Assertive Community Management

Assertive community management or assertive community treatment is an intensive, community-based, multi-disciplinary team approach. This type of service targets people with a complex pattern of health, social, legal, financial and family problems and have difficulty engaging in conventional treatment. These services take a chronic disease management approach where time in treatment is extended to replace disconnected episodes of acute care with effective case management. Key specific elements of an Assertive community management include, rapid, low-threshold access to services, small protected caseloads, high ratio of community to service-based appointments, assertive engagement, and a shared care approach within a multi-disciplinary team. Assertive care remains voluntary such that patient autonomy is respected and consent obtained for all interventions. This approach also engages family or carers when possible. 

Assertive community management has been widely used in the Mental Health field with extensive research examining its benefits and outcomes for patients with co-occurring mental and substance use disorders. However, the benefit of this type of services has not been widely evaluated for people with primary alcohol use problems. Very few randomised controlled studies exist, and many studies have severe mental health diagnoses as part of the eligibility criteria. Research examining the effectiveness of assertive community management among persons with alcohol use problems without a focus on co-occurring severe mental health is limited. Only one randomised controlled trial (RCT) was identified but was not statistically powered to provide a definitive test of the effectiveness of the intervention. Based on this one study, there is insufficient evidence to support any clinical recommendations.