When the patient–practitioner interaction is intended to be the main active ingredient
Funded by Alcohol Change UK, Drug and Alcohol Findings’ refresh of its Alcohol Treatment Matrix entails a close look at psychosocial therapies (also known as ‘talking therapies’), the mainstay of alcohol dependence treatment in the UK.
Every treatment involves direct or indirect human interaction, but for psychosocial therapies the interaction is intended to be the main active ingredient. They attempt to change how the patient behaves via their beliefs and attitudes, how they relate to others, and how others relate to them, or directly by ‘shaping’ through rewards and sanctions.
Techniques and strategies include: rewards and punishments contingent on client behaviour, as in contingency management; leading the client to see their substance use as contrary to desired self-images or objectives, as in motivational interviewing; harnessing social influences, as in group and family therapies and community living arrangements; identifying with the client what triggers their undesired substance use and training them how to manage or avoid those triggers, as in cognitive-behavioural therapies; ways to manage thoughts and moods which otherwise might precipitate relapse, as in mindfulness approaches; and more practical elements, such as those intended to upgrade the patient’s employability.
The lion’s share of research time has been taken up with testing which therapy is more effective, what differentiates the therapies, and how these differences impact recovery outcomes. However, more critical to their success it seems is what therapies share. These ‘common factors’ include:
- a confiding, emotionally charged relationship with a helping person;
- a setting in which psychological healing is expected;
- a plausible explanation for the patient’s symptoms;
- a ritual or procedure for resolving them – any ritual will do, as long as in that culture and for that patient it makes sense of their difficulties and signposts a convincing and feasible way out.
Row 4 of the Alcohol Treatment Matrix moves from evidence of effectiveness of psychosocial interventions, through how the therapist affects outcomes, the role of their managers and supervisors, the influence of the organisation they work in, and finally the context of the entire local treatment system. It is being updated in five fortnightly instalments which remain accessible via the matrix, whose five rows and columns form a 5×5 grid mapping the world of alcohol treatment and brief intervention research. Sign up to the mailing list to follow along every Wednesday.
“Wow, outstanding work! This is one of the best, most clear and scholarly write ups I’ve seen of this complex topic.”
Dr Lisa M. Najavits, Director of Treatment Innovations and adjunct professor, Massachusetts Medical School, USA, commenting on cell B4.
From Mike Ashton, co-editor of Drug and Alcohol Findings