On private rehabilitation

This article was written by the Drugs Team at Release.

It has repeatedly come to the attention of the Drugs helpline, (and to our legal team to try and recover the money), that there are many private detoxes and rehabs out there that are much more interested in income than outcome. That means money. Often the vulnerable get taken advantage of, and that could be you or your family scraping together or borrowing a lot of money to try and get some effective treatment. People often equate expense directly with quality and in many life instances that is often how it works, but it’s not always the case and this short article aims to make you aware of some of the pitfalls in the residential treatment industry.

Basically, be careful- you could find that you may taken advantage of, emotional vulnerability can be exploited (oh no, did you think you were leaving that behind you? ‘Fraid not.)

Firstly, Release would like to make it clear that we are not advocating that you rule out private treatment- not for prescribing-either maintenance or reduction, not for detox and not for residential care. There are some very good clinics out there. Private prescribing has been marginalised over the years by two major factors. One, the Home Office and GMC taking an aggressive stance against it and secondly, but related, guideline based protocols which are very conservative and er.. prescriptive. In other words ‘we tell you what is best for you’. The old idea of the ‘therapeutic alliance’ in the pharmacology of maintenance treatment seems almost last millennium. Probably because it was.

This piece is less about out-patient clinics however, it’s more about the growth in private sector residential care.

So how do you tell the ‘iffy’ ones from the better type of practice?

Here are a few pointers that you may find helpful.

Can you get a witness? Anyone without an official tie to the service who may be prepared to speak up about it?

Ask about their experience, is aftercare (where appropriate) offered? How long ago were they there?

If someone says they got thrown out ‘for nothing’. It may be worth checking their definition of ‘nothing’. We have heard some pretty liberal definitions. One bad experience would not necessarily be enough to dissuade us. It would be Release’s position that the whole experience is intensely subjective and some people’s perception of their needs may not accord to a majority viewpoint. Even the best services get it wrong sometimes. In terms of boundaries, during recovery periods people can get very needy. It is not unknown not only for residents to pair up but also, much less commonly for staff and residents to get involved in inappropriate relationships. Of course you can’t tell if this will happen, but it is worth keeping in mind as it can be a major pitfall.

Don’t rush into any decisions.

Make sure the facilities are satisfactory and include suitably qualified on site staff.

Could you get a similar service on the NHS? Some services have free or assisted places on the NHS. This can be very postcode dependent, but is worth checking out. If you are not offered an assessment-be wary. This could mean calling the service with any questions you may have. Look on the internet. Asking about open days (the majority quality rehabs have an open day or let you visit). Be a bit wary of any referral agency. Obviously some, such as Release, have no business connections with any organisation and will try to give balanced and comprehensive information. Others may get a commission.

Look at the underlying philosophy or ethics of the organisation. This may seem a little strange but some are heavily slanted towards a belief system, which may be OK for you or may be very difficult. Generally people who are not religious would need to be forewarned/aware if a programme involves hours of praying every day. Others claim to have ‘revolutionary’ treatments which involve some medically unrecognised procedures. For detox /rehabs (as opposed to post detox residential rehabs, where any pharmacological intervention is unusual and time is spent therapeutically, vocationally, practically or reflectively), if there is one detox   protocol for all addictions (i.e. heroin, alcohol and cocaine), be wary. Pharmacology tells us that the drugs work on different reward pathways and although in detox, benzodiazepines might be used for either and in some rehabs drugs might not be prescribed at all, it’s a good rule of thumb and one to think about. Find out what is on offer, read about the research on the subject, the net is full of information, but again, check who is saying it.

If you make an inquiry, get the conditions and the nature of the contract. If you are constantly called back, put under pressure or offered a small discount to book immediately, be very wary and if you are offered a taxi to pick you up, just as soon as the funds have gone through it is probably not the type of service that puts your needs upmost.

We have even had callers tell us that they have been offered considerable discounts if they have friends who they can refer at the same time! We have had people say they still can’t afford it but a few rehabs even appear have links with loan agencies!

This is definitely not recommended. It will often be the parents who are targeted for this type of pressure selling, accompanied by unrealistic recovery rates for graduates of the establishment.

‘Guaranteed 100% success rate for those who complete treatment’.

This is usually % of  people who stay at the unit for the full programme, which, as it does not take follow up at 1yr, 3 yrs etc. in consideration would be pretty close to 100% anyway because if you don’t complete you are not counted in the stats and if you stay the course, its assumed you are ‘cured’. If only it was so simple. What is the treatment plan? Is it tailored to individual need?

What after-care or follow up is included, if it is NA based and just involves doing x meetings a day, it is passing on responsibility for your care elsewhere. The way a group of people in recovery works is down to the composite of its members not an expensive rehab clinic hinting at affiliation. You cannot get affiliated to any of the NA fellowships. You can go to NA for nothing.

If the clinic runs groups find out if there is extra cost. Is the counsellor or facilitator a qualified therapist?

Many people ‘go private’ to avoid their doctor or employer, or someone else finding out about their drug problem, often included in this is having to tell insurance companies or DVLA about your problem as it can have long lasting ramifications. Release cannot tell anyone to mislead a government agency or contractual service. It may be that in real life there is no hard and fast rule on what actually happens –all agencies can choose to implement guidelines or turn a bit of a blind ’un to insisting you tell DVLA about your driving licence. If you have finished the first month of a detox the physical implications are diminishing but you are still required to inform the licensing authorities. If you are in residential you won’t be driving anyway. Prescribing services are required to tell your GP you are with them.

Read the small print-not just contractually/financially but in practical ways, some rehabs can be very insistent on rules like; using the phone, taking Paracetamol without permission and the like.

Some detoxes use slightly controversial methods, be very sure you understand what you are signing up for.

Never go in for a detox if you feel it’s a push time-wise, it is nearly always wishful thinking when looking at recovery times. If you are paying obviously not many can afford to do more than a month and is a weeks detox and four weeks in residential enough to change your life or get you on firm footing?

A swanky web site can be misleading; many of the images may have been  photo-shopped.  Check the ‘last updated’ reference, usually at the bottom of the Home page, but others sections may be just as relevant, if it is more than six months ago, it’s not a good sign.

We here at Release would be happy to assist if you have any questions about in patient detox or rehab. Call the drug team if you want to talk things over, we are here to help.