Models of care for treatment of adult drug misusers: Update 2006
services (e.g. housing, legal advice, social services), as well as harm reduction and relapse prevention advice as required.
Settings: The three main settings for inpatient treatment are:
General hospital psychiatric units
Specialist drug misuse inpatient units in hospitals
Residential rehabilitation units (as a precursor to the
Research evidence has demonstrated that clients who receive treatment in dedicated substance misuse units are more likely to have better outcomes than those who receive treatment in general psychiatric wards.
For further information and guidance on inpatient treatment, refer to:
Opiate detoxification in an inpatient setting (NTA, 2005)32
SCAN Consensus Project 1: Inpatient Treatment of Drug and
Alcohol Misusers (forthcoming).
Drug residential rehabilitation consists of a range of treatment delivery models or programmes to address drug and alcohol misuse, including abstinence orientated drug interventions within the context of residential accommodation.
Residential rehabilitation programmes should include care planning with regular keyworking with an identified keyworker. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning.
There is a range of residential rehabilitation services, which include:
Drug and alcohol residential rehabilitation services whose programmes to suit the needs of different service users. These programmes follow a number of broad approaches including therapeutic communities, 12-Step programmes and faith-based (usually Christian) programmes
Residential drug and alcohol crisis intervention services (in larger urban areas)
Inpatient detoxification directly attached to residential rehabilitation programmes
Residential treatment programmes for specific client groups
g. for drug-using pregnant women, drug users with liver problems, drugs users with severe and enduring mental illness). Interventions may require joint initiatives between specialised drug services (Tier 3 or 4, depending on local arrangements) and other specialist inpatient units
Some drug-specific therapeutic communities and 12-Step programmes in prisons
“Second stage” rehabilitation in drug-free supported accommodation where a client often moves after completing
an episode of care in a residential rehabilitation unit, and where they continue to have a care plan, and receive keywork and a range of drug and non-drug-related support
Other supported accommodation, with the rehabilitation interventions (therapeutic drug-related and non-drug-related interventions) provided at a different nearby site(s).
Residential rehabilitation programmes normally combine a mixture of group work, psychosocial interventions and practical and vocational activities. These components are also used in specialist residential programmes for particular client groups (e.g. parent and child programmes).
Clients usually begin residential rehabilitation after completing inpatient detoxification. Sometimes the detoxification will take place on the same site as the rehabilitation programme, to enhance continuity of care. Prior to starting the rehabilitation programme, the client should be supported by their keyworker (or other substance misuse professional) to prepare for admission, so as to minimise disengagement and maximise benefit, but there may also be preparation input from the rehabilitation service.
Settings: The main settings for residential treatment are purpose- built or refurbished units, which may be freestanding or converted residential houses. They vary in size, and clients are received from a wide (often national) catchment area. Some residential units have medical facilities for inpatient pre-residential programme detoxification treatment.
Aftercare, as described in Models of Care, is a package of support that is planned with the client to support them when they leave structured treatment. The aim of aftercare is to sustain treatment gains and further develop community reintegration. Aftercare may include drug-related interventions such as open access relapse prevention or harm reduction. It may also include non-drug-related support such as housing, access to education, and generic health and social care. It is important to note that aftercare is not necessarily what a client receives after leaving Tier 4 treatment or prison, as they may still have an active care plan, involving community interventions. Only once the client’s care plan is complete do they enter planned aftercare.
During a period of care-planned treatment, clients will receive a range of interventions to address their drug and alcohol-using behaviour and interventions to target non-substance use domains of functioning (e.g. housing, family support). Some of these interventions will come to an end when the care plan comes to an end, but some may need to continue.
As long as clients have an active care plan they are considered to be “in treatment”. When their care plan with the treatment provider comes to an end, they may continue to receive a range of services that they were receiving as part of the care plan, and