RESIDENTIAL REHAB BRIEFING: Evidence base
THE CONCORDAT OF PROVIDERS OF FULL RECOVERY
2. EVIDENCE BASE.
There is a paucity of research about residential rehab in the UK. This is due to a lack fo research interest and funding in this area of drug treatment. However, that which does exist is supportive of the merits of residential rehab in supporting people into recovery.
• National Treatment Agency-commissioned research undertaken by its then lead researcher Dr David Best clearly concludes that “The only type of formal treatment service which was a key factor in helping drug users to stay abstinent was residential rehab. Formal long-term structured (not rehab/TSF) treatments played only a peripheral role in the recovery journeys.” (statement by researchers Dr David Best, Jessica Loaring and Safeena Ghufran).
• The NTA and Commission for Social Care Inspection jointly carried out a review of treatment services in 2008 and concluded that “Residential rehabs outstrip other sectors in every outcome group we measure”. (statement by CSCI inspector David Finney)
• DORIS, the Abstinence and drug-abuse treatments: Results from the Drug Outcome Research in Scotland study (2006) followed 1,033 drug users contacting treatment services who were able to become and stay abstinent 33 months after starting treatment – and identified which services were most closely linked with such drug-free results. The Doris researchers defined abstinence in terms of people being totally drug free (other than alcohol or tobacco use) for at least 90 days before their research interview. 29.4% of those in contact with residential rehabilitation services but only 3.4% of those in contact with methadone maintenance services had a 90-day drug-free period nearly three years after having initiated a new episode of treatment.
• NTORS: The largest UK research into outcomes of drug treatment is the National Treatment Outcome Research Study, which published changes in substance use, health and criminal behaviour during the five years after intake. “Clients in the rehabilitation units included the more chronic, long-term users with the most severe problems. Rehabilitation clients presented with the longest heroin careers, they were more likely to be regular users of stimulants (especially cocaine), and were more likely to have shared injecting equipment. There were also more heavy drinkers among the clients entering the rehabilitation programmes. Rehabilitation clients were more likely to have been actively involved in crime and they had been arrested more often than the other clients,” the researchers stated.
Despite this, over 38% of the “residential clients” were abstinent from six illicit target drugs 4 -5 years after treatment compared to 35% of methadone clients. The gap is greater than it at first appears.
Methadone users were described as abstinent when using not only that drug but also psychoactive drugs other than “illicit heroin, nonprescribed methadone, crack or powder cocaine, non-prescribed benzodiazepines and amphetamines”. So they could still be using prescribed heroin, cannabis, ecstasy… Indeed, 40% of methadone maintenance patients became dependent on alcohol. Rehabs meant no drugs or alcohol at all.
Second, the NTORS researchers confusingly blended NHS inpatient/detox outcomes with residential rehab instead of separating them out, even though they are very different. Anecdotal evidence is that the former have little success (so bad in one notable case that it led to a call for retoxing clients before releasing them) and the latter far greater success rates. Thus we can conclude that the successful outcomes for residential rehab are higher than the 38% quoted in NTORS.
• Predictors of 4-year outcome of community residential treatment for patients with substance use disorders (2008) examined systematically how predictors of substance use treatment outcomes worked in over 2,000 male patients. “Greater substance use severity, more psychiatric symptoms, more prior arrests and stronger belief in AA-related philosophy at treatment entry predicted improvement significantly in substance-related problems four years later. At the one-year follow-up, being employed and greater use of AA-related coping predicted outcome significantly,” the research confirmed.
• 20 research facts everyone should know about rehab treatment for alcohol and drugs dependency. In 1999, Dr David Best, the Addiction Recovery Foundation and EATA met to initiate an easy-to-use reference document about addiction treatment, covering key issues and based on incontrovertible research. This is still available at: www.intervene.org.uk/addictiontoday/2008/01/the-guide-to-re.html
• Action on Addiction/ Clouds independent research: As long ago as 1995, an independent research psychologist was commissioned and allowed to select from any block of admissions into Clouds House rehab. Of 166 randomly chosen ex-clients, 61% were abstinent from all mood-altering substances 30 months after treatment. Of the predictors of successful outcomes, two were important. First was discharge status: 82% of people completing the programme satisfactorily showed good outcomes at follow-up. Second, 89% of ex-patients attending 12-step meetings were abstinent at follow-up.
• Also read the research-referenced Recovery: Linking addiction treatment and communities of recovery at www.facesandvoicesofrecovery.org/pdf/recovery_symposium/NeATTCRecMonoWhiteKurtz2006.pdf
• The University of Lancaster (UCLAN) report (2007) into prison drug services found that prisoners who wanted to continue to address their drug use on release also pointed out that a residential rehab' place would increase their chances of staying drug-free. Prison officers and drug workers interviewed in the study said that rehabilitation programmes were critical to the long-term success of behavioural changes achieved in prison, and suggested that residential rehab' programmes could operate as “half-way houses” between custody and community.