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 A2 about?

Medical and psychosocial interventions are respectively covered in cells A3 and A4; this cell is about the ‘common factors’ they share. Whatever the treatment, patients have to decide to seek or accept help and access it. At a practical level, decisions must be made about treatment objectives and the form, intensity and duration of care, relationships forged, and attention paid to psychological problems and social circumstances which affect the chance of sustained remission. At a deeper level, influences include the fact that someone or some institution has identified the patient/client as in need of and deserving help, believes they will benefit, is an accepted authority on the problem and its solutions, and offers a credible remedy via which they instil confidence and optimism – components often sidelined as the ‘placebo effect’, but which are actually active ingredients widely recognised as at least as important as the particular therapy.

Across medicine there are calls not just to recognise the power of the ‘placebo effect’, but to manipulate it in the in the interests of the patient. The flip side is avoiding counterproductive manifestations of common factors, such as negative expectations of the treatment or its side effects, or interactions with the patient which obstruct engagement with or the effectiveness of treatment. In the treatment of drinking problems and medicine generally, these negatives seem more powerful than the positives. At this level there are few or no universal truths; in certain contexts what are normally thought of as beneficial elements may be counterproductive. An example is encouraging unrealistic expectations of a treatment’s benefits or the probability of success, risking when these do not materialise increased distress, pessimism, and a sense of having failed in treatment on top of having ‘failed’ in life by becoming in need of treatment. Even empathy – often lauded as the essence of effective therapy – is not always positive … it all depends.

Also here we touch on the nature of dependence and the caseload seen in treatment services, helping place those services in the context of the spectrum of dependent substance use in society and the ‘natural’ processes of recovery which treatment seeks to harness and accelerate.