DRUG TREATMENT SERVICES
People
who have problems with drug use can access help and treatment either through
the health and welfare system (via drug advice services or GP referral)
or through the criminal justice system if they have committed an offence.
See Helpfinder,
our online database of drug treatment services in England.
Also see
Where
can you get help from?
Health
and welfare system
Drug
agencies
Most
areas of the UK have ‘street agencies’ or projects (sometimes called community
drug services or teams) which offer a range of services including information
and advice, counselling, detoxification and prescribing for opiate users,
needle exchanges and sometimes support groups and other services such
as acupuncture. They are usually only open during normal working hours.
While they may give information and advice over the telephone advice only
see people by appointment and have waiting lists.
GPs
and Accidents and Emergency (A&E) Units
The
main primary health care source for people is their GP and possibly the
local hospital A&E department. GPs and hospitals make more referrals
to specialist drug services than any other point of contact. As well as
referring patients on GPs provide general medical services, information
and advice and treatment (especially substitute prescribing) often in
partnership with a drug agency or DDU.
DDU
(Drug Dependency Unit)
These
are usually located in or adjacent to a hospital and specialise in helping
problem drug users, especially people who are dependent on drugs like
heroin. They provide counselling, detoxification, substitute prescribing
and other treatments. An appointment is usually needed and waiting lists
can be long.
Needle
exchange schemes
These
were set up in the 1980s in response to the spread of HIV among drug injectors.
As well as giving out clean injecting equipment and collecting in used
‘works’ these services can offer information and advice, health check
ups, safer sex advice and condoms and referral to other drug services.
Some schemes are based in drug projects or hospitals but others operate
from chemist shops. Some also use outreach workers who injectors meet
on the streets or in their own homes.
Outreach
services
Outreach
attempts to bring the service to the user. Detached work involves workers
going into the users own environment. Examples include support and needle
exchange workers going into user’s homes and support workers operating
at raves and in clubs. Institutional work is where a service operates
on the site of other agencies such as in a health centre, college or school.
Residential
services
Residential
treatment programmes are for heavily dependent drug users who are trying
to give up drug use. Residents must usually be drug free on admission.
This means that they usually have to undergo detoxification before entry.
Programmes usually last 3-6 months, but some 12 steps programmes last
for a year. These services are often based in rural settings. The types
of programmes vary but tend to fall be one of four main types:
Therapeutic
communities operate a hierarchical structure which residents work
through based on intense therapy sessions.
Minnesota
model – This is associated with the Alcoholics/ Narcotics Anonymous
12 step programme. It sees addiction as a disease, aims for long term
abstinence and includes spiritual as well as practical guidance.
General
houseprogrammes differ in their approach and are based on group and
individual therapy.
Christian
houseprogrammes are usually run by Christian staff with or without
any required Christian structure. Where there is a specific religious
requirement non-Christians will not be accepted.
Telephone
helplines
The
main one is Ask Frank (Tel. 0800
776600) which offers free, confidential information and advice 24 hours
a day.Email Email Frank@talktofrank.com.
Others include Drinkline which has advisers available from 9.30am - 11pm
during weekdays. Telephone 0800 917 8282.
Self
help groups
Narcotics
Anonymous (Tel. 020 7730 0009) co-ordinate local support groups for problem
drug users around the country. Families Anonymous (Tel. 020 7498 4680)
run similar groups for the families of drug users. Both are based on 12
step, abstinence models.
Criminal
justice system
Many
problem drug users are referred for treatment through the criminal justice
system.
Police
Arrest
referral schemes began in 1996 and have spread since. They range from
people being given telephone numbers for helping agencies when they are
arrested for a drug or possibly drug-related offence to drug workers operating
in police stations.
Prisons
A
lot of people enter prison with a drug problem and a lot of drug use takes
place within prisons. A range of services have been developed within prisons
including in-house treatment, information and advice. Currently provision
of clean needles are not allowed although some prisons do provide sterilisation
facilities. Prison doctors can refer prisoners on to helping services,
provided either in-house or by workers from drug projects coming into
the prison. Take up of treatment is usually voluntary but the introduction
of drug treatment orders and drug testing means that prisoners can now
be required to undergo treatment either in prison or while on probation.
Probation
Probation
work aims to prevent re-offending and part of this work is to minimise
drug problems. Probation services usually have good contacts with health
and drug agencies and can refer individuals for treatment. They also play
an important role in supervising care and reporting to courts prior to
and after sentencing.
Different
types of treatment
Advice
and counselling
This
can range from individual or group counselling as well as advice about
safer use, housing, work, benefits etc.
Opiate
detoxification (detox)
The
aim of detox is to reduce the amount of drug (usually heroin) from the
body prior to support to be abstinent. Doses of the drug are reduced until
the user is drug free. Usually this is done over a period of a few weeks
but sometimes involves abruptly stopping. Detox programmes are available
in hospitals but more commonly on a community basis where users remain
at home and receive support to deal with withdrawal symptoms and become
drug free.
Methadone
reduction programmes
These
involve prescribing methadone to heroin users to control withdrawal symptoms.
The aim is to gradually reduce the quantity prescribed until the user
experiences no withdrawal symptoms and is drug free. The degree of reduction
and length of time used to achieve abstinence can vary from a few weeks
to several months. Motivation is a key to the success of such programmes.
Participants regularly review their progress and usually receive therapy
and support as part of the programme. Methadone reduction programmes usually
take place in community settings.
Methadone
maintenance programmes
Here
the aim is not to eliminate drug use in the short term, but to stabilise
the use by prescribing methadone as a substitute for heroin. The idea
is to reduce the need for criminal activity and the harm caused by injecting
and to stabilise the user with a view to them giving up drug use in the
longer term. Programmes are usually delivered in community settings.
Heroin
prescribing
Very
few doctors in the UK are licensed to prescribe heroin to street users.
In the past some doctors have prescribed heroin, on the basis that many
heroin users do not like methadone or continue using heroin while on methadone.
Treatment
for stimulant drug users
There
is not much specialist care and treatment for people who experience problems
with use of amphetamine, cocaine or crack cocaine. While legally permissible
prescribing of amphetamine is rare and can be risky. Most agencies offer
treatment through counselling, possible referral to residential rehabilitation
and alternative (not substitute) prescribing of anti-depressants.
The
increase in crack use has led to some agencies offering specialist counselling,
cognitive behaviour therapy, acupuncture and other alternative therapies
and prescribing of anti-depressants.
Services
for younger people
Most
drug services are only equipped to deal with adult users – those over
18 years old. Confusion over legal issues about confidentiality and informing
parents has resulted in some agencies refusing to see the younger age
range. However, new initiatives have seen development of projects which
specifically cater for younger age groups and the appointment of staff
at existing agencies to work with young people.
Updated
January 2004
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