Frequently Asked Questions

“Detox” is a course of medical treatment that safely enables someone to come away from dependency to a particular drug, alcohol or a combination of the two.  For some clients, this is an essential medical intervention that is necessary to prevent acute medical emergencies occurring should treatment not be sought after a person stops taking a particular substance/alcohol. Under no circumstances should anyone stop taking a substance prior to going into treatment: especially alcohol: This could be very dangerous and, in some cases, life threatening.

Within the realm of a drug and alcohol rehab Centre, this is solely a medically supervised treatment plan, as opposed to those offered by beauty spas and retreats.  It is not about “flushing toxins from the body” and no amount of drinking water will help. Indeed, too much water can cause problems on it’s own. 

A considerable number of those who are alcohol dependent, on arrival at a Centre, do not need medical intervention though they may be offered medication to assist with insomnia and anxiety. As to how long a detox lasts depends entirely on the nature of the substance in questions, the amounts taken and for how long someone has been dependent on it. 

For alcohol clients, a detox will consist of a course of benzodiazepines over a period of time which is dependent on how much they drink and for how long they have been dependent.  Other adjunctive medication can sometimes be helpful. 

Cocaine use does not, ordinarily, need a “detox” as there are no recognized treatment plans. This is because this particular substance has a short term effect. However, center’s may offer a short course of adjunctive medication to assist the client for the first few days to ease any symptoms of anxiety and/or insomnia. Substances such as Ketamine, GHB/GBL are treated with Benzodiazepines and sometimes beta blockers. The same is the case with Cannabis. 

For those seeking treatment in relation to benzodiazepines, be very wary of center’s/referral agencies who tell you such treatment can be done quickly: It can not. It is very dangerous to try and compress a treatment plan for benzodiazepines. Please speak to Paul before entering into any treatment plan. 

Despite the claims made by referral agents and the big chains, there is NO such thing as an “NHS detox” or rehab. All drug and alcohol services are the responsibility of local councils. 

Services are contracted out to 3rd sector companies, charities, and the NHS. Clients will try to present at accident and emergency to be admitted for a detox.

The NHS have a duty of care: But only to what is reasonable in the circumstances. In other words, they will only admit someone, if they absolutely have to, and only for as long as they absolutely have to. As such, it is not uncommon for the NHS to admit someone to A+E and discharge them, several hours later, with the advice to carry on drinking.

If there is an underlying medical presentation then the person may be admitted and a detox provided, by default, because to not provide one would see that person develop withdrawal: which can be dangerous, and sometimes, life threatening.

Community services do the best they can, with the resources they have. They can provide support workers, key workers, groups, 1:1 support. If there is a need, they may provide a short admission to a statutory funded detox centre: This will be a brief admission (due to cost) and then the client, if appropriate, is moved on to a rehab centre. Ordinarily, these will not be centres that provide detox/rehab at the same time.

Many callers to rehab centers and referral agents ask about gyms and swimming pools.  Many referral agents will make false promises about such facilities to try, and earn a referral fee.

No drug and alcohol rehab centre has a swimming pool: It would be very dangerous. The medication needed to withdraw, safely, from alcohol would preclude swimming: It would simply be too risky. In any event, the cost of such facilities would be passed onto the client!

The same is sort of true with gyms and gym equipment. Most have very limited gyms with a few bits of equipment. As with swimming: It would be very dangerous for clients undergoing medicated assisted withdrawal to use gym equipment. As with swimming pools, if centres did have gyms, clients would be paying for them.

In some circumstances: Yes. There are clear clinical guidelines issued  by the National Institute for Health

and Care Excellence which guide clinicians as to what situations are safe for home treatment. I work with a

consultant psychiatrist (addiction medicine) and a whole team of professionals who can arrange home treatment for you. The vast majority of home treatment clients are alcohol depdendent, though home treatment

is also available, on a case by case basis, for cocaine, cannabis and other substances. Call for further information, the lines are always open. It can cost less to be treated at home, in some circumstances.

