Drug treatment is a very wide description of any intervention that seeks to address the causes and prevent the exacerbation of any individual’s problematic relationship with psychoactive substances.
In the UK these can be divided into the type of organisation providing the intervention; NHS service, ‘Not for profit’ / voluntary sector organisations contracted to provide services to the local population; private companies paid usually at the point of contact to deliver treatment a range of interventions and self-help groups.
The range of services provided will depend on ideology and how the organisation is funded.
Many services are consequently experiencing a shake-up, with ‘abstinence’ becoming the main justification for the existence of a service, that is to say many drug treatment services see drugs as the problem as opposed to a symptom of a far more complicated existential problem. Drug services are positioned in each health authority with the practical lead being taken by the specialist provider in the community.
They are required to follow the relevant guidance from NICE and RCGP/ Dept. of Health. The services they supply cover a wide range of interventions from substitute prescribing to individual and group therapy, motivational therapy, alternative therapies, relapse prevention and key-working interventions that might address issues such as housing and debt management. There is also needle exchange or NSP (Needle/Syringe Programmes). The range of pharmacological treatment options may be reduced in some areas to specific medications in line with NICE TA 114/15. Methadone/ Subutex (Lofexidine and Naltrexone for detoxification and relapse prevention.)
Some GP surgeries have entered into agreements with local specialist agencies that they will not prescribe for users, or if they do, it will be in conjunction with specialist drug services. The GP’s basically sign the prescriptions and ‘drug workers’ (or the grandiosely entitled ‘Substance misuse practitioners’) provide support and advice for the clients. Other GPs act independently, some list ‘substance misuse’ as their ‘special interest’. Many clients value this type of treatment very highly and it is fair to say these GPs are usually highly motivated and often deliver a high quality of service.
Modalities include maintenance, usually reviewed regularly with a view to dose reduction. Clients using illegal drugs on top of their scripts are assessed for the best individual resource to help. This may include regular urine testing and one to one counselling or group work. Many patients, particularly the younger less entrenched will be offered a community detox, with regular dose reductions and usually daily collection of medication. Employed patients may be given a more lenient collection regime. Detox may last weeks, months or longer.
In-patient detox, where clients are detoxified, are available through the NHS or private sector which can be prohibitively expensive and many patients, particularly those who do not wish to retain to the same environment may enter ‘rehab’. The length of these programmes may differ as will the needs of the patients. ‘Rapid Opioid Detoxification’ is covered in the section on Naloxone. In the private sector, after an assessment for suitability, money is the main consideration of treatment viability (although some organisations offer pro-bono places). In the NHS, people can self refer or more usually are referred through a GP to specialist services and from specialist services to detoxification and then on to residential rehabilitation facilities.
Types of drugs require different types of treatment, and generally while the assumption is that all chemical addictions are rooted in anxiety and trauma, the detoxification methods for different drug types varies. For example, a stimulant addiction can usually be treated by anxiolytics, sleep and nutrition, while opiate and benzodiazepine and poly-drug dependencies can be far more complex.
Other organisations exist on the periphery of ‘the treatment system’, and while follow-up and aftercare is very important to consolidate progress and help prevent relapse, it may be left in the hands of non-professionals or experienced volunteers who have overcome similar problems themselves.
There are a range of organisations that provide advice, support and information to drug users and their families.