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Heroin Addiction - Help for Addicts www.helpingaddicts.net
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Rehab Handbook
This is a guide to help anyone who is thinking about using services to help them stay drug free. The information comes from a UK leaflet, so some of it might not be relevant for people in other countries. It explains what is available and aims to help you decide if rehab is for you. Most areas have access to NHS community and/or hospital detox services for people to use before they start rehab.
All the information on this page is from the leaflet called 'The Rehab Handbook' and is available from drug services in the UK.
What does rehab mean? In the past when people have talked about 'rehab' they meant residential rehabilitation services. In recent years this has changed, as new community-based services have developed to help support people in staying drug free. These service may not use the term rehab to describe themselves; services that also offer detox may called themselves 'treatment centers'. Community programs often call themselves 'after-care' services or 'day programs' or use the project or service name. The term rehab on this page will be used to describe any service - residential or community based - that primarily aims to help people stay drug free.
Funding
For most adults, rehab places are paid for by the Community Care budget. This is money held by each local authority to pay for 'social care' of the people that live in their community. Funding for young people is usually the responsibility of child and family services.
Money from the Community Care budget can only be allocated to pay for rehab after a full 'assessment of need' has been carried by a Community Care Assessor who has been approved by your local authority - even if you go to a rehab that is far away.
The choice of community and residential rehab services may be limited as Social Services departments often have contracted with one or more rehab provider to buy a number of places per year on their programme. In theory they are able to buy treatment places from other services, but they will only do so if they are sure that the services with whom they have contracts can't help.
Community Care Assessment Community Care Assessments for drug rehabilitation are usually done by a social worker (or another approved member of staff) from a specialist drug agency. If you are on probation it may be done by your probation officer. Your local specialist drug agency should be able to help you contact the right person. If you don't know where your local drug agency is and your in the UK you can ring 'FRANK' The National Drugs Helpline on 0800 77 66 00.
Once you have referred yourself you should get a letter within a week with an appointment to see someone. At that appointment the assessor will want to find out about you, your history, your drug use and what help you need. They will discuss the options that may be open to you, and will agree a 'care plan' with you. The care plan will describe your needs and how any services that are provided are going to work with you to meet them. You are entitled to a copy of the assessment and care plan.
They have to make a decision about funding rehab having asked these questions:
All other options must be considered, costed and rejected before rehab can be recommended. If, having been through this process, you both agree that residential - rather than community - rehab is needed, the Community Care Assessor will also have to go through your finances in detail. This is because you will have to contribute all income which is not required for essential living expenses to your care.
Someone, usually the person who did the assessment, will take responsibility for coordinating the care plan (but not necessarily providing care themselves). This person is known as your 'Community Care Manager'.
Equal Opportunities Services should be offered to everyone on an equal bases of need. No one should be discriminated against in terms of getting a place at a rehab, because they are a member of a minority group. If you face discrimination talk to your Community Care Manager; part of their job is to ensure that you get treated equally and, if necessary, to help you get things changed.
Complaints The system means that not everyone who wants funding for rehab gets it. If you are not happy with a decision made by your Community Care Assessor then you can appeal to the Director of the Social Services department.
Community Rehab
These may be linked with dry-house accommodation which is sheltered, supported, shared or hostel type accommodation.
Community rehab doesn't work for everyone. The possible drawbacks are that:
You are also more likely to be able to negotiate a rehab programme with longer-term treatment aims of limited drug use (for instance giving up heroin but still smoking cannabis) than if you go into residential rehab.
Weigh these up in your own mind, talk through what is on offer and work with your Community Care Assessor to try to sort out the best possible rehab from what is available.
Types of residential rehab
However, there doesn't seem to be any one type that is clearly better than the others. What is important is that you are able to work with the programme on offer. In fact the main thing that makes a difference as to how well people do after rehab isn't which type of rehab they've attended, but whether or not they finished the programme.
Residential rehab can, generally speaking, be divided into four groups according to their understanding of why people take drugs and what people need to help them stop and stay off. However, more and more residential services are combining approaches or varying the service that they offer according to what suits the resident.
