The Drug Treatment 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 D3 about?

About the treatment of drug dependence in a medical context and/or involving medical care, typically by GPs or at specialist drug treatment centres or clinics. 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. Even when drugs are prescribed, the clinician-patient relationship influences whether they are taken, and this relationship can be therapeutic in its own right. In turn, clinicians work in a physical and social context which more or less legitimises and supports their work, generally taking the form of a service run by a distinct organisation. 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 also differ in how keenly and effectively they seek and incorporate evidence-based practices.

It is not easy for researchers to manipulate these qualities in order to test their roles in the implementation of evidence-based practices or their effects on outcomes for patients. Instead, observations of real-world practice look for links between organisational qualities and practice and outcomes which may derive from a causal effect of one on the other, but may be due to something else. As a result, rigorous research is scarce, and generic sources beyond the scope of the matrices become more important. If research on an issue which interests you does not specifically relate to medical treatment services, you may be able fall back on cell D2, which deals with similar issues across treatment.

In the UK and US context, and in particular for treatment based in primary care, the kinds of services which choose to treat addiction and are selected for or volunteer to join studies are unlikely to be typical practices. These studies demonstrate the potential of GP practices to offer treatment as safe and effective as specialist clinics and to greatly extend access, but there will be other less experienced or well supported GPs who would not do so well. There is some evidence, for example, that in normal practice in the UK, starting methadone treatment in primary care is not as safe as at specialist clinics, while going back to 1960s Britain, “The drug problem … was seen as the result of inappropriate prescribing by GPs,” leading to the establishment of a network of specialist clinics and limits on the prescribing of all but specially licensed doctors. Clinics too can and have provided sub-optimal treatment, in the 1970s deterring treatment entry by turning way from maintenance prescribing. In the end, it seems quality counts more than the particular medical setting.