The third series of 'matrix bites' from the Drug and Alcohol 
Effectiveness Bank looks at the treatment of alcohol dependence in a medical context or involving medical care:
Cell A3. Interventions: Should drug-based treatments be the norm?
In reply to the title question, some authorities think so, but in practice, doctors and patients disagree. For this ‘disease’, medications are not a cure, but aids to the patient’s impetus to get better and to processes in their lives which help realise and sustain this ambition – exemplified in the work of Jonathan Chick, responsible for all three major UK studies of the leading anti-drink medications.
Cell B3. Practitioners: Patients assess clinicians too!
The previous cell looked mainly at the medications clinicians prescribe; now we turn to the clinicians, and find that bedside manner is not just a conduit for treatment – to a substantial extent, it is the treatment. Learn from seminal studies that patients “sensitized to rejection” assess their clinicians as much as the reverse, asking above all if they are liked and accepted.
Cell C3. Management: Recruitment is the missing link
Studies may able to divorce the impact of interventions from the management of the delivering service, but in everyday practice, management and supervision determine whether treatments are adequately implemented and staff maintain appropriate attitudes and knowledge. The neglected topic of staff recruitment seems critical – so how do you identify the right people? Official advice is to start with small (and cheap) treatments and build up if needed, but is offering more to treatment-resistant patients just a waste?
Cell D3. Organisations: Is evidence-based innovation always a good thing?
The organisational context determines whether clinics, primary care practices, and inpatient units offer an environment in which staff and patients can maximise their potential. Given today’s upheavals in commissioning and service provision structures, is evidence-based innovation always a good thing, or can it produce a demoralised workforce in no position to do their best for patients?
Cell E3. Treatment systems: How can commissioners recognise a good quality service?
Spending on inpatient alcohol withdrawal can be wasted if patients don’t get follow-on care, and opportunities are lost if severely dependent drinkers seen by GPs don’t get routed to specialist treatment – examples of why treatment systems are critical. Do you share an expert group’s vision of what a good quality service should look like, and is Britain making progress on the perennial problem of organising care for mentally ill problem drinkers?
These 'bites' form the third row of the Alcohol Matrix. See here for a round up of row 1 covering brief interventions or row 2 covering fundamental issues to treatment. See here for NICE guidance, standards and tools for alcohol treatment.
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