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In times of information overload, researchers have found ways to synthesise a large amount of data from numerous studies bearing on the effectiveness of treatment for alcohol problems. Two of these ways are discussed: formal meta‐analysis and the box‐score ‘mesa grande’. It is concluded that meta‐analysis cannot answer questions regarding which treatments give the best results in the alcohol field. The mesa grande has certain limitations, which are described, but is useful for the formation of treatment policies when a clear summary of the research evidence on treatment effectiveness is needed. By contrast, large multi‐centre randomised controlled trials with enough statistical power to detect small effects of treatment should normally be preferred when a decision has to be made as to which of two or more specified treatments should be implemented in practice. Unfortunately, two multi‐centre trials, one in the USA and one in the UK, have given rise to the ‘dodo bird’ verdict of equivalent effectiveness of four treatment modalities. The findings of the UK Alcohol Treatment Trial cannot be used to advise treatment providers and practitioners which one of two treatments, MET or SBNT, should be preferred in practice. In the absence of relevant research findings, four possible ways of making this decision are outlined, including the suggestion that MET should serve as the first step in a stepped‐care model of treatment provision.

No studies have evaluated the relationship between cognitive impairment and alcohol treatment outcomes amongst older drinkers. This study aims to explore the extent of cognitive impairment amongst older adults seeking alcohol treatment and examine the relationship between cognitive impairment, treatment retention and alcohol use following treatment.

The study used data from the Drink Wise Age Well programme; an alcohol intervention service for older adults (aged 50+). The Montreal Cognitive Assessment was used to screen for cognitive impairment; alcohol use was assessed using the alcohol use disorders identification test.

In total, 531 participants completed the assessment at treatment entry. Over half the sample were male (57%), with a mean age of 60 years (Standard deviation: 7.09). Almost half (48.4%) had cognitive impairment at the entry to treatment: 51.6% had a normal cognitive function, 41.4% had mild cognitive impairment, 5.8% had moderate cognitive impairment and 1.1% had severe cognitive impairment. Cognitive impairment was not associated with increased treatment drop-out and was not predictive of alcohol use following treatment. Alcohol treatment was associated with a significant improvement in cognitive functioning.

This study suggests there may be a significant amount of unidentified cognitive impairment amongst older adults attending alcohol treatment. Assessment and routine screening for cognitive impairment in drug and alcohol services may help in care planning and setting treatment goals; in the absence of routine screening opportunities for treatment planning and intervention may be missed.

The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time.

A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented.

Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce.

Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.

It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.

Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.

For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.

Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.

Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.

Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.

Across the world, 3.3 million people die every year as a result of harmful use of alcohol. In Australia, excessive alcohol intake is responsible for 3.2 percent of the total burden of disease and injury. Disulfiram is one of the few pharmacotherapies approved for the treatment of alcohol dependence, and interferes with the metabolism of alcohol causing unpleasant symptoms as a deterrent effect. To date, no studies have examined the efficacy of disulfiram in an outpatient setting in Australia. The purpose of this paper is to describe the medium term outcomes of patients commencing disulfiram in a specialized drug and alcohol outpatient setting in Australia.

Data were extracted from outpatient clinical notes for all patients commenced on disulfiram at any location in the drug and alcohol service between January 1, and December 31, 2013.

In total, 80 patients were included in the study. At three months following commencement of treatment, 42 patients (53 percent) were considered to have been successfully retained in treatment. Totally, 36 (45 percent) patients reported remaining completely abstinent from alcohol during their first three months of treatment. Patients that self-referred to outpatient disulfiram treatment had 75 percent lesser odds of succeeding in treatment compared to those that were referred by other means (i.e. via hospital, GP or forensic services).

This study demonstrates that patients receiving supervised disulfiram for three months in the context of this treatment model can achieve abstinence. Further work is needed to compare this with other treatment options.

The purpose of this paper is to estimate the share of multiple substance disorders among clients entering treatment for substance-related problems, to identify the most frequent combinations of the substances involved and to investigate the profiles of the clients involved.

Data were taken from the Swiss treatment monitoring system act-info applied among inpatient and outpatient facilities (reporting years 2013–2015). All cases with information on multiple substance disorders, according to a definition close to the diagnosis F19 from the ICD-10 classification of disease were included. The measurements comprised designated primary substance, existing multiple substance use disorder, substances involved and basic socio-demographics.

From 10,009 clients included in the study, 1,653 (16.5 per cent) were reported as having multiple substance use disorders. A great variety of substance combinations was identified and alcohol was found in the majority of them.

Treatment strategies targeting accurately substance-related disorders as a whole complex should be promoted. In particular the alcohol-related aspect of the disorder should not be neglected when the focus is on illegal drugs.