The types of rehab are:
Most - but not all - residential services aaare 'abstinence based', that is, they aim to help people get off all drugs (including cannabis) and alcohol and to stay off. You may have other aims - which is fine - it is sensible to aim for things that are achievable: but if you don't want to sort out the things that are causing your problem drug use and stop using forever, you may find it hard to find a residential rehab that can help you.
12-step programmes The programmes are based on the belief that, for people who are severely dependent, control over drug use has been lost and abstinence from all psychoactive substances is the only way to sustain 'recovery'.
Not everyone can accept this philosophy - or being told how to think about substances - but if you need to completely restructure the way you think about, and react to, drugs and alcohol this programme may well offer you a way forward.
The counselling staff are usually people who have had a drug problem which they have overcome using this method. The programmes are structured and the day is usually carefully timetabled with very little 'free' time. There is a combination of 'life story' work, group work, individual counselling, lectures and videos. As people 'work through' the 12 steps their progress is evaluated by their counsellor and the other residents. Many 12-step services also offer programmes of support and counselling for families.
12-step first stage treatment programmes are usually 6-8 weeks long and generally integrate detox and therapeutic activity from first admission.
There is also a network of 'second stage' rehabs which run on the 12-step philosophy. People usually go into these after detox and stay 3-12 months, after which they may move on to 'third stage'. These are usually clean houses with some additional support. 'Third stage' rehab is sometimes funded through housing benefit.
Maintenance of abstinence is the goal and all residents are encouraged to attend NA meetings regularly for free 'support, encouragement and hope' after discharge.
General houses General houses provide support and promote change through individual sessions, group work and/or house meetings. They generally describe themselves as 'democratic communities' and place emphasis on residents deciding what they need from what is on offer. Each resident will usually have a key worker/counsellor who they meet with regularly to plan their care.
This model of care may be less directly challenging than other types of rehab. A number work on the basis that what needs to be changed is current thinking and behaviour than looking at the past - this is known as a cognitive behavioral therapy.
General houses are more likely to offer treatment aims of stabilisation of drug use and crisis intervention, although funding for residential services to meet these aims is rare as they can often be met by community services.
Concept houses 'Concept houses' are 'therapeutic communities' which usually work from a belief that people coming into rehab have a self-image and lifestyle that needs to be completely rebuilt. This is mainly done within the group.
They tend to have highly structured and intense programmes which emphasise 'getting in touch with feelings' and achieving personal growth through their expression. Some people find this powerful and healing, but for others it is too much.
As with 12-step programmes, many staff have been through the programme themselves.
Christian houses Christian rehabs tend to use one-to-one counselling and house meetings rather than confrontational groups to help people change.
They all have Christian staff but vary in the amount of emphasis they put on residents accepting Christianity - some have programmes more like those of general houses while others believe that residents need to be active Christians and take part in prayers, bible study and church attendance to combat their problems.
Most Christian houses are single sex but may not accept residents who are lesbian or gay.
Prison rehab
Prison-based rehab programmes will mostly be run by the same sort of agencies that run residential and community programmes on the outside. There should be detox, counselling, group work and drug-free wing programmes using the same philosophy as the residential and community programmes described above.
Clearly there are bound to be big differences between what happens, and what some people feel able to say, in prison compared to rehabs 'outside'. But if you are going to get a prison sentence and want to use your time inside to get to grips with your drug use - talk to the medical officer, a member of the health care staff or the prison drug counsellor.
In prison their will be a 'Counselling, Advice, Referral, Assessment and Throughcare' (CARAT) service whose responsibility it will be to help you get treatment and support during your sentence and to help you make contact with services following your release.
Will rehab be right for me? Tick all the statements which are true for you and then add up the scores in the brackets besides the ones you have ticked to find out:
Results The things that you did and didn't tick are used as an indication of whether or not rehab is going to be for you and, if it is, whether residential or community rehab is likely to be useful. However, it is not scientific and if you don't feel the 'results' are right for you re-read the statements and talk it over with your Community Care Assessor.