Please be very, very wary of companies who offer alcohol home detox’s by means of a phone call. They are often 

operating illegally and do not have the appropriate Care Quality Commission (CQC) registration. Such companies will charge anything from £995 for medication that costs around £12. You are unlikely to speak to a doctor and you will not be visited at home or have any contact with clinically trained staff after your initial consultation. 

NB: Some companies will tell you that they do not need to be registered with the CQC to provide home alcohol services. In some circumstances, this is correct but it is very complex. In essence, this can only be done if you are assessed by a consultant psychiatrist in addiction medicine (on the General Medical Council list of specialist doctors) or a GP/registrar also on the specialist register. In these cases, providing this doctor provides addiction services in their day to day role, and that service is CQC registered, then, yes, they can provide this service without additional CQC registration. However, there are two, very important, caveats: 

1) Payment is made to the doctor, directly. 

2) Only that doctor assesses you and provides any follow up and aftercare. 

Alcohol detox at home is only a viable option in limited circumstances and there are some definitive exclusion criteria. Ordinarily, those with a history of alcohol related seizures, on certain types of medication and without 24 hour live in support are, generally, unsuitable.  There are nationally recognized guidelines published by the National Institute of Health and Care Excellence.  Where funded, community drug and alcohol services will mirror these guidelines although due to their nature such services are able to be slightly more flexible. 

Some centre’s will not allow any devices to be taken in. Some will allow clients to take a phone and/or laptop but to surrender them on admission. They will allow access at certain times and clients may have to wait a number of days before they are allowed to use the items. Other centers will allow clients to use their phone and laptop, and to keep them with them, but this is always with the understanding that, when in group: they are powered down.

Also there are expectations around filming and content viewed online. Paul can advise as to which centre

is appropriate depending on a clients need to access devices during treatment.

Costs vary: A lot. It all depends where you go, and how long you go for.It can be inexpensive, starting from £1,677 a week and goes up from there.London, like with anything else, is very expensive. However, go a few miles out and it becomes far less expensive.

There are areas of the United Kingdom where there are no centres. Other parts have more than one: They are not evenly spaced out. Normally, a deposit of £,1500 is payable before admission with the balance payable on arrival.

A months treatment can cost between £7,000 and £17,000. All centres are registered with the Care Quality Commission so you have assurances as to essential levels of care. Some centres, which attract higher admission fees, offer “bolt on’s” which can enhance a person’s experience while in treatment.

Depending on the substance concerned  and the level of dependency, the time needed to achieve abstinence/detox may be four weeks: or more. No reputable centre would try and achieve a shorter treatment programme simply because a client can not raise funds.

The “12 steps” refers to the initial treatment model devised in America in the 1930’s. It is a systemic model where clients move across a series of steps. Within rehab centers, it is not expected that a client completes all 12 steps while in treatment. Ordinarily, centers have excellent links with local groups, and members of local AA chapters will come into the centers for meetings as facilitators or to share their personal experiences. AA is a worldwide organization and there are meetings all over the UK.  

Ideally, a client links in with an AA group close to home, before leaving treatment and then carries on with their step work when they go home. It is an abstinence-based model. While AA mentions a higher power, it is not aligned to any religious groups and this reference should not be taken to have any religious meaning.  

Clients will sometimes call in and ask for a “non 12 step” center claiming that the program  doesn’t work for them. There is no research to support this though it is possible that, at the time the client was in treatment, they were not in a receptive frame of mind to engage, or they left early.  

The 12-step philosophy has been around for nearly one hundred years. You will find that most staff who work in the centers themselves are in recovery and have completed step work. They will still attend AA, or another 12-step based group (narcotics anonymous, cocaine anonymous, etc.): This is how they maintain abstinence.  

As part of the 12 steps there are actions that need to be carried out by the client in treatment. For example, making a list of those who, through their addiction, the client has harmed.  

