The fifth series of 'matrix bites' from the Drug and Alcohol
Effectiveness Bank looks at 'treatment intended to safeguard the community':
A common theme is the contradiction between treatment centred on the patient’s welfare, yet offered within a system which prioritises the wider community, and sees the patient essentially as a threat. That divide is regularly and productively bridged, but not without difficulty, and sometimes not well enough for research to discern the intended benefits.
Cell A5. Treatment interventions to safeguard the community
What seems a core contradiction is illustrated by the cover of WHO guidance on treating problem-drinking prisoners. Subtitle, “An opportunity for intervention”, is belied by the barbed wire-topped wall. How could such an environment host productive intervention? Yet those same walls create the ‘dry space’ in which intervention seems possible.
Cell B5. Are relationships overshadowed by coercion – or even more important?
Asks whether lack of research on the practitioner’s influence in criminal justice contexts means that when coercion is driving treatment, therapeutic relationships are unimportant. Some evidence and expert opinion argues the contrary, because in a coercive context, “genuinely adopting and communicating [motivational] qualities is much trickier”.
Cell C5. Is this the most difficult management task in the addictions field?
Asked of managing ‘wet’ centres where street drinkers can continue to drink, the title question could have been asked generally of managing treatment within criminal justice and allied systems.
Cell D5. When it comes to treatment for offenders, is small beautiful?
About the influence of an organisation’s structures and processes on how well it delivers treatment for drinking problems in criminal justice settings. Context for the title question is a market which drives service providers to grow ever bigger, perhaps in the process losing innovative impetus.
Cell E5. Have we got the right ingredients for criminal justice/health collaboration?
Last cell explores systems of screening, brief interventions and treatment for problem-drinkers at various stages of the criminal justice system. We invite you to benchmark your own systems against the key ingredients for partnership working, and to ponder why drinking is prominent in sending thousands to prison, yet not in services provided in prison.
These 'bites' form the fifth and final row of the Alcohol Matrix. Round ups of the previous rows below:
- Row 1: brief interventions
- Row 2: fundamental issues to treatment.
- Row 3: treatment in a medical context
- Row 4: psychosocial or 'talking' therapies
See here for NICE guidance, standards and tools for alcohol treatment.
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