What is Rehab?
• What is Rehab?
• Rehab ‘philosophies’ and approaches
• What about detox?
• Admission and funding arrangements
What is Rehab?
Residential rehabilitation - rehab for short - describes a drug and/or alcohol treatment programme that is provided in a residential setting. Rehabs are usually abstinence-based and provide an intense programme of support and care aimed at people who have difficulty becoming drug free in the community.
They are provided as either traditional rehabilitation models or newer, more locally-based models:
• Traditional models of rehab often involve the person having a complete break from their current circumstances and staying at a centre that is away from their home and drug-using environment
• Newer models of residential treatment are emerging across the country, which include supported housing provision linked to structured treatment and other local services.
Some rehabs provide residential treatment in ‘stages’. Although this is not universally the case, ‘stages’ of rehab are broadly mapped as follows:
• Stage 1: First stage usually corresponds to short-stay rehabilitative programmes or the initial stages (up to 12 weeks) of long-stay rehabilitative programmes, focusing on intensive therapeutic interventions and the immediate responses to becoming drug free
• Stage 2: Second stage usually corresponds to the later stages (more than 12 weeks) of long-stay rehabilitative programmes, focusing on the development of life skills, reintegration through education, training or employment-focused needs; the skills required to sustain a drug-free lifestyle while still receiving intensive support from the programme
• Stage 3: Third stage is offered by some organisations and usually corresponds to independent living and supported housing with some support and mentoring maintained with the main rehab.
Rehab placements for Stage 1 usually last 6 – 12 weeks. Not all residents then need or request additional stages, but, where they do, funding for the next stage may need to be agreed (see below for funding arrangements).
Rehab ‘philosophies’ and approaches
There are 6 main philosophies or approaches provided by traditional model rehabs. These philosophies heavily influence how the programme is run, although increasingly services combine different elements of the philosophies to meet individual client needs.
In identifying the suitable service, it is important to match a client’s understanding of their drug and/or alcohol misuse to the rehab’s approach to treatment and particular philosophy:
This is an increasingly broad term stemming from the 12 steps of the Minnesota Model and is associated with the approaches of Narcotics/Alcoholics Anonymous (NA/AA). Addiction is viewed as a disease and residents usually work their way through the 12 steps as part of a planned programme of recovery. The model is increasingly being modified and adapted to allow greater flexibility and individual care planning, and services may refer to their programmes as modified 12-Step or modified Minnesota model.
Residents will often spend time in “step” groups, in addition to other individual and group therapeutic activities. Although the residential element of 12-Step programmes may last 3 months or less, ex-residents will be expected to continue to attend NA/AA group meetings in the community.
In a therapeutic community, staff and clients participate together as members of a social and learning community. The service may have a hierarchical structure which residents work through and in which each stage has a different pattern of activity, together with growing freedom and responsibilities. Time will be spent in therapeutic group work, one-to-one keywork sessions, developing practical skills and interests, education and training.
Like 12-Step programmes, therapeutic community models have been adapted over the years and made shorter and more flexible. The intensive nature of their approach to individual psychology still means that they tend to be among the longer programmes (6 – 12 months)
Faith-based services have religious staff and may or may not require residents to share their faith or participate in faith-related activities. These activities will include; time studying religious texts and the lessons to be learned from them, in discussion and in prayer.
These are programmes which do not adhere to a particular philosophy and use a range of different methods and interventions focused on meeting the needs of individual residents.
Cognitive-behavioural therapy (CBT) and social learning
These are programmes that include psychological treatments such as CBT, in which actions are believed to influence future behaviour.
Personal and skills development
The programme in a service operating a personal or skills development model may focus less on psychological therapeutic interventions and more on the practical skills and knowledge needed to get by in the wider community. They may be closely linked with local education or employment training providers and residents will spend much of their time in structured programmes of educational classes, training activities and group work. There may also be opportunities for work experience.
What about detox?
Some rehabs provide residential detox facilities in addition to the rehabilitation programme, which residents may choose to access prior to starting the rehabilitation programme. Others rehabs do not, and residents requiring a drug or alcohol detox will be required to complete it elsewhere, either in an inpatient detox unit or in the community as an out-patient detox. Wherever it is completed, all rehabs will require residents to be drug free before starting the rehabilitation component of the programme and for its duration.
Not everyone will need a detox prior to rehab and advice is best sought from a local community drugs service about an individual’s ‘readiness’ for rehab. Detox is usually funded from a separate budget to the rehab component and these arrangements will be explained by the community drugs service that should also provide support and advice for the individual preparing to go to detox and rehab.
Rehab Online does not provide details of inpatient detox-only facilities, but does provide details of rehabs that also offer detox facilities.
Admission and funding arrangements
Admission to rehab is voluntary, but is dependent on an assessment of eligibility. It can also be part of a community sentence or post-custodial sentence from the courts.
It is possible for residential treatment to be arranged and funded privately by direct contact between the client and the service but in most cases, where the client is in contact with a community drugs service and a place in rehab is going to be publicly funded, the following process applies:
• An initial assessment of need for rehab will usually be made by a generic or specialist substance misuse service, criminal justice agency or general advice service which will refer the client for a community care assessment. It is also possible to directly contact the local social services department
• A community care assessment is carried out to ensure that the person meets admission and eligibility criteria. Care managers in local authority social services departments usually perform this function but it may be delegated to another agency such as a community drugs service or a voluntary sector drugs agency
• If eligibility for residential care is supported and funded, the person is referred directly to a suitable rehab programme
• The residential service will then usually make its own assessment of the person’s suitability for the programme either by a face-to-face or telephone interview
• Prospective residents may also be invited to visit the service and talk to current residents to ensure that they fully understand the programme on offer
• When funding and a suitable placement have been agreed with the care manager and the rehab, arrangements can be made for admission.
Rehabs calculate their charges in varying ways. Some offer an all-inclusive weekly price. Others may make a separate charge for activities and services considered to fall outside the scope of their regular charge. These additional charges might cover detoxification, resettlement/aftercare, accompanied visits to court or drug testing.
Some rehabs make arrangements with local authorities to buy a certain number of placements in a year at a discounted rate. This is shown on Rehab Online as the charge for block contracts.