When it comes to drug and alcohol rehab, what works? Learn everything you need to know about what constitutes successful substance abuse treatment. This list of 20 key elements of an addiction treatment programme that works compiled by the European Association for the Treatment of Addiction and is based on evidence as well as the knowledge of leading experts in the field.
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1. Rehabilitative treatment works
- Treatment works and is as successful as medical treatments for a range of chronic conditions, such as diabetes, hypertension and asthma.
- Rehab can improve a client’s mental and physical health.
- Rehab can reduce criminality.
- Rehab can improve employability.
- Rehab can enhance general social functioning.
- Rehab can reduce the demands on health and social services.
- Rehab can bring significant benefits to families and loved ones.
- The costs of treatment are more than outweighed by the financial savings it brings
- It’s important that people are referred to the right type of treatment.
- Not all services are equally effective – many could be more effective and some may even make matters worse.
Click here for a detailed look at the statistics about how and why rehab works.
2. Treatment should be readily available
- The harder it is to access treatment, the worse the outcomes for the person suffering from substance dependency.
- There should not be a delay between assessments and admission: The longer the delay, the less likely someone will go to treatment and the less likely the treatment will be successful.
- Access and quick intervention save lives.
- Patients should be adequately prepared for treatment before admission.
3.Low motivation isn’t a barrier to treatment success
- The assumption that treatment will succeed only if a client is admitted voluntarily or with a high level of motivation to get sober is incorrect.
- External pressure from families, employers or the criminal justice system can actually enhance treatment effectiveness.
- Court orders are a good way to help people in need access rehab.
- It is counter-productive to restrict access to treatment to those who are enthusiastic and willing to attend rehab.
- Motivation to change and to maintain change can be enhanced through treatment.
4.Going to rehab more than once doesn’t mean you’re a lost cause
- Addiction is often described as a relapsing condition and many people relapse after treatment.
- Relapse does not mean a person will not benefit from further treatment.
- Many people require a number of admissions to rehab before they finally find long-term sobriety.
- There is evidence that an apparently unsuccessful treatment episode can contribute towards an individual eventually overcoming their addiction in the long term.
5.Abstinence and controlled use both have their place
- With people who have less severe substance use problems attempting to moderate drug or alcohol use can be appropriate.
- Controlled use is not sustainable for people with more severe substance abuse problems.
- For full-blown addiction, an abstinence-based approach is recommended.
- Services for reduced use and harm reduction should be available to those who are not ready, willing or able to achieve abstinence yet.
6.Approach should reflect clients’ beliefs and expectations
- Evidence shows that some treatment approaches may be slightly more effective for different categories of client.
- The most important consideration is the client’s own views and beliefs: These should be taken into account wherever possible.
7. Treatment should be individualised to clients’ needs
- The length of treatment, approach, setting (inpatient or outpatient), range of issues addressed, use of medication etc should be tailored to the individual and their unique circumstances.
- This should be based on an assessment of the individual’s needs and expectations.
- One size fits all approaches are often unhelpful.
- A person’s needs may change during treatment and treatment plans should be reviewed and adapted accordingly.
8. Treatment should enhance motivation and self-efficacy
- Motivation is important for long-term sobriety and improving motivation should be a central focus of treatment.
- Many clients have little confidence in their ability to change and tackling this should be a key consideration in treatment.
9.Treatment should address unhelpful attitudes and beliefs
- Treatment can fail when a client’s unhelpful attitudes and beliefs are left unaddressed.
- Myths need to be challenged. These include examples such as ‘I can’t have fun without using’ and ‘I need to use or drink to cope with life’.
- These problematic beliefs need to be tackled in a non-confrontational manner.
10. Relapse prevention is important
- Even though addiction is a relapsing disease, the likelihood of relapse should be reduced by providing clients with practical skills for avoiding and coping with potential relapse triggers.
- Exploring how a client might respond to a lapse in order to avoid a full-blown relapse is helpful.
- However, a belief that relapse is inevitable should not be fostered.
