Pilot study of assertive community treatment methods to engage alcohol-dependent individuals

Aims: Assertive approaches to treatment, which are becoming established for individuals with severe and enduring mental illness, may also be beneficial for engaging alcohol-dependent individuals without severe psychiatric co-morbidity, but so far there has been little research on this. This pilot study looked at the feasibility and potential benefits of introducing assertive community methods into the treatment of alcohol-dependent individuals with a history of poor engagement. Methods: Non-randomized parallel cohort study comparing a Flexible Access Clinic employing assertive community treatment methods with the Usual Care Clinic. Participants were individuals re-referred to our service after they had previously disengaged from treatment. Results: Patients receiving assertive treatment attended assessment a mean of 14 days earlier than those receiving treatment as usual. Treatment at the Flexible Access Clinic was associated with significantly higher rates of completing assisted alcohol withdrawal (35% versus 26%) and entering an aftercare placement (23% versus 14%). Aftercare was entered significantly earlier in the Flexible Access Clinic group (93 days versus 125 days). Conclusions: These promising results point to the feasibility and potential efficacy of assertive community treatment methods for alcohol dependence, and the need for a randomized controlled trial of effectiveness and cost effectiveness.