European drug rehab guidelines and the main points to assist those setting up a drug or alcohol facility in Europe.

Guidance

This guidance is designed to assist the regulatory inspection of residential services. Specifically for people recovering from addiction to drugs or alcohol. It recognises that this is a distinct sector which has many differences. Especially from other residential services for younger adults. The aim is to interpret the National Minimum Standards so that they can be understood and applied consistently to this sector.

Homes

This is a small sector of approximately 205 homes. Some of which are registered to additionally provide nursing care if they provide a detoxification service. Essentially this sector provides short-term task focused care of between 3 and 12 months duration. Which basically marks it out as being different in ethos from other sectors. 

National treatment agency

This document has been drawn up in consultation with key stakeholders such as the National Treatment Agency and EATA. The principal providers representative body, and FDAP (Federation of Drug and Alcohol professionals), which represents people who work in the sector.

Inspection process

As with other inspection activity the views of service users should be central to the inspection process. Service users will usually be well able to express themselves. Because treatment tends to focus on the development of awareness and insight into the problems leading to addiction.

One factor to bear in mind is that service users are often challenged about their beliefs and lifestyles. This during treatment in order to achieve the changes necessary to overcome addiction. 

Therefore care needs to be exercised in order to fully triangulate and test out negative views. Which may indirectly relate to the recovery process. Legitimate complaints should be dealt with in the usual way.

Stages of treatment

There are distinct phases or stages of treatment which the sector recognises. These include: –

a. Detoxification.

This is a medically assisted withdrawal from an addictive substance. It often requires medical monitoring and nursing input to help manage side effects.

b. First stage treatment.

This is highly intensive individual counselling and group work. People usually enter this after detoxification which may have been undertaken in a hospital setting. It tends to last 3 – 6 months at maximum.

c. Second stage treatment.

This is where service users need less intensive counselling or group work. Their recovery can be more self- directed. It is the stage immediately prior to after care or independence.

There are some key themes specific to this sector to bear in mind:

a. Contractual restrictions of Freedom.

1, When entering treatment service users need to comply with a structured treatment programme. This is in order to work towards their recovery. If entering a residential service rather than remaining in the community it makes sense that they should keep to the rules of the establishment. These rules are set out for good clinical reasons. Certainly contact with a previous drug-dealing network would harm recovery because there would be ready access to addictive drugs.

2, These are acknowledged in NMS 2.5, which recognises that there can be restrictions on choice, freedom, services or facilities, which are based on specialist, needs and risk and/or required by a treatment programme.

3, Note that such restrictions need to be clearly agreed with the service user on assessment or admission. This does not infringe a persons Human Rights i.e. they will not lose their liberty or be locked in to the establishment against their will, rather they may forfeit their continued participation in the residential treatment programme if they break their agreement, and therefore may have to leave.

b. Environmental Considerations

The ethos of some residential centres is based on peer support and this may extend to room sharing as an integral part of the programme. 

This is in line with NMS 25.5, which allows for up to 4 people sharing. Regarding room sizes the fact that much of a residents time is spent in the communal areas rather than the bedroom should guide decisions on bedroom size compliance. 

In addition it may not be necessary to insist on en-suite toilets provided that there is an adequate provision of communal toilets where privacy and dignity can be maintained. 

Also the gender balance within the home needs to be considered, including facilities to allow privacy and dignity to be upheld. How this works should be subject to regular consultation with the user group.

c. Detoxification programmes for a European drug rehab

Most centres, which operate a detoxification regime, are registered to provide nursing care because the side effects require skilled monitoring and a quick response time.

A small number of centres operate a “community detoxification” programme where a specialist GP takes responsibility for the care of the residents. Care needs to be taken in these centres to ensure that a proper contract is in place with the GP and that the assessment process includes a risk assessment of the likely side effects on withdrawal.

d. Diversity

Although these services offer primarily short-term care an awareness of the diversity agenda in respect of age, race, disability, gender, sexuality and religion is still important. It is a priority of CSCI to promote this agenda and therefore residential services need to be encouraged to consider these issues throughout their operations, as it is easy to overlook them amongst the emphasis on the treatment programme.

Within the sector there will be found a range of treatment approaches. The principal ones are 12- step, which is aligned with Alcoholics Anonymous; Cognitive Behavioural models which focus on learning how to develop new behaviours; Therapeutic Communities which focus on developing a socially productive lifestyle; and those with a faith based philosophy, primarily Christian. Others are also entering the field although they are small in number. The ethos of each needs to be fully understood as it guides the nature of the treatment programme on offer.

e. Routes into Treatment

There are essentially two distinct routes into treatment; a) the public health route through medical or drug/alcohol teams referral, or b) the criminal justice route where orders such as “rehabilitation orders” are made as an alternative to custody. Residents may arrive with different agendas and different motivations towards treatment, however the treatment programme is usually no different and outcomes are broadly similar.

f. Other inspection information

The National Treatment Agency (NTA) undertakes Improvement Reviews of the drug treatment system in partnership with the HealthCare Commission. During 2005/6 this focussed on care planning and community prescribing. In 2008 it will cover residential treatment. Up to date information can be found on the NTA website, www.nta.nhs.uk.

Article on European Drug Rehab Guidlines