Multiple substance use was until recently not sufficiently documented in treatment monitoring systems. A recent version of the European treatment demand indicator (TDI) has introduced the notion of “polydrug use problem” as complementary information to the primary substance, which remains the key variable for reporting treatment demand. This study represents a first attempt to explore systematically this new data.

Although studies suggest alcohol abuse is not the major problem among offenders and others with intellectual disabilities (ID), it is still a significant problem. There are also suggestions that alcohol may have a more serious effect on those with ID. The purpose of this paper is to describe a treatment for alcohol-related difficulties designed for people with ID.

A programme for alcohol-related problems is described and four case studies are presented to illustrate the sessions and review the way in which people with ID have responded to the methods. The cases have a mixture of alcohol-related problems including anger, anxiety, social withdrawal and depression. The alcohol programme is coordinated with a range of person centred interventions for specific difficulties.

All cases responded to the programme positively. Two cases showed reductions in anger, two reported reductions in anxiety and one reported reductions in depression. All cases increased their alcohol knowledge considerably.

The programme seems promising in its approach to alcohol-related difficulties. It is noted that alcohol education alone is likely to improve participants’ wellbeing in the absence of coordinated intervention for other relevant personal difficulties. A controlled treatment trial for effectiveness is clearly required.

The paper describes a programme for alcohol-related problems and may be the first such programme that has contained pilot evaluation.

Evaluating the prevention, intervention, and treatment programme is critical to understanding the decision-making behaviour of substance abusers. The study interweaves behavioural health economics with the extended PRECEDE–PROCEED Model and examines the effectiveness of treatment settings for substance users in New Jersey Drug and Alcohol Abuse Treatment (13,775 samples). The study also identifies the factors that are associated with substance users’ recurrence to the treatment centre. The results concluded that educational attainment, counselling services from health care providers, mental agency services, and detoxification treatments have a significant impact on preventing relapse behaviour.

Evidence is lacking as to the superiority of dual-focused versus single-focused approaches in treating depression and alcohol use comorbidity. Different people may also value the different features of treatment options differently, necessitating a decision-support tool. This study aims to test the acceptability, feasibility, safety and potential usefulness of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT).

ADDAPT was developed according to International Patient Decision-Aid Standards and in consultation with potential end users. Adults with depression and alcohol use comorbidity, who were considering/recently considered psychological treatments, were recruited via online advertisements. After clicking on the study URL, participants accessed the ADDAPT e-book and completed validated and purpose-designed questionnaires.

Of the 24 participants, most would recommend ADDAPT to others (79.2% agree) and endorsed it as easy-to-use (75%), useful in decision-making (79.2%), presenting balanced (87.5%), up-to-date (91.7%), easy-to-understand (79.2%) and trustworthy information (83.3%), which did not provoke anxiety (i.e. safety; 75%). Post-use, participants felt well prepared to decide on treatment (M = 3.48/5) and demonstrated good treatment knowledge (M = 65.83%). All but one participant indicated a treatment choice supported by best available evidence, and decisional conflict scores except for the uncertainty subscale were below the threshold for decisional delay (all M < 37.5/100).

ADDAPT is the first decision-aid of its kind, with pilot findings supporting its acceptability, feasibility, safety and potential usefulness for improving decision-making quality among people considering psychological treatment options for depression and alcohol use comorbidity.

Research suggests that homework compliance within cognitive behavioral therapy is associated with treatment adherence and positive treatment outcomes through generalization of learned skills. The purpose of this paper is to determine whether there were differences in aggression and substance use between participants who did and did not complete therapy homework assignments.

Secondary analyses were conducted using data from Easton et al.’s (2017) randomized controlled trial of substance abuse domestic violence (SADV) treatment among substance dependent intimate partner violence (IPV) offenders. Analyses of covariance were conducted in order to determine whether homework completion had a significant effect on aggression and substance use. Correlational analyses were conducted to determine the association between quality of homework and outcomes.

Participants (n=63) who completed at least two homework assignments had fewer days of alcohol use during treatment compared to those who did not complete any assignments, p=0.03. There was not a difference in the number of days participants engaged in violence based on homework completion. Analyses indicated that those who displayed aggression proximal to alcohol use during treatment completed significantly fewer homework assignments compared to those who did not display aggression proximal to alcohol use (p=0.04).

This research was limited to a sample of male substance using offenders of IPV within the US additional research utilizing a larger sample size in order to investigate differences in homework completion across treatment groups is needed. Further analysis of the barriers to and predictors of homework compliance among this population is recommended.

This research highlights the need for incorporation of homework and further exploration of methods and treatment modalities to ensure homework compliance among substance using male offenders of IPV.