RESIDENTIAL REHAB BRIEFING: Introduction
THE CONCORDAT OF PROVIDERS OF FULL RECOVERY
1. INTRODUCTION: WHAT REHABS OFFER.
Residential rehab’ (rehabilitation) – offering addicts a 4-52 week place to recover from their addictions, gain life skills, and not only re-integrate into but also give back to society, and make amends for their past – have been a feature of the UK addiction landscape for almost four decades.
Residential rehabs providing intensive psychotherapeutic and physical intervention in various forms have traditionally aimed to support people to recovery. This is defined by the scottish and US governments (no UK definition) as:
Scottish government definition of recovery:
“Recovery is a process through which an individual is enabled to move-on from their problem drug use towards a drug-free life and become an active and contributing member of society.” (The Road To Recovery).
US government definition of recovery:
“Recovery from substance dependence is a voluntarily maintained lifestyle characterised by sobriety, personal health, and citizenship.” (US Drug Policy 2010)
This regularly includes post-treatment support via links to traditional mutual aid groups such as Alcoholics Anonymous, Narcotics Anonymous and other fellowships and mutual aid groups local to the individuals return address.
Residential rehab seeks to support people to become drug-free and to value their recovery by helping them to understand why they used substances addictively, the impact this has had on theirs and others lives, and provides apsiration, tools and sign-posted support to help people to continue their lives drug-free and sober.
Many residential rehabs also provide support to family members and carers.
• Residential rehabs provide:
A safe drug-free environment
Safe, supervised, supported clinical detoxification
Bespoke care plans
Full structured supported psycho-social individually planned intervention:
Group work (structured and peer-led)
Education about addiction
Supportive engagement: physical needs
An introduction to visible recovery
Highly trained, qualified and accredited staff
A solid foundation for sustained recovery
Education, therapeutic and support programmes for families of addicts.
For research: Reunions, Open Days for the public, Exit questionnaires.
It is worth noting that rehabs providing all the above services on one site offer a complete treatment journey from daycare / detox and treatment to aftercare and resettlement
All potential clients undertake assessment with service prior to admission.
In some rehabs, new admissions met at train station.
• A safe drug-free environment
24/7 total care.
Information pertaining to all risk factors are sourced – pre-cons, pre-sentence reports, medical and psychiatric reports, CCA’s etc.
Patients checked for drugs on admission and tested if suspicious.
Strict rules regarding boundaries and behaviour are given to client – these will already have been discussed at assessment.
Premises regularly checked, patients searched and urine screened, visitors checked.
Access to outside world is limited – no mobile phones, no access to telephone for seven days, all post is checked (in and out), no leaving properties without escort and staff permission, access to money not permitted until week 10.
Patients confronted by peers who wish to be drug-free and sober.
Patients supervised on therapeutic outings.
Volunteer drivers: recovery champions, available every day.
Shop etc managers nearby advised by rehab re patients visiting.
Training on searching given by a specialist security expert.
• Safe, supervised, supported clinical detoxification
Provided by some but not all rehabs.
Detox – 24/7 nursing/doctor/consultant cover with full programme, own counsellor and complementary therapist.
• Bespoke care plans
Socially mixed community.
Intensity of services.
Care of patients with complex needs.
Named buddy, nurse and counsellor.
Continuous assessment and reassessment.
Every client has individual care plan, reviewed, say, at week 3, 7 and 11 and in second-stage every four weeks.
Referral made to local probation service as necessary to manage DRR, licence, parole, MAPPA and review weekly.
Spiritual leaders attend centre regularly and clients access religious services weekly as they wish.
Structured timetable and set waking and bed times and rota of daily ‘chores’ which contribute with pride and altruism to the rehab community and prepare patients to look after themselves post-treatment.
Therapeutic activities include groups, lectures, workshops, life skills and social skills; in second-stage care, training courses and voluntary work are customised for residents.
• Full structured supported psychosocial individually planned intervention:
Support workers: recovery champions, 24/7.
Volunteer drivers: recovery champions, available every day; to provide therapeutic support if necessary on outings and act as role models.
Isolation is not permitted; patients are encouraged and taught to build relationships with peers in a drug-free environment, and deal with personality issues that arise via individual communication and/or groupwork.
• Group work (structured and peer-led)
Most popular models of traditional qualified psychotherapies used are: Psychodynamic, Reality therapy, group therapy, MI, MET, CBT, Gestalt, Family systems, Images & poetry, Creative therapies (art, music, dance, drama), Humanistic, Yalom’s groupwork (curative factors), Transactional analysis, Rogerian, Psychosynthesis, Complementary therapies, Genesis relapse prevention (Addiction Today survey #111, March 2008).
Other psychotherapy approaches used are: Psychoanalytic, person centred, equine-assisted therapy, REBT, cognitive analytic therapy (ibid).
2-3 x group therapy sessions daily plus workshops/lectures.
Therapists trained to link the above traditional therapeutic processes to mutual-aid and selfhelp principles and groups, for life-long free aftercare.