All centers operate on a group therapy model which, in a 12-step center, incorporates the 12-step model into this. For further information on the 12 steps, visit: https://www.alcoholics-anonymous.org.uk/ 

There are centers that offer a non 12 step programme. Ordinarily, these are based on a SMART alcohol recovery premise. SMART stands for: self-management and recovery training. It is a more modern-day approach that encompasses medical research. However, there is no research, to date, that suggests that a SMART approach is any more successful than a 12 step one.  

In centers in the UK, SMART is usually delivered, in a group therapy model, as part of an eight-stage model. As with 12 steps, clients move through eight stages as part of their recovery. It is seen as a practical based programme rather than an explorative one. As SMART is a newer phenomenon, there are fewer groups in the UK. As such, some clients may find that their nearest physical meeting could be some distance from their home address. SMART has virtual meetings, online, which may be easier to access.  https://smartrecovery.org.uk/

However, as mentioned above, there is no research (to date) which suggests SMART is better than 12 steps, or that 12 steps are better than SMART. The most important thing is that someone goes into treatment.  

Most people who think they need to “detox”, when they are assessed on admission, turn out not to need one. Detoxification, shortened to “detox” is a process of using prescribed medication to safely withdraw from the substance of dependence. With alcohol and benzodiazepines, as well as gabapentinoids (pregabalin and gabapentin) this is essential if the dependence has been ongoing for some time and can also depend on amounts being used.  

This process is done alongside the therapeutic aspects of rehabilitation. Most clients, who do need detoxification, are able to join in with the therapy on the first day. Some may need a day or two to settle. However, every center has the same protocols in that: As soon as someone is physically stable enough to join in with groups, then they must: No exceptions.  

Ketamine, cannabis, cocaine, GHB/GBL, etc. do not need a “detox” but the client may need supportive medication to get them through the early stages of rehab. Clients dependent on significant amounts of GHB/GBL/ketamine will need medication. Not to detox, but to safely come away from intoxication/dependency. As with alcohol and benzodiazepines, it all depends on the length of time a client has been using and how much they are consuming.  

Centers can arrange “sober transport” for all clients. This means a driver who is in recovery and understands what it is like to be caught up in addiction. It is not unknown for clients to arrive at a center, having consumed alcohol on the way to the center. This is infinitely safer than suddenly ceasing to drink.  

For clients dependent on opioids and opioid like agents (heroin, tramadol, codeine) it is also essential not to stop using them before going into rehab. While the risks associated with sudden cessation of opioids and opioid like agents are lower, it will make the client unwell and lower their tolerance. This means that they may develop strong cravings and that they will go and seek a larger than normal amount to satisfy their cravings: An incredibly dangerous scenario.  

Some clients can use their medical insurance to pay for treatment. However, there are , however not all centres will accept clients on insurance. Furthermore, not all policies cover drug and alcohol use.

The first thing to do is to check the policy to ensure that it covers drug and alcohol rehabilitation: Most do not. If it does, then there may be a time limit on the time they will pay for and other restrictions such as where they will pay for you to do. The best advice is to speak to the insurance company: in the first instance.

Insurance companies negotiate significantly reduced rates for clients they fund which means that some centres will not take insurance clients. Also, it can take a very long time for the insurance company to pay a centre, which in turns delays the commission paid to a referral agent (if applicable).

Some companies provide medical insurance for employees. The same rules apply: Firstly, you need to check that the policy covers drug and alcohol rehabilitation. Secondly, there may be a geographical and time restriction as to where you can go and how long you can go for.

The answer is: yes, and no.

There are centers that  will admit clients  for a week, but not many, and the nearest one could be a significant distance away  from where a client is based. There aren’t as many centers in the UK as people think and extensive  travel may be required.

