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. 

Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing treatment. Explores whether payment by results stifles patient-centred practice or stretches services beyond comfort zones, the surprising results of a randomised trial of service-improvement mechanisms, and the multiple answers to how many drinkers should be in treatment. See the remaining four cells in row 2 of the matrix for more on generic features of medical and psychosocial therapies. 

What is this cell about? How across an administrative area to engineer an effective and cost-effective mix of services which offers patients/clients appropriate options for entering and moving between services or using them in parallel. Involves commissioning, contracting and purchasing decisions to meet local needs in the context of resource constraints and national policy. Activities include: needs assessment; restructuring services or re-tendering; contractual requirements on services to demonstrate evidence-based practice, meet standards, and implement performance monitoring; and financial or other rewards/sanctions linked to activity, quality or outcomes.

At this distance from the preoccupation with intervention effectiveness, research is scarce and rarely of the ‘gold standard’ randomised controlled trial format (there are just two in this cell: 1 2). Instead researchers often have to interpret how things happen in the messy real world, attempting to isolate what may have been the active ingredients among a complex set of variables not under their control. The key limitation of such methodologies is the difficulty of establishing which (if any) of the measured influences was cause, and which effect.

Applicability of evaluation research to the real world is always a concern, but one sharpened in the current era by the fact that rather than ‘getting better’, services are focused on ‘getting by’. In this context, evidence and evidence-based guidelines may not be able (report listed above) to adequately influence practice. Research may, for example, indicate the desirability of local treatment systems being able to detoxify patients in hospital if needed and refer them to the shelter of a residential facility to solidify their recovery, but in 2017 a survey of alcohol services and alcohol-involved professionals in England found most could not say there was sufficient local access to these services. The main reason was the squeeze on funding: “In comments, respondents repeatedly said there was simply no money, especially for [rehabilitation] services.” The same year a survey of substance use services in England warned that “the capacity of the sector to respond to further cuts has been seriously eroded”. Instead of targeting the “comprehensive and high quality services” needed to actualise the government’s recovery agenda, service providers were concerned about being able to maintain the basics of “safety and quality in an environment where the pace of change has not yet steadied”.