medical context and/or involving medical care, typically by GPs or by alcohol treatment or psychiatric units in hospitals. Clinical staff are responsible for medications, so the centrality of these to an intervention distinguishes it most clearly as medical. Drugs (primarily benzodiazepines) help patients withdraw from alcohol more comfortably and safely, but of greater interest in the current context are the medications (primarily in the UK acamprosate, but also naltrexone and disulfiram; 1 2) intended to tackle dependence itself by sustaining post-detoxification abstinence or promoting abstinence or moderate drinking. An interesting history (2014; free source at time of writing) of pharmacotherapy for problem drinking records that the modern era of these treatments began with the evaluation in 1948 of disulfiram’s power to make subsequent drinking an unpleasant experience 

However, medications are never all there is to medical care. Typically guidelines see psychosocial support as an essential accompaniment, and ‘medical’ treatment may consist entirely of advice and psychosocial support from clinicians. When they are prescribed, the role of medications is usually to help forge a relatively alcohol-free space during which patients can lose the habit of regular drinking, be supported to find other ways to cope, and construct a life incompatible with a return to dependent drinking. Even if there is no formal psychosocial therapy, medication-based treatments also entail potentially therapeutic interactions with prescribers and other staff. Arrangements or programmes to help ensure patients take the medications may themselves be therapeutic, and provide a ‘hook’ on which to enlist family and other associates in the patient’s recovery. Without these supports, any benefits of medication may be lost once the medication phase of treatment ends. All these approaches have been succinctly summarised in guidance listed above for the non-specialist clinician, which along the way provides an overview of recommended medical treatments for drink problems in the UK. 

Though use of alcohol-treatment medication has been increasing in the UK, treatment usually still consists entirely of advice and support. Drugs are almost universally used to ease withdrawal in inpatient units, but in 2018/19 in England in non-residential community settings or primary care, of the 73,556 drinkers not also being treated for drug dependence just 19% were prescribed medication; specifically in primary care, the only identifiably medical setting, it was 47%. As we’ll see later in this commentary, relegation of medications to a minority option seems to reflect their generally minor effects relative to the other influences which constellate into what is misleadingly dismissed as the ‘placebo effect’, to which a section is devoted below. For this ‘disease’, medications usually add little (but on average, do add a little) to the patient’s impetus to get better, the processes in their life which help them realise and sustain this ambition, and the impact of deciding to enter and get actively engaged in treatment, one manifestation of which is regularly taking medication.

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