Every week, CA, NA and AA undertake a share with clients, there are professionally-led 12-step or relevant programme meetings inhouse, leading to clients feeling motivated and safe enough to attend in the community –
traditional ‘fellowship’ meetings: eg, Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Methadone Anonymous, Gamblers Anonymous, OA, CoDa, AlAnon, etc.
House meetings: service user voice and responsibilities;
Regular meetings with registered manager and patients.
Life-skill workshops include Anger, Assertiveness, Family dynamics, Relationships, Offending Behaviours, Sexual Health, BBV, Spirituality, Loss and Grief, Effects of Drugs and Alcohol on mind and body, Anxiety and Stress, Art therapy, relapse prevention etc.
Life- skills workshops also include money management including budgeting and saving, menu planning, nutrition, home economics – including laundry, repairs etc, health and safety in the home, parenting, literacy and numeracy, goal setting etc.
• Education about addiction
Socially mixed community.
Helping clients in early recovery learn more about their disorders, recognise roadblocks to recovery, and deepen understanding of the path they will follow toward recovery.
Helping clients learn about other resources that can be helpful in recovery, such as meditation, relaxation training, anger management, spiritual development, and nutrition.
Principal characteristics. Psychoeducational groups generally teach clients that they need to learn to identify, avoid, and eventually master the specific internal states and external circumstances associated with substance abuse.
• Social activities
Attend social events arranged to enable patients to get used to socialising without mood-altering substances, barbecues, parties (fancy dress, themed or informal) picnics etc
Supervised walks in the countryside, to connect with nature which aids and accelerates healing and puts patients in groups together with common drug-free interests and activities.
Introduce patients to drug- and alcohol-free social activities such as inhouse (later external) theatre works, drama workshops, visits to shops.
Rebuilding relationships with significant others on visiting days, and building relationshops with families of fellow patients.
In extended care/second-stage rehab, clients can be introduced to, say, substance-free night clubs such as GodSpeed, to the theatre and shows, to dinners and other evenings out, in the safe company of drug-free companions.
• Supportive engagement: physical needs
Physical examination by doctor on admission.
Appointment with doctor to review current meds, prescribe detox and/or discuss ongoing prescribing regimens. Weekly review of detox, monthly meds review with all necessary prescribing undertaken.
Arrangements made for all outpatient appts – GU, chiropodist, dentist, optician etc.
Examination by psychiatrist before/on admission.
Medical reports are sourced for clarification regarding current prescribing regimens.
The following are included in residential rehab (1) to help restore physical health, (2) to connect disassociated patients with their bodies, (3) to teach patients that physical contact need not be sexual (abuse) and (4) self care for post-treatment:
Stretch and Relax
Indian head massage
Also deliver workshops on smoking cessation, HIV and Hep C and Well woman and Well man clinics.
Fully catered: special chefs and diets to aid and accelerate physical and neuro recovery.
• An introduction to visible recovery
Concentrated community of recovery.
Many residential rehabs are run and staffed by people in recovery. This provides an opportunity for people in treatment to witness recovery in action early in their treatment and inspire hope and aspiration via ‘recovery icons’, and an information source. Many residential rehabs also run family programmes to introduce the families of addicts to recovery and address harmful behaviours in the systemic family model.
• Highly trained, qualified and accredited staff
Named buddy, nurse and counsellor.
Patient:counsellor ratio is small, eg no more than 4 patients per counsellor.
Highly trained in search techniques, to keep environment drug free.
Trained in addiction specialities.
Trained in generic psychotherapeutic techniques, including motivational interviewing and MET, cognitive behavioural, cognitive analytical, gestalt, psychodrama
Trained in family counselling.
Trained in groupwork.
Trained in behaviour addictions such as sex, food, etc.
Trained in relapse prevention techniques.
Trained in confidentiality and disclosure.
Trained in self-harm management and suicide prevention.
Trained in blood-borne viruses management.
Trained in conflict resolution.
Trained in nutritional practices and healing diet plans.
Many trained in complementary therapies.
• Post-treatment support
Many residential rehabs remain in contact with their alumni. This can include regularly get togethers, via telephone calls, or regular sober and drug-free activties such as interest groups (i.e. theatre groups, recovery advocacy etc).
Relapse prevention is ongoing throughout recovery programme, including harm minimisation strategies – have to do this to meet contracts (!).
Free weekly aftercare usually for 1-2 years but can be longer if desired.
Facebook site for information exchange.
Ongoing access to staff if need assistance.
• A solid foundation for sustained recovery
Professionals do not “do” recovery to people, it is the individual who does recovery. In a relatively short amount of time, residential rehab provides a strong foundation to sustain recovery by:
Removing an individual from an unsafe environment;
Providing a safe drug-free environment in order to become drug-free;
Providing an intensive intervention to help people to understand their addiction and how to use this use knowledge to maintain a sober and drug-free life;
Teaching people self-management and self-care;
Teaching people communication skills;
Introducing people to the recovery world early on via traditional recovery supports such as Alcoholics Anonymous and Narcotics Anonymous etc.