Our Treatment Plan is Split Into Three Main Stages:
Comprised of a telephone triage assessment, and a paid home assessment, the pre-treatment process involves analysis of your dependency history and personal situation - as well as previous treatments and/or complications.
The telephone triage assesses general information relating to each client's situation, and involves discussion of the price of our service.
The paid home assessment ascertains the viability of the home detox to the particular client - essentially, the specifics of your situation, and whether or not our service is right for you.
The main body of treatment involves prescribing and administration of detoxification medications, relative to the particular dependency.
Depending on the particular medications used, this component of treatment would last for either ten days, or twelve weeks, with stabilisation and monitoring.
Alongside this, a process of counselling is undertaken, which involves practical advice and workshopping of difficulties encountered during withdrawal.
These processes are each personalised to the specific requirements of individual clients.
Post-treatment care involves relapse prevention through use of medications, treatment referrals based on underlying conditions, and psychosocial support. Medications are prescribed based on the substance of dependency.
Underlying conditions, and their severity, are monitored through self-assessments. Manifestations of cravings are monitored through self-reporting and ongoing assessment throughout treatment.
While aftercare is an optional addition to our service, it is recommended in order to secure effective long-term success.
Our pre-treatment assessment is split into two stages: firstly, a free telephone triage, in order to learn the basic information relating to your specific case, and informing you about what kind of treatment process to consider. The triage also involves discussion of prices and duration of these services, in order to judge if your personal situation is suitable for a home detox. This is followed by a more comprehensive home visit assessment.
The triage explores various aspects of your case, including:
- Dependency history, and length of time of use.
- Past treatments - successes and complications thereof.
- General health, both physical and mental.
- Social circumstances - the environment in which you are living, and whether it is conducive to successful treatment.
- A SOCRATES assessment to analyse a client's problem recognition, level of preparation for combating problems, and ambivalence; analysing the extent of work, and focus thereof, for the detox process. This applies to both alcohol and opiate dependence.
- An AUDIT-C assessment for alcohol dependency.
While the triage analyses basic information relating to the case, a treatment plan cannot be realistically formulated until a home visit has occurred. This is the second stage of pre-treatment assessment. During the home visit, various means of assessment will be used in order to further clarify the information given over the phone. These include:
- Specific questions regarding opiate use/dependency, and history of addiction.
- Evaluation of social conditions; whether your home situation is suitable for detox, relative to your substance of dependency and degree of dependency. This includes possible risk factors to treatment, such as cohabitation with other substance-dependent individuals.
- Assessments of various markers of physical health, with the consent of the client, including: blood pressure, pulse, temperature, oxygen blood concentration, rate of respiration, a body scan, breath readings, and a urine-drug screening.
- A twenty-point SADQ assessment for alcohol dependency.
Following these assessments, we will discuss the responsibilities of the client, and those of the service. In order to commence detoxification treatment, signatures of consent, from both the client, and a third person - chosen by the client, and assessed as suitable to manage the client's detox as directed by the service - would have to be obtained.
The consent given would relate to agreements from the client to maintain abstinence from their dependent substance, as well as use of detox medications as prescribed. Signatures must also be obtained in relation to payment for the service - non-refundable in the event of a client's termination of treatment - as well as consenting to breath-tests on request; consenting to use of blood samples for analysis of liver and kidney function; and consenting for the results thereof being sent directly to the service.
The third person would have to provide signed agreement to take on the role of administrator of medicines, and being present throughout detoxification. They would also have to attend the initial home assessment, in order to be confirmed as suitable for the role. The client would have to give signed consent for the third person to present prescriptions to a pharmacy, and have medications dispensed to them, on the client's behalf.
Once these agreements are formalised, and all responsibilities of all parties are understood and consented to, the main stage of detoxification treatment can begin.
Detoxification treatment is composed of two main aspects: prescription and use of detoxification medications, and ongoing counselling during home visits, which involves the discussion and workshopping of any issues encountered throughout treatment.
Specifics of treatment are for discussion only after the assessment portion of the detox is concluded, however the medication and counselling plans generally follow a standard framework.
