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PDF (Review of the Effectiveness of Treatment for Alcohol Problems) NFS Cover with spine 1/11/06 10:36 Page 1 Review of the effectiveness of treatment for alcohol problems Review of the effectiveness Review of the effectiveness of treatment for alcohol problems Duncan Raistrick, Nick Heather and Christine Godfrey National Treatment Agency for Substance Misuse 8th floor, Hercules House, Hercules Road, London SE1 7DU Tel 020 7261 8573 Fax 020 7261 8883 Email: [email protected] Website: www.nta.nhs.uk Publications All NTA publications can be downloaded from www.nta.nhs.uk. To order additional copies of this report, complete the online order form at www.nta.nhs.uk. Alternatively, email [email protected] or telephone 08701 555 455 and quote product code ALCOHOL2 0 prelims.qxp 17/11/2006 11:54 Page 3 About the authors About the authors Duncan Raistrick Leeds Addiction Unit, 19 Springfield Mount, Leeds, LS2 9NG Duncan Raistrick qualified in medicine from the University of Leeds in 1971 and trained in general practice in Nottingham, specialising in neurology in Leeds and Liverpool, and in psychiatry at the Maudsley Hospital, London. He gained membership of the Royal College of Psychiatrists in 1977 and received an MSc from the University of London in 1978. He became a fellow of the Royal College of Psychiatrists in 1999 and was the medical adviser on alcohol to the chief medical officer and a member of the Health Advisory Service for HM Prison Service. He was a member of the working group on the Department of Health publication, Drug Misuse and Dependence – Guidelines on Clinical Management. Duncan is currently a member of the NTA Research Advisory Group and co-director of the RESULT Information Management System, and has published research papers and books including Tackling Alcohol Together. His research interests are the nature of dependence, outcome measures and therapist characteristics. He is an associate medical director of the Leeds Mental Health Trust. Nick Heather School of Psychology and Sport Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST After ten years as a clinical psychologist in the NHS, in 1979 Nick Heather developed and led the Addictive Behaviours Research Group at the University of Dundee. In 1987, he was the founding director of the National Drug and Alcohol Research Centre at the University of New South Wales, Australia. He returned to the UK at the beginning of 1994 to take up the post of consultant clinical psychologist at the Newcastle City Health NHS Trust and as director of the Centre for Alcohol and Drug Studies in Newcastle. Nick has recently retired from salaried work and is now emeritus professor of alcohol and other drug studies in the Division of Psychology at Northumbria University. He has published numerous scientific articles, books, book chapters and other publications, mostly in the area of addictions, with an emphasis on the treatment of alcohol problems. Christine Godfrey Department of Health Sciences, Seebohm Rowntree Building, Alcuin College, University of York, York YO10 5DD Christine Godfrey is a professor of health economics at the Department of Health Sciences and the Centre for Health Economics at the University of York. She has been involved in research into the economics of addiction since 1984. She is currently a member of the Expert Committee on Drug Dependence, the World Health Organization, a non- executive board member of the Health Development Agency and a member of the Scientific Committee on Tobacco and Health at the Department of Health. She is one of the principal investigators of UKATT and is currently undertaking a range of cost-effectiveness analyses on smoking, drinking and illicit drug interventions. 3 0 prelims.qxp 17/11/2006 11:54 Page 4 Review of the effectiveness of treatment for alcohol problems The National Treatment Agency for Substance Misuse The National Treatment Agency for Substance Misuse (NTA) is a special health authority within the NHS, established by Government in 2001, to improve the availability, capacity and effectiveness of treatment for drug misuse in England. Treatment can reduce the harm caused by drug misuse to individuals’ well-being, to public health and to community safety. The Home Office estimates that there are approximately 250,000–300,000 problematic drug misusers in England who require treatment. The overall purpose of the NTA is to: • Double the number of people in effective, well-managed treatment between 1998 and 2008 • Increase the percentage of those successfully completing or appropriately continuing treatment year-on-year. In addition to its remit on drug treatment, the NTA is also commissioned to undertake specific work on alcohol treatment, including the development of Models of Care for Alcohol Misusers (DH, 2006) and commissioning the Review of the Effectiveness of Treatment for Alcohol Problems (NTA, 2006). Reader information Document purpose To provide accessible information on the effectiveness of alcohol treatment Title Review of the Effectiveness of Treatment for Alcohol Problems Lead authors Duncan Raistrick, Nick Heather and Christine Godfrey Publication date November 2006 Target audience Commissioners, managers and providers of alcohol treatment services Circulation list See above Description A critical appraisal of the international evidence of the effectiveness of treatments and interventions for alcohol problems Cross reference Models of Care for Alcohol Misusers (MoCAM) (DH, 2006) Alcohol Misuse Interventions: Guidance on Developing a Local Programme of Improvement (DH, 2005) Alcohol Needs Assessment Research Project (ANARP) (DH, 2005) Contact details 8th floor, Hercules House, Hercules Road, London SE1 7DU. Tel: 020 7261 8573. Fax: 020 7261 8883 Email: [email protected] Website: www.nta.nhs.uk Gateway/ROCR approval The NTA is a self-regulating agency in relation to Department of Health Gateway 4 0 prelims.qxp 17/11/2006 11:54 Page 5 Foreword Foreword This timely, authoritative and comprehensive review of what research tells us about alcohol treatment is very welcome. Alcohol misuse represents a significant burden to the NHS and wider society. Both The Alcohol Harm Reduction Strategy for England (2004) and the Choosing Health White Paper (2005) identified a need for better identification and treatment of alcohol problems. The evidence base reviewed here informed the publication of Models of Care for Alcohol Misusers (2006), which provides clear guidance on the development of local systems to identify and intervene with alcohol misuse problems. This review offers practitioners, as well as commissioners and managers of services, the information they need to ensure that what they provide reflects the best available evidence. This review covers the published international research literature on alcohol interventions and treatment. In describing the effectiveness of the various interventions and treatments available it will enable local services and partnerships to assess current provision and plan future developments to meet the needs of their populations. Our relationship with alcohol as a society is complex. A source of pleasure and enjoyment for many it is also implicated in many of the most challenging problems we encounter. This review addresses the techniques for intervening early to identify excessive and risky alcohol use as well as the approaches for dealing with developed problems. UK and international research informs us that alcohol treatment can be an effective and cost effective response to alcohol problems. While there is compelling evidence for investment in alcohol treatment, this review makes clear that it will be essential to invest wisely in interventions of proven effectiveness. In order to prevent harm associated with alcohol misuse and to treat people with alcohol problems effectively, local partnerships will need to commission and deliver effective, integrated solutions. I believe this publication is a key reference tool to facilitate the development of effective local alcohol treatment systems that can contribute to reduced alcohol-related harm in our communities. I congratulate the authors on their achievement and have no hesitation in commending this review to service providers, commissioners and anyone else with an interest in alcohol treatment. Baroness Massey of Darwen Chair, National Treatment Agency for Substance Misuse 5 0 prelims.qxp 17/11/2006 11:54 Page 6 Review of the effectiveness of treatment for alcohol problems The steering group Annette Dale-Perera, director of quality, National Richard Phillips, acting chief executive, Alcohol Concern Treatment Agency Professor IT Gilmore MD PRCP, president, Royal College Dr Emily Finch, clinical team psychiatrist, National of Physicians Treatment Agency Dr Duncan Raistrick, associate medical director, Leeds Tim Murray, policy officer, National Treatment Agency Mental Health Trust Professor Colin Drummond, professor of addiction Professor Nick Heather, emeritus professor of alcohol and psychiatry, St George’s, University of London other drug studies, Northumbria University Dr William Shanahan, lead clinician, Central and North Dr Linda Harris MRCGP, clinical director, Wakefield West London Mental Health NHS Trust Substance Misuse Integrated Substance Misuse Services and RCGP and Prison Services Substance Misuse Unit 6 0 prelims.qxp 17/11/2006 11:54 Page 7 Contents Contents Ten key themes ..........................................................9 6.1 Background .............................................69 1 The review process ..........................................13
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