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Effective Interventions Unit: Residential detoxification and rehabilitation services for drug users: A review
Executive Summary
This review provides information about
residential detoxification and rehabilitation services for drug users. It includes:
a description of the aims of residential detoxification and rehabilitation services and the interventions provided by them;
a summary of the evidence on their effectiveness;
a mapping of these services in Scotland; and
brief details of how Scottish residential services are used.
The review does not consider the effectiveness of residential services for alcohol users, nor does it compare the effectiveness of residential and community services. Such a comparison is actually quite difficult because the
immediate aims, duration and interventions associated with residential and community services are
different.
Description of residential detoxification and residential rehabilitation
Residential detoxification and residential rehabilitation are
not the same. The primary aim of residential detoxification is to provide the means for
safe and humane withdrawal from a drug of dependence. Detoxification is not so much a form of treatment for drug misuse, as a
gateway to treatments that are aimed at long-term abstinence.
Residential rehabilitation programmes, on the other hand, aim to support individuals to attain a drug-free lifestyle and be re-integrated into society. They provide
intensive psychosocial support and a
structured programme of daily activities which residents are required to attend over a fixed period of time.
Not all residential rehabilitation programmes are alike. Residential rehabilitation programmes differ markedly on the basis of their
underlying philosophy and in the details of the programme structure, intensity and duration.
Effectiveness of residential detoxification and residential rehabilitation
Completion rates for residential detoxification programmes are very high - around 75-80%. However, lapse or relapse following residential detoxification programmes is common. Detoxification programmes will result in
better long-term outcomes if they are followed up by some form of
structured aftercare.
The four main factors that impact on and influence the effectiveness of residential rehabilitation programmes are -
time in treatment, retention, client characteristics and provision of aftercare. More specifically:
Residential rehabilitation programmes of
at least three months duration are more effective than shorter programmes.
Those who
complete residential rehabilitation programmes have significantly better long-term outcomes than those who leave prematurely. Unfortunately, residential rehabilitation programmes have
high drop-out rates. Studies have shown that one-quarter of clients leave within two weeks of entry and 40% leave within three months.
Clients with less severe problems are more likely to be retained in treatment. However, even clients with very severe problems, including co-morbid psychiatric problems, can achieve similar outcomes to those with fewer difficulties if more intensive individualised services are made available to them.
Following completion of a residential rehabilitation programme,
community aftercare is necessary to sustain the good outcomes achieved.
Residential detoxification and rehabilitation services in Scotland
There is currently
no comprehensive directory of residential detoxification and rehabilitation facilities in Scotland. Therefore, as part of this study, we undertook to map all residential detoxification and rehabilitation units in Scotland - and to answer basic questions about each service such as: (i) its location (ii) the number of beds available in the facility and (iii) the duration of the programme.
We identified
21 residential detoxification and rehabilitation units in Scotland, with 329 beds for adult drug users. This figure does not include residential crisis services or supported accommodation services, although many supported accommodation services are similar to residential rehabilitation in terms of their aims and interventions.
Nine of the 21 units are based in the west of Scotland - six of these are in Glasgow. A number of facilities give priority to clients from particular geographical areas, thus reducing the number of beds available to clients from outside those areas.
Based on available data, an estimated 905 Scottish drug users were admitted to a residential treatment facility between April 2002 and March 2003, and an estimated 1,294 were admitted between April 2003 and March 2004. Because of inconsistencies in the data sources,
these figures can only be considered to be very rough estimates. The actual numbers are likely to be greater.
Residential treatment is expensive. On average, the cost of a week in a residential rehabilitation programme ranges
between 310 and 425 per week, although some facilities cost considerably more than this. The cost of residential detoxification may be twice as much (or more) because of the clinical input provided.
Most non-NHS residential treatment facilities receive self-referrals, and in such cases the client is usually also self-funded. However, many referrals to residential programmes are also made by statutory services. In most areas of Scotland, funding for residential rehabilitation is managed by social work departments, whereas funding for residential detoxification is managed by NHS Boards. Only a few areas of Scotland currently have arrangements for joint funding of residential treatment for drug users.
In addition, it would seem that only a few areas in Scotland have developed criteria for determining when a client's needs can best be met through a residential service. In many areas, practitioners
will not usually consider referring a client to a residential service until community services have been tried and exhausted.
Conclusion and possible areas for further research
Residential detoxification and rehabilitation programmes should not be seen as stand-alone interventions, but rather as components of an integrated package of care. Adequate preparation and after-care provided in community settings are key to the success of residential treatments.
Further research in this area may focus on undertaking a more detailed mapping of residential services in Scotland, improving retention rates and investigating models of good pathways of care between community and residential services.
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