Exploring Interventions

Explanation
Detoxification refers to the process by which an individual is withdrawn from the effects of a psycho-active substance. According to Lee (2015; Campbell and Spooner, 2015), it is not enough in itself to ensure recovery, but needs to be supported by psycho-social intervention and support of various kinds.
Detoxification may take place in inpatient facilities or in the community, under medical supervision (often supervised by a combination of GP and community drugs team and potentially over a longer period). For opiate dependence, methadone or buphrenorphine may be used as a short term substitute. For alcohol, benzodiazepine, diazepam and other medications may be given on a very short-term basis.
Both fall under the clinical guidelines from NICE.

Explanation
In relation to alcohol, brief intervention or therapy is a key component of government strategy to reduce health harms, its main objective being to encourage individuals to reduce alcohol consumption rather than to stop altogether. They are short, one-off inputs delivered opportunistically or as part of a screening programme (Allan, 2014).
Also used in connection with drug use and smoking, the main components are advice, offering practical steps towards change and specific feedback (Allan, 2014). The style is empathic, encouraging responsibility and self-efficacy rather than helplessness in the face of substance misuse problems. It may also include an element of motivational counselling (Hodgson, 2002)

Explanation
Although in the past HR this was a key aim in response to the risk of HIV infection and still exists in relation to hepatitis, recovery and abstinence are now more prominent in the current strategy (Shea, 2015).
That said, harm reduction, defined as a focus on reducing and minimising the harm which can result from an activity, without necessarily aiming to reduce its prevalence or use (Shea., 2015), is still present in many practices. These might include
· Needle exchanges
· Advice on safer injecting and other aspects of use
· Providing information
· Advice about managing use eg pacing use, buying limited quantities

Explanation
Pharmacological treatments do include substitute prescribing but can be broader, for example
· Facilitating detoxification
· Reducing the likelihood of relapse
Relieving substance-related physical and mental health problems (Allan, 2014)

Explanation
The National Treatment Agency says that “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.”
http://www.nta.nhs.uk/options.aspx
7015 individuals were in a structured day programme of some kind 2015-16 (Public Health England, 2016)

Explanation
In fact, relapse prevention is a key strategy in maintaining positive change and ensuring that it is not jeopardised by personal factors such as depression or hopelessness, social pressures or other external factors (Allan, 2014). It aims to bolster coping strategies and often uses cognitive behavioural techniques to recognise triggers and unhelpful thinking (Allan 2014) as well as situational management, such as avoiding certain social situations or groups of friends.

Explanation
Talking therapies’ covers quite a wide range of approaches including counselling, motivational work and mindfulness (Smith, 2015). Where cognitive behavioural therapy has the edge over these is its element of practical action – the behavioural part. It has been therefore been very popular relative to other more open-ended counselling approaches, and has uses in contingency management, relapse prevention and dealing with the link between thoughts and emotions (Allan 2014). Such approaches have been endorsed by NICE (Galvani, 2012)

Explanation
In fact residential rehabilitation is used most for opiate users (687 out of 841 individuals in 2015-16 – Public Health England, 2016)
As described by the NTA,
“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 countrycrisis intervention units (usually in urban areas) that help people in drug-related crisis. These are generally shorter stay unitsresidential 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 specialistdrug services and other specialist inpatient units"second stage” or “move-on” supported accommodation, where some clients go to after rehabother 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.”

Explanation
Mutual aid includes groups such as NA and AA which run 12 step programmes, and these are the most established and widely available in the UK. However the term now encompasses a much wider range of self-help and recovery-orientated support groups, many under the banner of SMART Recovery (Allan, 2014)

Explanation
12 step programmes conceive dependency as a disease characterised by loss of control and so reject the social model, which is more about culture and learnt behaviours. They aim for sobriety rather than just abstinence, implying a ‘healthier’ attitude towards self and others.
The 12 steps range from the first which is an admission of powerlessness over the substance concerned, to the twelfth which is a commitment to impart spiritual learning to others. That means that there is an element of almost evangelism in the approach, although it is not associated with religion as such.

Explanation
Aftercare is important to consolidate progress and prevent relapse, but is not often given the priority it deserves. Allan (2014) identifies the need to plan carefully for endings and to make sure that individuals know where they can go for on-going support (eg mutual aid, community provision) and practical help with issues such as housing. He goes on to say that moving people on from treatment too quickly can be counter-productive

Explanation
The concept of recovery varies according to context
· It has been used for a long time in the medical profession to refer to the resolution of an addiction problem
· In 12 step programmes it is associated with abstinence and a new set of social relations
· In the newer recovery field it is seen as being ‘characterised by voluntary-sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibility of society’ (UKDPC). The recovery movement is therefore concerned with social identity and active participation.
In comparison, the version of recovery adopted by the English and Scottish governments is more focused on moving people out of treatment quickly, avoiding practices such as ‘parking on methadone’ and emphasising the goal of abstinence (Leighton, 2015)