In the case of alcohol dependency, detoxification medication is administered for a maximum of ten days, however further supplements may be used depending on the manifestations of underlying conditions, and the effects they have upon withdrawal. Withdrawal symptoms are monitored by means of a CIWA-ar assessment; the aim of the treatment is to lower the severity of withdrawal symptoms to below that for which treatment is required, and maintain the symptoms at that level.
In the case of opioid dependency, treatments for individual symptoms can often be administered by way of over-the-counter medications. For substance-substitute treatment, the relevant medications - which are prescribed specifically to the requirements of the client - may be administered for up to two weeks, in order to stabilise dosage, followed by a reduction process lasting between eight and twelve weeks. In order to monitor withdrawal symptoms, a COWS assessment will be conducted; as with alcohol dependency, the aim is to reduce withdrawal symptoms to below the point where treatment is required, and maintain this level.
While industry guidelines indicate a general framework in terms of duration of medicinal treatment, it should be noted that fluctuations from this may occur depending upon the individual needs of the client.
Alongside the medication treatment plan, a comprehensive process of counselling takes place. Whereas different medications are prescribed based upon different types of substance dependency, counselling generally runs according to the same strategy of motivation enhancement - regardless of the particular condition being treated.
The counselling strategy involves analysis of feedback, both objective - such as test results - and subjective - such as analysis of the behaviour of the client. We seek to compare the self-assessment of the client and their condition, with the results offered by the objective monitoring tests. We highlight discrepancies between the statements of emotional wellbeing made by the client, the results gleaned from monitoring, and the behaviour of the client themselves. These discrepancies are explored, and solved practically.
Resistance to treatment is managed therapeutically. Reflection is encouraged, by both parties, in order to better organise treatment and recognise areas of particular difficulty. At this stage, a client's ambivalence to treatment is generally expected to be low, with them understanding the necessity for treatment. The effort and pro-activity of the client in this regard is usually apparent - based upon their behaviour, and the results of the SOCRATES assessment. The extent of problem-recognition by the client is generally understood through their behaviour in reflection - the counsellor then works to reinforce this.
More steps may be encouraged, if problems outside of the dependency themselves are likely to impede or jeopardise the treatment process. Other issues and alterations may be addressed, with a view to making demonstrable changes.
The remainder of the treatment process, in terms of counselling, consists of the planning and management of short-term detoxification, and long-term lifestyle changes to ensure lasting success and sobriety. This process is managed based upon the situation of the specific client, and may involve tests for suitability of later medications following the initial detoxification.
While there is a standard set of processes and procedures undertaken during treatment, it will be the priorities for the client - recognised by us - that determine at which stage, and in which order, such processes and procedures take place. Our service is truly tailored for the needs of the client, and will not sacrifice personal care in favour a general framework for treatment.
Aftercare is an optional service, and is offered separately to assessment and treatment. Following successful reduction or withdrawal from the dependent substance, we encourage consideration of further treatments which aim to prevent relapse, and ensure effective, long-term success.
One key aspect of our aftercare process is understanding the manifestations of cravings, and recognising the underlying conditions which might intensify them. Anti-craving medications can then be prescribed to assist with withdrawals, depending upon the substance in question. This is the only aspect of aftercare which is offered directly by our service.
As is the case throughout our treatment, our aftercare is tailored to suit the needs of the client, and their health priorities. As such, there is a wide range of third-party referrals which may be made after conclusion of post-detox assessments and monitoring, including:
- Relapse Prevention Counselling
- Support Groups
- Coaching - such as life skills coaching, or careers advice
- Relationship therapies, such as marriage counselling
- Cognitive Behavioural Therapy
- Pain management specialists
While these services are not provided directly by us, we can fully assess clients who consider further care after their successful treatment. The work carried out throughout the detoxification and withdrawal process allows us to make our referrals with the best interests, and input, of the client at the very centre of the decision-making process. This helps the client to avoid avenues of help which may not be necessary or beneficial to their long-term treatment, and helps to maintain a healthy trajectory beyond detoxification itself.
Though this is an optional portion of our service, it is still convenient to the client, and beneficial to their lasting success, to consider our aftercare.