11.Associated contributory factors should be addressed
- In addition to addressing the client’s substance use, any medical, psychological, social, vocational and legal problems faced by the individual should be addressed in order to reduce the likelihood of relapse.
- A full assessment should include these factors and addressing these problems should be a part of the treatment process.
12. Co-existing psychiatric disorders should be addressed
- Addiction often occurs alongside other mental health conditions, therefore dual-diagnosis treatment approaches are essential.
- Initial assessments should include investigating any potential co-occurring psychiatric conditions and treatment for other mental health conditions should be integrated into rehabilitative treatment.
- Specialist psychiatric services should be included in treatment.
13. A supportive, non-confrontational style is most productive
- Historically, a lot of addiction treatment has been confrontational and sometimes even punitive. In some facilities this is still the case.
- Research shows that a confrontational style is counter-productive and not effective.
- Clients should be treated with respect and understanding.
- However, his does not mean that manipulative and inappropriate behaviour should go unchallenged.
14.Client engagement and completion rates should be maximised
- Incomplete treatment reduces treatment success.
- Efforts should be made to retain people in rehab for the entire duration of treatment, provided that the individual client does not threaten the outcomes of other clients.
- High client engagement is usually associated with a high completion rate and long-term success.
- High client engagement includes clear treatment plans, positive relations between clients and counsellors, client confidence in the treatment service, a broad range of services and in-house provision of transport for those who encounter difficulties attending treatment.
15. Treatment length matters, but…
- Evidence shows that the longer the treatment period, the more successful the outcomes. Some research shows that 90 days or less of treatment is of little benefit to those with severe addictions.
- However, even brief treatment admissions are better than no treatment.
- Aftercare programmes are a good way to keep patients in some form of treatment if long inpatient treatment is not possible.
16. Both residential and day care (outpatient) has its place
- Outpatient programmes are beneficial for some categories of clients, predominantly those with less severe substance use problems.
- However, residential treatment is better for other categories of client including those with severe addictions, homeless persons, people with unsupportive home environments, those who are socially isolated, people who are medically unwell, those with severe co-occurring psychiatric problems and those who have relapsed after completing an outpatient programme.
17. Medication can enhance long-term outcomes
Although giving medication alone is of little benefit for treating addiction, prescribing medication alongside rehabilitative treatment can improve outcomes.
18. Self-help groups and aftercare improve results
- Aftercare programmes should be provided after a client completes rehabilitative treatment.
- Evidence shows that this method of follow-up improves the likelihood of long-term success.
- Additionally, self-help groups have also shown to be beneficial to clients once they complete treatment.
19. Experienced and qualified staff are NB
- Evidence shows that the staff at a treatment centre are integral to a client’s successful treatment.
- Staff should be appropriately qualified and experienced.
- Staff members should be well-trained, closely supervised, confident in their work and empathetic to their clients.
- A high staff to client ratio is important to ensure clients get the attention that they need.
- Often counsellors are recovering addicts but they do not need to have a history of addiction in order to help clients. But having a team consisting of both recovering addicts and others without a history of addiction is a good idea.
20. Good organisational standards are essential
- Treatment centres should have high organisational standards. There are clear guidelines in this regard.
- Treatment centres should be licenced by the relevant authorities.
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Some of our related articles on addiction recovery and rehabs in Johannesburg.
- Recovery by Fear – Understanding the role of fear in recovery from addiction.
- Absolute Denial – Unpacking the concept of absolute denial in addiction.
- Minimising Addiction – The concept of minimising in addiction and its impacts.
- Rationalising Addiction – Insight into how rationalising plays a role in addiction.
- Blaming in Addiction – Understanding the habit of blaming in addiction.
- Compliance in Addiction – Discussing the role of compliance in addiction recovery.
- Flight into Health – An explanation of the ‘flight into health’ phenomenon in addiction recovery.
- Rehab Services including Assessments, Detox and Costs Of Treatment
- Private Rehab Facilities including Residential Inpatient, Long-Term Rehabs and Sober Living
- Counselling including Family Support, Outpatient and Dual Diagnoses
- Treatment Phases including Relapse Prevention, Aftercare and Stepwork