Summary of “What Works? A Summary of Alcohol Treatment Outcome Research” by William R. Miller, Paula L. Wilbourne, Jennifer E. Hettema

In part one of Miller and Myers’ handbook on alcoholism treatment approaches, we discussed all the different models that have been used to depict addiction since the 1920’s prohibition years and onward, including the long and still-standing disease model that continues to play an important role in societies throughout the world. However, in some countries, such as Canada, Switzerland, Portugal, Barcelona, and a few states in the U.S.A., Harm Reduction is showing more and more traction and drug policy is beginning to change. The private sector in South Africa is still heavily influenced by the disease model of addiction. However, on the governmental front of S.A., harm reduction and drug policy are also changing with the onset of the new national drug master plan in 2024 – 2029. Psychedelic assisted therapy and mental health are likely to play a much greater role and be taken much more seriously as national health crises, similar to the fentanyl crisis in the United States.

I would like to remind the readers that the work presented here is not mine, but rather that of Dr Miller, Dr Myers, and other colleagues at the University of New Mexico. Check out their CEU/CPD courses that are more focused, such as Community Reinforcement Approach, Motivational Interviewing, and Family Training. Although, as mentioned previously, part one concluded that each client should be provided with an eclectic approach tailored specifically to their needs. Now that we have established that, let’s move on to part two.

Context and Purpose:

According to the authors, it is imperative that alcohol and substance abuse disorders are treated using evidence-based, cost-effective treatment methods. As with the selection of treatment for life-threatening physical illnesses, the article reflects on the importance of rigorous outcomes research to inform treatment decisions.

Review of Treatment Outcome Research:

A review of alcohol treatment outcome studies has been conducted by Miller and colleagues since the late 1970s. In the early stages of their work, the authors produced narrative summaries, which evolved into more sophisticated analyses, including “box scores” of the evidence supporting various treatment methods. Their study revealed a significant trend: more expensive treatments had a lesser amount of scientific evidence to support their efficacy.

Methodological Rigour in Studies:

It was necessary for the authors to consider the methodological quality of outcome studies in order to improve their analysis. The studies included a wide range of criteria, such as evaluating alcohol consumption treatments, comparing them with control groups, using proper equating procedures, and measuring at least one issue related to alcohol consumption.

Cumulative Evidence Score (CES):

Each treatment modality was assigned a Cumulative Evidence Score (CES) based on the results of the review process. This score is calculated based on the studies’ methodological quality and outcome logic. According to the CES, the effectiveness of several treatment options can be compared comprehensively.

Treatment Effects:

There were 381 studies reviewed, 194 of which reported differential benefits from the treatments being tested. A variety of treatment modalities were used, and the results indicated a variety of effectiveness levels for each.

Key Findings:

There are several effective treatment modalities available for alcohol use disorders, according to the review. A brief intervention with a CES of 390 emerged as the most effective. Other effective methods include motivational enhancement, community reinforcement, and treatments involving GABA agonists like Acamprosate.

Evolution of Treatment Research:

It is noted in the article that between 1950 and 2000, the number of clinical trials increased substantially and methodological quality improved.


As a result of the study, there are now a number of consistently effective treatment methods for alcohol dependence disorders, demonstrating the importance of evidence-based treatment approaches in treatment planning. In order to provide the most effective care to individuals with alcohol problems, the authors emphasise the need for ongoing research and refinement in treatment methods.