0 - 3 If you ticked three or more statements which scored 0 and your total score was between 0 and 3 you have probably already decided that you want to go through a rehab programme. The decisions you have made and the way that you are thinking about things should mean that, if funding is available, you will probably be able to find a residential rehab or community programme that will suit you.
4 - 7 If you scored between 4 and 7 it is possible, as things stand, that community rehab and other services will have more to offer you to help you get things sorted out.
It may be that you are not altogether certain about going into a residential rehab or that there are some things about the way most rehabs choose residents/run their programmes (or the way that funding decisions are made) that might make going to a residential rehab difficult for you. The things you ticked with scores of 2 or 3 are probably the biggest obstacles.
If you want to go into a residential rehab talk these issues over with your Community Care Assessor to see if they can be overcome. However, they will probably, at least in the short term, be looking at ways of helping you with community support or rehab services.
8 + If you scored 8 or over you may not be ready for the sort of big changes that most rehab services work towards.
If the idea of getting away and sorting things out did appeal there are a number of things - particularly the ones that scored 3 - which probably mean that it will be hard to find a rehab, and even harder to get funding.
You might be able to change these things and it could be helpful to think about using other community drug services to help you start to get your drug use, life and mind set ready for rehab.
Rehab Checklist
About the rehab:
The programme:
Practical:
The right time to start
The process from referral to admission often takes weeks while you wait for appointments, assessments and funding. It helps if you can to hold onto the desire to get off; and to use the time you are waiting to make as much progress as you can.
While you are waiting for admission you might feel like changing your mind - if you do feel like giving up, talk things over with your drug worker or Community Care Manager before you make any decisions.
Preparing yourself for rehab
Practical:
Emotional:
Physical:
Legal:
If you can sort things out before you start it will mean that you will have fewer stresses from the outside and the best possible chance of achieving what you want during and after rehab. You don't want to go through the rehab process only to come out and have lots of stress waiting for you.
Making it work It is best to go into rehab with a commitment to making big changes and being prepared to endure huge short-term hassles, stress and emotion to achieve the long-term aim of being clean. Success often depends on determination to achieve the goal and being prepared to weather the storm to get there.
Everyone has a unique experience of rehab and so past experiences - yours or other peoples - probably won't tell you much about how it is going to be for you this time. You can expect any residential detox to be very different from - and probably easier to cope with - anything you have tried yourself at home. Choosing a rehab that suits you and being clear about how the programme works will help you get through.
The first few days in a rehab are often the hardest. A lot of people leave in the first week. Whatever they tell themselves at the time, people who leave early usually relapse.
The sorts of things that unsettle people are:
But if you are ready to talk through your feelings with the staff and other people on the programme when you feel confused, anxious, angry or lonely then you are more likely to find the support that you need - and succeed in completing the programme.
A part of going into a rehab programme is accepting that 'they know best'. Understandably, not everyone wants to do this and it is often the cause of people leaving early. If you don't like the sound of it, talk the issue through with your Community Care Manager as, unless you can accept it to some degree, rehab (especially residential) is unlikely to work for you.
What if I lapse? Rehabs generally discharge anyone who uses drugs or leaves without permission during the programme. Some may look at the circumstances: how well the person was progressing, the impact of the episode on other service users, the nature of the lapse etc. and issue a warning. However, because abstinence for everyone on the programme is usually the aim; lapses often result in people being asked to leave.
If you are thrown out of a rehab you are likely to lose your funding. In many areas that could mean that you won't get another chance to go to a rehab for at least 6 months, possibly a year or more.
If you discharge yourself, or are discharged, from a rehab and then realise that you want to go back, you must contact both your Community Care Manager and the rehab straight away - usually within 48 hours - to talk to them about readmission.
People lapse and/or leave for many reasons: it may be because they weren't ready to stop or that rehab wasn't right for them.
