Types of treatment

Types of treatment

Your treatment will depend on the type of drug problem you have (see box below). If your treatment goals change at any time, staff should support you in this wherever possible.

Type of drug

Which treatment(s) might I be offered, and when?

Detoxification

Psychological interventions

Incentives programme (see box in Types of treatment)

Behavioural family and/or couples therapy

Therapies such as cognitive behavioural therapy [a]

Opioids (such as heroin, opium or morphine)

If you are dependent on opioids and want to become abstinent.

Details are given in Opioid detoxification.

If you are having methadone or naltrexone maintenance treatment.

During and after detoxification.

If you are at risk of physical health problems (such as HIV or hepatitis C) because of your drug misuse – in this case you should be offered an incentive to reduce your risky behaviour.

If you are in close contact with a partner who does not misuse drugs and you:

  • misuse opioids

  • continue to misuse drugs while having maintenance treatment or

  • have completed opioid detoxification.

If you are in close contact with a family member, carer or partner who does not misuse drugs, and you are having naltrexone maintenance treatment.

If you are having maintenance treatment and also need treatment for anxiety or depression.

Stimulants (such as amphetamines or cocaine)

Should be offered.

If you are in close contact with a partner who does not misuse drugs.

If you also need treatment for anxiety or depression.

Cannabis

If you also need treatment for anxiety or depression.

[a] Therapies such as cognitive behavioural therapy are also helpful for people who have achieved abstinence but are experiencing anxiety or depression.

What is an incentives programme?

In an incentives programme, a person who has a drug problem may be given a voucher or a privilege if they have a negative test, showing they have not used illegal drugs (the test is usually a urine test).

Vouchers are worth a few pounds and can be exchanged for items that encourage a healthy, drug-free lifestyle. They should increase in value every time the person continues to have a negative test. The privilege might be a take-home dose of methadone.

Before starting the programme, the person should agree their treatment goal with staff. The staff should also make sure that the person understands how the programme works. The person should be tested regularly until they have reached their goal.

NICE has said that incentives programmes should be introduced gradually to drug treatment centres. For more information about this, visit www.nice.org.uk/CG051.

Questions about treatment

  • What treatment(s) might help me best and why?

  • What are the pros and cons of this treatment?

  • What does the treatment involve?

  • How will it help me?

  • What other treatments are available?

  • Please tell me more about incentives programmes.

  • Can I have help for anxiety and depression and other mental health problems as well as for my drug problem?

Opioid detoxification

Detoxification (often described as 'detox'), as carried out in the NHS, involves using prescribed medication to help a person stop using drugs. Before starting treatment, you should be given detailed information about opioid detoxification and its benefits and risks.

Healthcare professionals should talk to you about opioid withdrawalsymptoms and how to cope with them. They should explain that once you have become abstinent, your body will be less able to cope if you start taking opioids again, particularly if you are also using other drugs. This is called 'loss of tolerance' and means that there is a risk of overdose if you take these drugs again after being abstinent.

Staff should also discuss other treatments to help you remain abstinent and to help with any mental health problems. You should be offered practical help to make other positive changes in your lifestyle, such as your diet, and to meet other general health needs.

You should be given information about self-help groups (such as 12-steps groups) and support groups (such as the Alliance). Staff may help you to make contact with them if needed.

If you are considering starting detoxification on your own you should seek advice from staff, or, at the very least, keep in contact with a drug treatment service. You should be encouraged to take part in a detoxification treatment programme.

What happens when I first see a healthcare professional about detoxification?

You should be offered an assessment, where healthcare professionals will ask you questions to help them offer you treatment that best suits your needs. They should ask you to have a urine test to confirm your drug use. You may also have a saliva test or a breath test. If you have withdrawal symptoms, these will be assessed.

Healthcare professionals will also want to know about:

  • any problems you have had with alcohol or other drugs, and any treatments for these

  • any physical or mental health problems you have had, and any treatments for these

  • whether there is a risk of you harming yourself or if you are likely to use other drugs or alcohol as ways of coping withwithdrawal symptoms

  • your personal circumstances (such as your financial and work status and your living arrangements) and your family and friends.

At the assessment you can ask questions to help you understand your drug problem and the treatment for it.

When will detoxification not be offered?

People will not usually be offered detoxification if they:

  • have a medical condition that needs urgent treatment

  • are in police custody or serving a short prison sentence or a short period of remand

  • go to an emergency department or hospital for an urgent medical problem. In this case, the emergency will be dealt with and withdrawal symptoms treated. The person may be offered an appointment with a drug service.

For pregnant women, detoxification should be undertaken only with caution and after careful discussion.

What happens during opioid detoxification?

You should be offered an opioid substitute called buprenorphine or methadone. Your healthcare professional should take account of which one you prefer. However, if you are taking either as maintenance treatment, detoxification should usually start with the same medication.

In certain circumstances, you may be offered a drug called lofexidine instead of buprenorphine or methadone.

Your healthcare professional should discuss with you how much medication you will be given and how often, and how long treatment will last. This will usually depend on your drug dependence, whether you have any other problems, and where you are having treatment (see Where you can have treatment for your drug problem). Your healthcare team may check that you are taking the medication as prescribed.

You should not usually be prescribed drugs called dihydrocodeine or clonidine.

You may be offered additional medicine to help you cope with withdrawal symptoms.

Ultra-rapid, rapid and accelerated detoxification

You should not usually be offered the following:

  • treatments called ultra-rapid or rapid detoxification that use medication to help speed up withdrawal

  • a treatment called accelerated detoxification, which uses low doses of medications such as naltrexone and naloxone to shorten detoxification.

You should not be offered ultra-rapid detoxification that uses general anaesthetic or heavy sedation. There are very serious risks with this procedure, including death.

What if I have other problems or illnesses?

If you have any mental or physical health problems, these should be treated alongside your opioid dependence.

If you have an alcohol problem as well, you may be offered help to cope with this. If you are dependent on alcohol, you should be offered alcohol detoxification.

If you are dependent on benzodiazepines, you may be offered benzodiazepine detoxification.

What happens after detoxification?

After successful detoxification, you should be offered support and continued treatments including psychosocial interventions (see table in Types of treatment) for at least 6 months to help you remain abstinent.