A weeks admission is only possible for alcohol clients if the amount of alcohol consumed fits within the guidelines. For clients using cocaine, most centers will admit for a week. For anything else, it would not be possible to be admitted for anything less than a fortnight (or , at least, ten days). In any event, a week is not  a very long time. If a client needs time to be physically able to join in the therapy groups, by the time they get into the swing of things, it is time to go home.

There are companies who offer rapid opioid detox in five days : Please do not do this. While it is safe there are other inherent difficulties with this approach. This is simply a medical based treatment programme, without any therapy.  Clients leave, often with cravings, and lacking tolerance to opioids due to a rapid medical treatment. It is not unknown for clients to compensate by ingesting a larger amount of opioids than they normally would: This could be very  dangerous.

In any event, anyone going into a rehab centre, even for a week, is expected, as part of the treatment programme, to join in with the groups as soon as they are physically able to do so. The idea of someone simply staying in their room while they detox is not a reality in a rehab centre.

Any Centre offering detox and therapy must be registered with the Care Quality Commission (CQC) . It is absolutely imperative that, before booking into a Centre, a client physically checks the CQC website to ensure that the Centre is registered: Do not rely on the center’s own website or promises made by agents. While it is a criminal offence to advertise registration that does not exist, prosecution takes time and, thus it is essential that this is checked.  (Care Quality Commission (cqc.org.uk)  Thankfully, whilst very rare, there are occasions where a Centre that has lost it’s registration continues to advertise the CQC logo on it’s website. 

The CQC have a rigorous inspection policy and there  reports are published on the internet. Centre’s are legally required to publish their reports, on their websites, within three weeks of the publication by the CQC. However, there is no stipulation as to where on the website this information needs to be published and no requirement to even have a website.

Before a Centre is granted registration, very extensive checks are made into the building, the staff and policies and procedures. As such, it can be some considerable time between when a centre opens and the first inspection report. Thus not all center’s will have inspection reports on the CQC website.  Inspection reports use a traffic light system. In short, look for green! 

Paul is happy to assist as he has an excellent relationship with all the chains and most of the independent center’s (indeed he has worked in a few of them!) 

Drug and alcohol rehab centers exist to help clients get into recovery. This means to be free of the substance a person is dependent upon and build up a mental toolbox so that the client has an array of techniques and strategies at hand to stay focused and abstinent. Some centres provide rehab for sex addiction as well as gambling and pornography. 

There needs to be an underlying dependency on drugs and/or alcohol for someone to use the service, though this could be a historical dependency and not active use. Many clients who have sought help before can identify the signs of relapse and seek help to prevent sliding back into active use. 

While there are differing opinions as to what constitutes alcohol misuse disorder, the general rule of thumb is that if someone who drinks alcohol exhibits any (or more) of the following, help should be sought: 

* Being unable to limit what you drink

* While wanting to cut down, feeling unable to do so or making abortive attempts to cut down

* Spending a lot of time trying to access alcohol and/or dealing with the after-effects of drinking

* Taking time off work/studying because of alcohol use

* Strong desire to drink (cravings) 

* Continuing to drink despite advice to stop from a doctor/healthcare professional, friends, family, employer, etc

* Limiting hobbies due to alcohol use. 

* Drinking while driving and/or operating heavy machinery

* (RED FLAG SYMPTOM) Developing a tolerance to alcohol so that you have a reduced effect from the same amount or need to drink more to have the same effect. 

* (RED FLAG SYMPTOM) Experiencing withdrawal symptoms. Sudden cessation should never be attempted. If someone experiences sweating, nausea and tremor, they need to drink alcohol. This may sound counterintuitive, but it could be life-saving. 

NEVER ATTEMPT TO STOP DRINKING ALCOHOL AT HOME. ​

Clients who are prescribed antidepressants and/or anti-psychotics often ask if they can be admitted to come off these medications: This is not possible. Any attempt to do so must only be done in close collaboration with their GP and/or psychiatrist (if applicable). It is not the remit of a rehab centre to do this.