Healthcare professionals and partners

Advice and information is provided by non-specialists such as GP surgeries and accident and emergency departments. This should include:

• information about drugs and alcohol, and their effects
• advice on reducing and giving up drugs and alcohol
• information on reducing the potential harm from drug misuse, such as injecting more safely and preventing overdose
• how to get help for drug problems
• how to get help for other problems, such as housing and sexual health
• information for carers, partners and families of drug users.  

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Most harm reduction is about preventing diseases passed on by contaminated blood (particularly HIV and hepatitis infections), and preventing overdose and drug-related death. All drug treatment services, whether residential or based in the community, should provide this as a core service. Examples of harm reduction are:

• needle exchange services, which distribute and dispose of needles, syringes and other injecting equipment (such as spoons, filters and citric acid)
• advice and support on injecting more safely, injecting less and preventing other people from starting to inject
• advice and information on preventing infections associated with drug misuse, particularly hepatitis A, B and C, and HIV (blood-borne viruses)
• testing, advice, information and counselling around hepatitis and HIV
• vaccination for hepatitis A and B
• access to treatment for hepatitis B, C and HIV infection
• advice and support on preventing overdose and drug-related death
• assessing clients and referring them to other treatment services if necessary. 

More information on Harm reduction

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At its most simple level, mutual aid can be described as people with similar experiences helping each other to manage or overcome issues. What it infers is a system where people come together with their peers to build a network of support.

There are many models of mutual aid, with varying approaches and set ups for different cohorts of people. The most widespread are the ’12-step’ fellowships (Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Families Anonymous, Marijuana Anonymous etc), but there are also SMART Recovery Groups, Intuitive Recovery and Secular Organisations for Sobriety, to name but a few. These supportive networks span the country, at times and in places where a large number of people can access support.

Some people’s journey to recovery takes them straight to mutual aid; for others, their journey goes via the ‘formal’ structured treatment system or doctors, nurses and counsellors. Either way, mutual aid groups provide an immense opportunity to offer the kind of supportive environment needed to help individuals recover and to support them in the long term – as well as giving them the opportunity to support others.

• Find a Mutual Aid Meeting here

More information

Community prescribing is specialised drug treatment in the context of a care plan. It is provided as part of primary care, by a GP with an interest in drug misuse or a doctor in a specialist drug treatment service. Where clients receive the treatment may depend on the seriousness of their problems, how long they have been in treatment or how stable they are. Community prescribing can include:

• stabilising a client on substitute drugs
• prescribing substitute drugs, such as methadone and buprenorphine, for a sustained period (maintenance prescribing)
• prescribing for withdrawal (community detoxification)
• prescribing to prevent relapse
• stabilisation and withdrawal from sedatives, such as Valium and Temazepam
• prescribing for assisted withdrawal from alcohol, where appropriate
• treatment for stimulant users, which may include prescribing to help relieve symptoms
• non-medical prescribing (by nurses or pharmacists) 

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Counselling is not to be confused with basic advice and informal support. It should be carried out by a trained and competent professional and be included in a client’s care plan. Counselling needs to be formal, structured – with clearly defined treatment plans and goals – and regularly reviewed. Psychological therapies can include cognitive behaviour therapy (CBT), coping skills, relapse prevention therapy, motivational interventions and family therapies. 

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Structured day programmes usually run a set series of activities for a fixed period of time (for example 12 weeks). Clients attend these services according to a set attendance level (usually 3-5 days a week), as set out in their care plans. There is a timetable of activities which will either be the same for everyone, or be set individually for clients according to their needs. Programmes often include group work, counselling, education and life skills, and creative activities. 

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This is known medically as “assisted withdrawal” and involves a stay as an inpatient. Most people receiving detox are given medication to help clear their bodies of drugs. The inpatient treatment can also include stabilisation on substitute medication, emergency medical care for drug users in crisis, and in some cases treatment for stimulant users. As well as the inpatient treatment itself, other services may be available, such as preparation for entering inpatient treatment, counselling, help with alcohol problems, harm reduction and treatment for blood-borne viruses. Inpatient treatment is provided in:

• general hospital wards (usually psychiatric wards)
• specialist drug inpatient units (a whole ward or unit specifically for drug treatment)
• residential rehab units with attached detox units to help people come off drugs before entering the main rehab programme.

Clients are normally admitted into inpatient treatment through community drug services. It is important that people leaving inpatient treatment receive proper support to maintain the positive changes they have made and prevent themselves relapsing. . 

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Residential rehabilitation (rehab) usually involves clients staying in a facility for weeks or months and a complete break from their current circumstances. Rehabs normally have a mixture of group work, counselling and other practical and vocational activities. There are several types of facilities:

• traditional rehab units, with programmes to suit the needs of different service users. Different units have different approaches, for example therapeutic communities and the 12-Step programmes used by Alcoholics Anonymous and Narcotics Anonymous. Most of these take clients from all over the country
• crisis intervention units (usually in urban areas) that help people in drug-related crisis. These are generally shorter stay units
• residential treatment programmes for specific client groups, for example pregnant women, people with liver problems and clients with mental illness. These may require joint initiatives between specialist
• drug services and other specialist inpatient units
• "second stage” or “move-on” supported accommodation, where some clients go to after rehab
• other supported accommodation, with the rehabilitation interventions (therapeutic drug-related and non-drug-related interventions) provided at a different nearby site(s).

As with inpatient treatment, clients will generally access rehab through community services. People entering rehab will usually have gone through detox before entering. This detox could be somewhere else – for example in a hospital, or in the community – or at the rehab itself, if it has an attached detox unit.

Rehab online is an online directory of residential rehabilitation services.
 

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Aftercare is support that is planned for when clients leave structured treatment. The aim is to maintain the positive developments clients have made in their treatment, and help them return to normal life. Examples include help with housing, education, employment, general health care and relapse prevention.

If you are service user or family member affected by drugs, go to our service users, carers and families section for more information about what help is available and how to get it.

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