Things don't have to get out of control following a lapse. Understanding what caused a lapse can help you prevent it turning into a relapse. If you do stop again, learning from the experience will make you wiser and stronger next time. Staying in contact with services is likely to help too.
If you are leaving for good you should take your belongings with you as it may be difficult to get them back later.
What do I do after rehab? Coming out of rehab drug free can be one of the best feelings there is. Completing the programme may seem like a million miles away when you are still at the stage of thinking about going in - but thinking early on about what you will do after rehab can prevent accommodation, support or other problems making life difficult for you when you leave. Your Community Care Manager or drug agency should be able to help you organise accommodation and support upon your return.
Many rehabs offer help for people leaving the programme. Many also offer support - including regular reunions - for people who have left.
Some residential services have their own, or have links with, 'halfway houses' or 'secondary care' units. These range from therapeutic communities offering a continuation of the programme to supportive lodgings. Some 12-step programmes have links with local NA groups.
To stay drug free you will probably need to avoid getting into situations that may tempt you back for at least a couple of years - and possibly for much longer. It can be hard enough without 'testing yourself' by getting into risky situations: it is seldom helpful and often leads to relapse.
In the end rehab is about getting drug free, learning new ways of coping and getting back control over your life. Life after rehab won't always be easy but you will have a choice about how you want to deal with the hard times.
Credits Written by: Andrew Preston and Andy Malinowski With grateful thanks to: Nick Barton, Director, Clouds House; Jon Derricott, Alex Georgakis, Broadreach House, Plymouth; Ray Ghandi, Senior Clinical Nurse Specialist, Derby Substance Misuse Service; Mary Glover, Kim, Peter Rorstad, ADAPT; Simon Shepherd, Chief Executive, European Association for the Treatment of Addiction and Mary Treacy for reading the first draft and offering advice and suggestions. Published by: Exchange
Supplies Ltd. ISBN 0 9520600 8 6 The Rehab Handbook. Fourth edition The printed edition of
this book is printed in the UK on recycled paper made from Distributed by HIT, telephone: 0870 990 9702 and DrugScope, telephone: 01235 465500 Exchange Supplies is an independent publisher of information about drugs, drug use and treatment. Exchange publications aim to give drug users the information they need to make informed choices about their drug use, in an easily readable and accessible format. For more information go to: www.exchangesupplies.org/aboutus.html The Rehab Handbook is updated and revised regularly. If there are any comments or suggestions you would like to make, please send them to: Andrew Preston, Exchange Supplies, 1, Great Western Industrial Centre, Dorchester, Dorset DT1 1RD or andrew@exchangesupplies.org |
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Source: www.hit.org.uk (HIT) Last updated: 10 August 2004 |
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THE
REHAB HANDBOOK
If
you are thinking about using rehab services you will probably have to think
about how it is going to be paid for right from the start. Whether
provided by charities or Social Services departments, rehab services cost money
to run. The cost is worked out as a charge per person, per day or per
week. It can be expensive, with residential rehab often costing more than
£300 per week.
Over
the last few years alternatives to residential rehabilitation have been
developed in many areas. What is available varies from place to place but
community rehab may include one or more of the following:
On
the other hand community rehab may mean that you can:
Residential
services vary in many ways: they have different lengths of programme, levels of
support and counselling, ways of looking at life and drug use etc.
The
government has started to recognise the link between drugs and crime, and come
to realise that there are a lot of people in prison with drug problems.
The intention of the prison service is to provide the same services for people
with drug problems (but not alcohol problems, unless they have a drug problem as
well) that are available in the community, within each prison region or cluster.
If
funding is approved there are a lot of things you may want to find out before a
final decision is made. Below is a list of questions you may want to ask
your Community Care Assessor and/or the rehab(s) you are thinking about:
If
you want to stop using drugs for ever and got a low score on the questionnaire,
you will probably feel like the best time is right now. Unfortunately some
delay is almost inevitable.
It
is likely to be helpful if you use the time before admission to do some sorting
out. The types of things you may want to try to sort out are: