Into the matrix

Editor Mike Ashton gives a guided tour of Findings’ new matrices, which offer a vast resource of addiction treatment evidence that no practitioner should be without. 

The evidence base for addiction treatment is enormous, hard to encompass, and even harder to assess. Wouldn’t it be great if we could somehow identify the major documents practitioners should read, even if they read nothing else? Just such a discussion took place in a sub-group of the Substance Misuse Skills Consortium (www.skillsconsortium.org.uk), the sector-led partnership that aims to develop the substance misuse treatment workforce in England. I participated as editor of the Drug and Alcohol Findings Effectiveness Bank site (http://findings.org.uk).

Findings had already constructed a matrix for the consortium, which mapped the evidence-base universe, though for a different purpose. Funded via the National Treatment Agency for Substance Misuse (now absorbed in Public Health England) Findings undertook to develop this framework into matrices, presenting the most important documents and resources for treatment practitioners and commissioners to understand the evidential basis for their work and to implement its most important lessons.

Important groundwork

The level of ambition involved can hardly be overestimated. Despite the obvious need, no agency, no matter how well funded or expertly staffed, from multi-million dollar US government institutions to the European Union’s drug centre or the UN’s World Health Organization, had attempted such a project.

In Britain it could only be envisaged within a reasonable time frame and limited resources because for the past 16 years Drug and Alcohol Findings had been monitoring and collecting evaluation research, assessing the studies, and selecting and analysing those of greatest relevance to the UK. Along the way, seminal research had been identified and analysed in its own right (the Old Gold series in Findings magazine – see http://bit.ly/19MCk6l) and as the backdrop to understanding more recent work. Reviews were collected and read to help understand the significance of each individual study and guidance documents helped make sense of what they might mean for the UK.

This work had accumulated into the largest live drug and alcohol library in Britain, holding 17,000 documents relevant to the ‘what works’ agenda. The managing committee’s experience in collating and disseminating information about addiction and its treatment preceded by decades the advent of Findings – in the case of the editor, back to 1975. With the groundwork already done, this ambitious superstructure could be constructed.

Understanding the matrices

In May 2013, the result was the Matrices – one for harm reduction and treatment of problems related to the use of illegal drugs (http://bit.ly/1ca1bA3), and one for brief interventions and treatment of alcohol-related problems (http://bit.ly/12aGdQd).

The best way to envisage them is of course to take a look. We liken them to a grid-map of territories in the alcohol and drug treatment worlds, segmented to reflect practical divisions in the delivery and organisation of services. Across the top are five columns, moving from the intervention itself (Is it feasible? Does it work? How does it work?) to the contexts within which interventions are implemented – by practitioners, who are managed and work in organisations, which coalesce into whole treatment systems. All of these affect the treatment’s feasibility and impacts – contexts variously of greatest interest to frontline staff, supervisors and managers, management committees and commissioners.

Intersecting the contexts down the side are five rows. Choose whether your interest is harm reduction (drugs only), brief interventions (alcohol only), cross-cutting treatment issues, medical treatments, psychosocial therapies, or criminal justice work.

For both drugs and alcohol, the result is a five-by-five grid totalling 25 cells. Within each cell are the major historical and contemporary research landmarks in that territory, reviews offering a panoramic view, expert guidance based on this research, and an option to explore beyond these dozen or so selected documents by searching the Drug and Alcohol Findings Effectiveness Bank. Each document entry can be clicked on to access the original document, either directly or via the Effectiveness Bank’s analysis of the study.

Some cell territories have only rarely and partially been explored, while others are relatively well mapped. As well as signposting the achievements, the Matrices expose the gaps in the evidence base. Arrangements are being made to update the Matrices, probably on an annual basis, piggybacking on the work Drug and Alcohol Findings continues to do to identify and analyse documents for the Effectiveness Bank.

‘Terrific stuff’

So what can you do with the Matrices? As a manager, they list the documents you could advise your new staff to read to help them understand the basis of addiction treatment, those you could commend to your existing staff to advance their professional development, as well as giving you practice-improvement clues from the world’s leading researchers.

They will help practitioners understand the most important foundations of their work and how to build on them, and help commissioners appreciate the different ways they can influence effectiveness. Familiarity with these relatively few documents could be seen as an indicator of an important dimension of the quality of an organisation and its staff – an appreciation of the key evidence on which practice has been built and can be improved.

As Audrey Freshman, director of professional development and continuing education at Adelphi University, said: ‘Wow – this is terrific stuff.’  DDN

Mike Ashton is editor of Drug and Alcohol Findings (http://findings.org.uk), a national UK collaborative project involving the National Addiction Centre, DrugScope and Alcohol Concern and supported by Alcohol Research UK and the J Paul Getty Jr Charitable Trust.

Mike explains the Matrices’ development at Lifeline’s FEAD video bank: http://bit.ly/16JqzJu

An updated version of the presentation’s slides is available at: http://bit.ly/17lxiMd. This drills down to one study in one cell of the Alcohol Matrix – a seminal study from the 1950s that demonstrates that such work still has considerable current relevance.

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