Models of care for treatment of adult drug misusers: Update 2006
Delivery (including maintenance)
This approach will require treatment systems to be configured both to create effective exit routes out of specialised drug treatment, including efficient access to Tier 4 provision for those who wish to be drug-free, and to be well integrated with primary care and other systems of support and care for those in maintenance treatment.
Drug-related aftercare support, such as support groups or individualised sessions or alternatively from mutual aid groups run by Narcotics Anonymous or non-12-Step equivalent groups, has been demonstrated to sustain abstinence.
Improving community integration and treatment completion may require some drug treatment system or service redesign,
As well as planning for numbers in treatment and numbers of clients retained in treatment, commissioners should plan for numbers of planned client exits from treatment
Investing in quality drug treatment delivery to maximise gains and service users’ improvement in treatment (whether achieving stability on maintenance treatment or achieving effective abstinence)
Enhancing routes to treatment completion or, for stable patients who no longer need specialist care, better routes to community maintenance in primary care settings
Commissioning a range of aftercare provision for service users to follow structured treatment, as a development of Tier 2 interventions, and ensuring a range of other support mechanisms for ex-service users (e.g. drug-free support such as Narcotics Anonymous or equivalents)
Investing in strategic partnerships with housing, education and employment, together with bespoke initiatives for drug misusers aimed at reintegration.
Figure 1: The client’s journey
These pathways should include drug-related and non-drug- related support. Drug treatment providers and commissioners are responsible for the drug-related support, and should form the necessary local strategic links to enable clients to access non- drug-related support, including improved social support, housing, education and employment opportunities to maximise treatment gains.
Improving treatment completion Few service users who enter drug treatment intend to be in specialist drug treatment indefinitely. For those who wish to be drug-free, commissioners and providers need to create better pathways and exits from specialist drug treatment.
Improving community integration Whether service users are in treatment (e.g. maintained on substitute opiate medication) or leaving treatment they should have access for social support (e.g. housing support, educational support, employment opportunities) to maximise positive gains they have made in treatment.
Service users who are stable but who wish to be maintained on substitute opioid medication should have opportunities to receive social support, education and employment where appropriate. For stable individuals who do not need to continue in specialised drug treatment services, there should be clear pathways into maintenance and monitoring in primary care settings with ongoing community integration interventions and support. However, it is vital that such service users have explicit accessible pathways back into specialised structured drug treatment services if needed (e.g. in case of relapse).
DAT partnerships should consider linking their drug treatment targets to wider mainstream targets, that relate to housing, education and employment for drug users (e.g. Office of the Deputy Prime Minister for Supporting People, Department of Work and Pensions for Jobcentre Plus and Progress2Work).