Dextox, rehab, integration & aftercare explained

There are a lot of options available for treatment including inpatient and outpatient programmes – to understand what’s out there, take a look at our simplified guide to treatment…

Detoxification (aka Detox)

Treatment usually starts with a period of medically supervised detoxification – a process that aids the body to rid itself of drugs or alcohol. As many drugs have a strong physical effect on the body, clients undergoing detoxification must be supported by professional healthcare workers. It is dangerous for people to try and detox themselves (going ‘cold turkey’), as each person will react differently to withdrawing from drugs and the side effects could be life-threatening if not managed professionally. Detox usually lasts approximately six weeks.

A common from of detox is when clients are weaned off a managed course of Methadone (a legal synthetic drug used as a replacement in the treatment of heroin addiction). In such cases Methadone is prescribed by the client’s GP, and dosage is regulated over a period of time so that the client enters the detox programme on a low dose of Methadone only. Habitual users of benzodiazepines (such as Valium) and people who are alcohol dependent may experience a range of symptoms including seizures and psychosis when quitting.

Detox is almost always provided in inpatient (residential) facilities where medical care is available, either within a hospital or voluntary sector service. There are a limited number of places in Ireland, which means that there are often long waiting lists for places.

After a six-week detox, the body will have physically recovered from drugs. Now the real work for the individual begins. The next phase, rehabilitation, deals with the mental and psychological aspects of the person, and addresses the root causes of the addictive behaviour.

Rehabilitation (aka Rehab)

Clients can only start rehab once they are clean of drugs and alcohol, so that they can focus properly on their mental and physical recovery. Rehab concentrates on the issues behind each person’s drug misuse and the behaviours they developed through their addiction. Group work, one-to-one counselling sessions, assignments and peer-to-peer support are all common activities used within this phase of treatment. This is also the time in recovery when relationships with friends and family are explored, to heal past wounds and prepare for the future.

Rehabilitation is either provided in an inpatient (residential) or outpatient (day programme) setting. The programmes are very structured with a full day of activities. Some programmes are based around a community approach such as a therapeutic community, where clients also look after the community’s welfare through undertaking shared chores such as cleaning and catering or tending the garden and maintenance duties. This approach provides opportunities for clients to learn vital life skills that will be key to their overall recovery. Other programmes are shorter in duration and are designed around the 12 Step model developed by Alcoholics Anonymous (AA).

Duration of rehabilitation programmes:

Inpatient:

Short-term residential programmes:

Typically three to four weeks, with intensive follow-up sessions for several months. This model combines the 12 Step approach with a focus on behavioural and emotional change and group affiliation. Although most of the therapy is conducted in groups, the treatment plan is tailored to the individual’s needs.

Long-term residential programmes:

Involving stays of six to twelve months, long-term residential programmes often run as therapeutic communities. Here, too, there is an emphasis on group affiliation and the reshaping of outlooks and behaviours.

Outpatient:

Methadone maintenance:

Long used to counter heroin addiction, these HSE-sponsored programmes prescribe and administer Methadone, an oral synthetic opiate. The theory is that this keeps clients out of the dangers of drug culture (such as dirty needles and overdose). Methadone decreases the craving for illegal opiates without inducing withdrawal symptoms but is itself addictive.

Long-term day programmes:

Daily attendance for the duration of a six-month programme, typically within a therapeutic community model. Emphasis again is on group affiliation and the reshaping of outlooks and behaviours.
Integration & Aftercare Programmes

The first three to six months following rehab is the period of greatest vulnerability to relapse. Consequently, continuing care services are designed to monitor the emotional health of recovering people, reminding them of their commitment to lifestyle change and supporting their needs, as they attempt the difficult job of living their lives with a new perspective and resolve. Integration is the first phase of care following rehab and often facilitates a gradual return to the wider community by offering some form of supported group housing.

When clients are again beginning to manage their own time, accommodation and relationships, aftercare will continue to work to support the client in sustaining a healthy, balanced, drug-free life.

Many integration and aftercare programmes continue to provide one-to-one counselling sessions for the client along with weekly group meetings and family sessions if required. Most continuing care programmes last for six to twelve months following completion of rehabilitation.