Following the release of the Alcohol Matrix, the second in a series of 'matrix bites' have been released the Drug and Alcohol 
Effectiveness Bank. This series covers row 2 of the matrix, addressing issues at the heart of alcohol treatment; What is it for? Who needs it? What constitutes its essence?
Cell A2. The interventions: Do they do the work – or does the patient?
Have patients already done 90% of the therapeutic work before they get to the clinic? Is treatment 'merely' a socially endorsed way to 'get better' in our societies, which works because we believe it works? Perhaps we been misled by studies which exclude the sickest patients. How should we conceive of treatment: a specific technical fix forged by experts to key in to a specific disorder, or the offer of concern, hope and understanding to troubled people lacking those supports in their daily lives?
Cell B2. The practitioners: Is the relationship the treatment?
Every treatment is a human interaction. We know for sure that therapists, counsellors and clinicians differ in effectiveness, and that characteristics like gender and qualifications are generally not the explanation. Nor can we rely on hard and fast rules like, "Always express empathy", "Never (or always) tell the client what they 'must' do". The hard answers seem to lie in the soft variables – social skill, centring on the patient, intuiting which client needs which approach in which situation, being genuine.
Cell C2. Management: It can be transformational
Controlled studies can divorce interventions from the management of the service delivering them, but in everyday practice, whether treatments get adopted and adequately implemented, and whether staff are able to maintain recovery-generating attitudes and knowledge, depend on management and supervision. Research on these issues is scarce, but also exciting and inspirational; at this level, whole services can be transformed from merely going through the motions, to enthusiastic client-engagers.
Cell D2. Organisations: Focus on 'soft' values or 'hard' incentives?
Highlights the most wide-ranging investigation ever of the organisational health of British alcohol and drug treatment services. The implication was, ensure your staff experience what through them you want your patients to experience: respect, understanding, and support. In the hard-nosed era of carrot-and-stick incentives, does this really holds true?
Cell E2. Treatment systems: Messages from giants of addiction research
Introduces the two giants of addiction treatment research and theory who led the way in re-envisioning treatment as (or as promoting) long-term continuing support. Highlights the US study which exemplified the strengths and limitations of payment-by-results schemes, and asks whether these stifle patient-centred practice and engender a mentality of doing just enough to get the money, or stretch services beyond their comfort zones. More fundamentally, how many drinkers should we be treating, and what proportion are already in treatment?
See here for a round up of row 1 of the alcohol matrix covering brief interventions or visit the matrices page of the Effectiveness Bank web site for articles, presentations, and a video explaining their genesis and construction.
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