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 at 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. However, medications are never all there is to medical care and most treatments do not feature them. Though almost universally used to ease withdrawal in inpatient units, in 2018/19 in England just 19% of the 73,556 ‘alcohol-only’ patients being treated in the community were prescribed an anti-alcohol medication. Narrowing in on primary care – the only identifiably medical setting – it was 47%, still just under half. Typically guidelines see psychosocial support as an essential component of treatment, and ‘medical’ treatment may consist entirely of advice and psychosocial support from clinicians. 

Apparent also in the studies set in hospital treatment units listed in cell B2, how clinicians relate to patients affects whether they enter (study listed above) and engage (study listed above) in treatment. The clinician-patient relationship may also be a therapeutic – or possibly anti-therapeutic – influence in its own right. Even when medications are prescribed, the clinician-patient relationship remains critical. Effective prescribing requires the collaboration of the patient to stay in and complete treatment, to help select the appropriate medication and dose, and to help monitor the need for changes by disclosing their use or non-use of the medication, how they have reacted to it, and their drinking or drug use. Good relationships also promote the provision of broader psychological, social and practical support, which can improve substance outcomes.....