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 C4 about?

Every treatment involves direct or indirect human interaction, but this cell is about the management of treatments in which interaction is intended to be the main active ingredient – ‘psychosocial’ or ‘talking’ therapies. Based on varied understandings of how dependence arises and how it can be overcome or ameliorated, they attempt to change how the patient behaves via their beliefs and attitudes, how they relate to others, and how others relate to them, or directly by ‘shaping’ behaviour through rewards and sanctions. Programmes range in form from brief advice and counselling to extended outpatient therapies and all-embracing residential communities where clients stay for months.

Differences between psychosocial therapies have been tested and contested and occupied the lion’s share of research time, but as long as it is a well structured, bona fide treatment which ‘makes sense’ to patient and therapist, the ‘common factors’ shared by supposedly distinct therapies (on which see see cell A4) seem more critical to their success.

The content and approach of these therapies and the qualities of the staff delivering them matter of course, but so too do the management functions of selecting, training and managing staff, and managing the intervention programme, including how a service decides treatment goals and which types of patients are offered which therapies. In highly controlled studies, it may be possible to divorce the impact of interventions from the management of the service delivering them, but in everyday practice, whether interventions get adopted and adequately implemented, and whether staff are able to develop, maintain and improve competence, depend on management and supervision. These functions are the focus of the current cell.

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