We need to learn more about the influence of therapist and interactional variables on the outcome of treatment for alcohol problems but this chapter has shown that there exists a range of effective treatment approaches, each backed by a body of consistent findings from acceptably rigorous research, with which to help people recover. Project MATCH has provided some indication of what works best for which type of client. In the majority of cases, however, client-treatment matching must rest, for the time being, on the preferences of both client and therapist, the expertise and resources available to treatment providers and the particular needs and unique characteristics of the individual problem drinker.

The chapter has also shown that there is a range of widely practised treatments, which have either been shown conclusively to be ineffective by research or for which no evidence of effectiveness currently exists. Miller & Hester (1986) complained of an almost perfect inverse relationship between effective and practised treatments in the treatment system in the US with which they were familiar: those treatments that were supported by research were not practised and those that were practised were not supported by research. This state of affairs was relevant in varying degrees to all national treatment systems. It is difficult to be certain whether and how far this situation has improved because there is a dearth of reliable data on what actually takes place in day-to-day treatment provision. What can be asserted with some confidence, however, is that there remains some way to go before practice in the alcohol problems treatment field can meaningfully be said to be evidence-based.

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