People who have problems with drug use can access help and treatment either through the health and welfare system. (via drug advice services or GP referral) or through the criminal justice system if they have committed an offence.
Health and welfare system
Most areas of the UK have ‘street agencies’ or projects (sometimes called community drug services or teams) which offer a range of services including information and advice, counselling, detoxification and prescribing for opiate users, needle exchanges and sometimes support groups and other services such as acupuncture. They are usually only open during normal working hours. While they may give information and advice over the telephone advice only some see people by appointment and have waiting lists.
GPs and Accidents and Emergency (A&E) Units
The main primary health care source for people is their GP and possibly the local hospital A&E department. GPs and hospitals make more referrals to specialist drug services than any other point of contact. As well as referring patients on GPs provide general medical services, information and advice and treatment (especially substitute prescribing) often in partnership with a drug agency or community drug team.
Community drug teams
These are usually located in or adjacent to a hospital and specialise in helping problem drug users, especially people who are dependent on drugs like heroin. They provide counselling, detoxification, substitute prescribing and other treatments. An appointment is needed.
Needle exchange schemes
These were set up in the 1980s in response to the spread of HIV among drug injectors. As well as giving out clean injecting equipment and collecting in used ‘works’ these services can offer information and advice, health check ups, safer sex advice and condoms and referral to other drug services. Some schemes are based in drug projects or hospitals but others operate from chemist shops. Some also use outreach workers who injectors meet on the streets or in their own homes.
Outreach attempts to bring the service to the user. Detached work involves workers going into the users own environment. Examples include support and needle exchange workers going into user’s homes and support workers operating at raves and in clubs. Institutional work is where a service operates on the site of other agencies such as in a health centre, college or school.
Residential treatment programmes are for heavily dependent drug users who are trying to give up drug use. Residents must usually be drug free on admission. This means that they usually have to undergo detoxification before entry. Programmes usually last 3-6 months, but some 12 steps programmes last for a year. These services are often based in rural settings. The types of programmes vary but tend to fall be one of four main types:
- Therapeutic communities operate a hierarchical structure which residents work through based on intense therapy sessions.
- Minnesota model – This is associated with the Alcoholics/ Narcotics Anonymous 12 step programme. It sees addiction as a disease, aims for long term abstinence and includes spiritual as well as practical guidance.
- General house programmes differ in their approach and are based on group and individual therapy.
- Christian house programmes are usually run by Christian staff with or without any required Christian structure. Where there is a specific religious requirement non-Christians will not be accepted.
The main one is Ask Frank (Tel. 0800 776600) which offers free, confidential information and advice 24 hours a day. Email Frank@talktofrank.com. Others include Drinkline which has advisers available from 9.30am – 11pm during weekdays. Telephone 0800 917 8282.
Self help groups
Narcotics Anonymous (Tel. 020 7730 0009) co-ordinate local support groups for problem drug users around the country. Families Anonymous (Tel. 020 7498 4680) run similar groups for the families of drug users. Both are based on 12 step, abstinence models. Another organisation that runs networks of self-help meetings is called SMART Recovery (Tel. 0845 603 9830).
Criminal justice system
Many problem drug users are referred for treatment through the criminal justice system.
Arrest referral schemes began in 1996 and have spread since. They range from people being given telephone numbers for helping agencies when they are arrested for a drug or possibly drug-related offence to drug workers operating in police stations.
A lot of people enter prison with a drug problem and a lot of drug use takes place within prisons. A range of services have been developed within prisons including in-house treatment, information and advice. Currently provision of clean needles are not allowed although some prisons do provide sterilisation facilities. Prison doctors can refer prisoners on to helping services, provided either in-house or by workers from drug projects coming into the prison. Take up of treatment is usually voluntary but the introduction of drug treatment orders and drug testing meant that prisoners could be required to undergo treatment either in prison or while on probation.
Probation work aims to prevent re-offending and part of this work is to minimise drug problems. Probation services usually have good contacts with health and drug agencies and can refer individuals for treatment. They also play an important role in supervising care and reporting to courts prior to and after sentencing.
Different types of treatment
Advice and counselling
This can range from individual or group counselling as well as advice about safer use, housing, work, benefits etc.
Opiate detoxification (detox)
The aim of detox is to reduce the amount of drug (usually heroin) from the body prior to support to be abstinent. Doses of the drug are reduced until the user is drug free. Usually this is done over a period of a few weeks but sometimes involves abruptly stopping. Detox programmes are available in hospitals but more commonly on a community basis where users remain at home and receive support to deal with withdrawal symptoms and become drug free.
Methadone reduction programmes
These involve prescribing methadone to heroin users to control withdrawal symptoms. The aim is to gradually reduce the quantity prescribed until the user experiences no withdrawal symptoms and is drug free. The degree of reduction and length of time used to achieve abstinence can vary from a few weeks to several months. Motivation is a key to the success of such programmes. Participants regularly review their progress and usually receive therapy and support as part of the programme. Methadone reduction programmes usually take place in community settings.
Methadone maintenance programmes
Here the aim is not to eliminate drug use in the short term, but to stabilise the use by prescribing methadone as a substitute for heroin. The idea is to reduce the need for criminal activity and the harm caused by injecting and to stabilise the user with a view to them giving up drug use in the longer term. Programmes are usually delivered in community settings.
Very few doctors in the UK are licensed to prescribe heroin to street users. There are also three heroin prescribing hospital-based programmes for a small group of users for whom other treatment options have not been successful.
Treatment for stimulant drug users
There is not much specialist care and treatment for people who experience problems with use of amphetamine, cocaine or crack cocaine. While legally permissible prescribing of amphetamine is rare and can be risky. Most agencies offer treatment through counselling, possible referral to residential rehabilitation and alternative (not substitute) prescribing of anti-depressants.
The increase in crack use has led to some agencies offering specialist counselling, cognitive behaviour therapy, acupuncture and other alternative therapies and prescribing of anti-depressants.
Services for younger people
Most drug services are only equipped to deal with adult users – those over 18 years old. Confusion over legal issues about confidentiality and informing parents has resulted in some agencies refusing to see the younger age range. However, new initiatives have seen development of projects which specifically cater for younger age groups and the appointment of staff at existing agencies to work with young people.