Home > Alcohol Matrix cell B3: Practitioners - medical treatment.

Drug and Alcohol Findings. (2016) Alcohol Matrix cell B3: Practitioners - medical treatment. London: Drug and Alcohol Findings and the Substance Misuse Skills Consortium. 3 p.

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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. But drugs are never all there is to medical care, and are prescribed in a relapse-prevention role to only a minority of patients in Britain. Even when they are prescribed, the clinician-patient relationship influences whether the drugs are taken and is also a therapeutic – or possibly anti-therapeutic – influence in its own right. Apparent also in the studies set in hospital treatment units listed in cell B2, how clinicians relate to patients affects whether they enter and engage in treatment. Through these mechanisms and perhaps also directly, relationships ultimately affect the degree to which treatment helps overcome drinking problems.

Pinning down the impact of these influences is however much harder than pinning down the impacts of medications or other specific interventions. To set the scene for randomised trials, researchers can ensure some patients get treatment x, and others treatment y or no treatment at all. The relationship-forming qualities of treatment staff are less easily controlled. Rather than deliberately allocating patients to workers known to differ along these dimensions, studies often have to rely on an association between outcomes and relationship quality or staff attributes observed in everyday practice, or as a by-product of a trial organised for another purpose. Usually the most that can be said is that the findings are consistent with these qualities affecting outcomes, not that they actually did affect outcomes. Usually such research designs cannot eliminate the possibilities that clinicians are reacting to the patient’s progress rather than causing it, that patients differed from the start, or that the clinician’s behaviour and the patient’s progress are both related to other factors.

However, difficulty in demonstrating to scientific standards that something is true, does not mean it is untrue. Observations and patient feedback testifying to the role of the clinician-patient relationship are persuasive, if not clinching, evidence.

Item Type:Evidence resource
Drug Type:Alcohol
Intervention Type:AOD disorder, AOD disorder drug therapy, AOD disorder treatment method
Source:Drug and Alcohol Findings
Date:November 2016
Pages:3 p.
Publisher:Drug and Alcohol Findings and the Substance Misuse Skills Consortium
Corporate Creators:Drug and Alcohol Findings
Place of Publication:London
EndNote:View
Subjects:B Substances > Alcohol
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
J Health care, prevention and rehabilitation > Treatment and maintenance > Patient attitude toward treatment
J Health care, prevention and rehabilitation > Treatment and maintenance > Provider / worker / staff attitude toward treatment
J Health care, prevention and rehabilitation > Health care delivery
T Demographic characteristics > Substance or health care worker
T Demographic characteristics > Doctor
T Demographic characteristics > Nurse

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