The alcoholism treatment service at the Maudsley Hospital, London

Abstract

This article describes the linked clinical, research and teaching functions of the Maudsley's Alcoholism Treatment service. Emphasis is placed on the heterogeneity of the patients who are seen. Therapy must therefore always be patient-specific and the Procrustean insistence that patients should fit the programme rather than the programme fit the patients should be resisted. Within the diversity of approaches which are employed some important common elements can though be identified: detailed case assessment as the necessary basis for everything else, goal setting, a flexible intensity of response, networking with other treatment resources, and attention to methods of patient recruitment. The relationship between outpatient and inpatient services is discussed: about 80% of all new referrals are treated entirely on an outpatient basis. The clinical setting provides a teaching base for the Diploma in Addiction Behaviour. There is a close link between this clinical service and the Addiction Research Unit; issues of clinical and research collaboration and the interpretation and clinical application of research findings are considered. Whatever the theories in which a team believes or the techniques which it practices, the nurturing of hope is the vital essence of the practical business of treatment.

In‐patient treatment for the alcohol‐dependent person: a public health perspective

“…The literature also suggests, however, that in-patient treatment can be important for the treatment of the sequelae of alcohol dependence and, in some cases, for detoxification. Table 1, based chiefly on Edwards [15] and Miller & Hester [16], shows the conditions under which in-patient treatment for alcohol-related conditions may be indicated. The table also incorporates our suggestions for the goals of in-patient treatment of these conditions.…”

“…We believe there is reasonable basis for questioning the indication for in-patient treatment in two conditions. First, serious psychiatric co-morbidity has been suggested by a number of authors as a condition that may warrant in-patient treatment [7,15,17,18]. The basis for this recommendation is unclear, especially since the evidence from the psychiatric literature also suggests no benefit for more intensive treatments over less intensive treatments [19][20][21].…”