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Effective Interventions Unit: Residential detoxification and rehabilitation services for drug users: A review
Chapter 4: Conclusions and Future Research
This review was undertaken to inform further research to be commissioned on the effectiveness of residential rehabilitation under the Scottish Drug Misuse Research Programme. Existing research evidence makes it clear that drug users will achieve better outcomes the longer they remain in treatment. This review indicates that residential detoxification and rehabilitation services may have an important role to play for clients whose aim is to be drug-free. Residential detoxification and rehabilitation are undoubtedly effective in the treatment of drug misuse. However, this statement comes with some caveats:
Residential detoxification must be seen as only a first step in the process of becoming drug-free.
Residential rehabilitation programmes should be at least three months long.
Clients must be retained in the programme.
Appropriate aftercare should be included as part of the treatment.
Unfortunately, residential rehabilitation programmes have high drop-out rates. Roughly half of clients who enter a residential rehabilitation programme will leave prematurely. The majority of these clients will leave within the first few weeks of entry.
Further research in this area may focus on ways of increasing client retention.
In terms of future research,
it may also be beneficial to undertake a more detailed mapping of residential rehabilitation services than was possible for this review. Such an exercise would not only clarify the differences between residential rehabilitation and supported accommodation, but would also provide community practitioners with greater information about the range of options available to their clients.
Despite the good outcomes that can be achieved through residential treatment, this review is not suggesting that residential services are appropriate for
all drug users. A comprehensive assessment of an individual's needs and social circumstances, and a clear understanding of his / her aims and aspirations, are the best basis upon which to make a decision about his / her suitability for residential treatment. However, there is some evidence to suggest that, at least in some areas of Scotland, further work needs to be done on developing clearer referral processes and establishing criteria for deciding when an individual's needs can best be met through placement in a residential service. In addition, some areas would undoubtedly benefit from having joint (health and social work) management and joint funding of budgets for drug detoxification and rehabilitation. Given the aims of the Joint Future agenda, many local areas are already beginning to move in this direction.
The findings of this review show that residential services cannot be seen as stand-alone services. Residential detoxification can only be considered as a first step in the process of becoming drug-free, and even long-term residential rehabilitation programmes need to be followed up by continued support in the community. Adequate preparation and after-care provided in community settings are key to the success of residential treatments. Residential services should be considered as only one aspect in an integrated package of care for drug users.
Future research could examine existing pathways into residential treatment and pathways out following successful completion to identify models of good practice and factors that help to sustain the benefits achieved.
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