Rehab moves from the Priory to suburbia as patient numbers rise
• Presence of 'sober living homes' upsets neighbours
• MP demands licensing for treatment centres
Methadone / heroin / drugs / drug abuse. Photograph: Danny Lawson/PA
A big rise in the number of drug and alcohol addicts entering withdrawal treatments has led to an increase in residential rehab centres, which have moved away from the Priory-style model of country house retreats towards using ordinary houses in suburban streets.
Rehab centres have sprung up in towns with relatively cheap housing, where the spread of multiple-occupation houses - known as "sober living homes" - for chaotic, reforming addicts in residential streets has resulted in friction with neighbours who resent their presence.
There are also concerns that there is no industry standard for what constitutes a long-term cure for addicts, few comparative performance figures and rarely refunds for failure.
In some cases patients have died after taking overdoses while attending treatment programmes. Some inside the industry say such problems reflect the inevitable difficulty of weaning patients off severe addictions.
About 200,000 people attended "structured" courses last year at daycare and residential centres, according to the NHS's National Treatment Agency for Substance Misuse - more than double the number of a decade ago.
The increase is largely a result of a government strategy aimed at placing more addicts on community treatment programmes in order to reduce drug-related crime and long-term health costs.
Several rehab centres have been set up recently in Luton, Bedfordshire, where the debate on the issue is highly charged and a local MP has been lobbying for government action.
"We need proper legislation to incorporate [these rehab businesses] in an overall framework," said Margaret Moran, the Labour MP for Luton South. "Families spend lots of money and make the assumption that these places are regulated. They are just desperate to get their sons or daughters off drugs.
"When people are being shipped in [to Luton] from other parts of the country, this is a bit like dumping the problem on someone else's doorstep. Where there's addicts, there's drug pushers.
"As a minimum, some form of licensing [for treatment centres] is the only way forward. Anybody could pop up and claim they could do it. It looks like a lucrative business and it's feeding on people's desperation."
She would like to see companies forced to obtain a government licence before operating.
One local dispute has focused on a terrace house in Luton run by Trust The Process Counselling (TTP) as accommodation for recovering addicts attending its 12-week courses. Moran has supported a resident in the street who complained about antisocial behaviour at the neighbouring address.
"People agree there's a need [for treatment]," said Gavin Cooper, TTP's operations director, "... but there's a general 'not in my backyard' response."
Referring to the specific house, he added: "The environmental health department have been around and have been unable to find evidence of the problem complained about. We even wrote to [the neighbour] extending an offer to buy out his house."
TTP, established in 2006, was set up by people in recovery who wanted to help addicts. It is proud of the high proportion of clients completing its 12-week course. "We have had anywhere between 70% and 85% finishing," Cooper said. "We are reducing addiction. The longer you keep people in treatment the better the chance of keeping people clean. It's about empowering people to take control of their lives."
TTP's 12-step programme is based on the formula devised by Alcoholics Anonymous. "There are very few thoroughbred alcoholics these days. Those between 18 and 40 tend to be poly-substance abusers, often alcohol plus cocaine. The disease of addiction knows no financial boundaries. We have schoolteachers, bankers, lawyers and people of no fixed abode," he said.
TTP, which has registered parts of its operation as a charity, charges £6,444 for a 12-week residential course. "It's a big chunk of money," admitted Cooper, "but one of our motivations is to provide more affordable treatment. Some private clinics charge £4,000 a week."
Geoff Mullins, the head of counselling at TTP, said that measuring success was difficult. "It can depend so much on a client's opinion of himself," he said. "It's difficult to follow people up.
"We fully support tighter legislation. The CSCI [Commission for Social Care Inspection, a government agency] recently changed the way it registers these facilities. It's voluntary but we are registering. There are people who are unethical and substandard.
"Most young people see Amy Winehouse as role model but 99% of the population would be ashamed if people knew they were going for treatment. It's not glamorous - unless you are in a band."
One of TTP's clients died earlier this year while on a residential course. The man, a schoolteacher, "had relapsed and took an overdose", Mullins explained. Another client, he added, died six months after leaving the scheme.
Darren Rolfe, the director of another rehab centre in Luton, the Perry Clayman Project, said: "We are seeing more and more clients. The demand is greater because of the stresses of modern life. We are here to give them their life back."
The body that represents the rehab industry, the European Association for the Treatment of Addiction UK (EATA), is now backing enhanced inspection procedures to reassure families that patients are receiving effective care.
One early consequence has been a drive by the CSCI to register more residential drug and alcohol treatment centres - including those where accommodation is not at the same address as the treatment centre. The commission's main focus for regulation has been the infrastructure of residential homes but it is now checking that there are "professionally validated" treatment programmes and a "credible quality assurance system".
There is no national licensing system. Paul Hayes, chief executive of the National Treatment Agency, said: "The NTA recognises there's an anomaly, whereby some residential drug treatment services fall outside the current regulatory framework.
"We have been discussing with the Department of Health and CSCI how this might be addressed."
EATA has more than 500 members, not all residential. It runs an accreditation scheme and has applied for NHS funding to extend its work.
Sharon Carson, its chief executive, believes there is a need for a complaints procedure for dissatisfied clients and their families. She said: "As the sector has developed there's a need for better measures [for] assessing the quality of courses. If there are problems with services the public need to be able to take their issues further. But I don't know what the perfect model [of regulation] would look like."
A Department of Health spokeswoman said rehab centres were already subject to regulation: "Drug treatment services need to submit data in line with the national drug treatment monitoring system. Services need to meet national and local performance measures on waiting times, retention, care planning and discharge."
The first rehabilitation courses for addicts are generally considered to have been those developed by the founders of Alcoholics Anonymous in the late 1930s. The organisation's 12-step programme is still a commonly followed model.
Many interventions have been tried, including psychotherapy, acupuncture, exercise or diet regimes, meditation and counselling. No quick chemical fix has been found. Absolute abstinence, rather than moderating drug or alcohol consumption, is advocated.
Rehab as a retreat for drugged-out rock stars has attained a dubious glamour, with awareness boosted by the troubled soul singer Amy Winehouse, who celebrated her resistance to "rehab" treatment with the chant "I won't go, go, go".
The roll call of celebrities who have checked into exclusive rehab centres in Britain and the US, such as the Priory in south-west London, is lengthy and includes Robbie Williams, Kate Moss, Britney Spears and Charlie Sheen.
Case study: 'I feel as if I have some hope'
Steve, 40, has been addicted to various substances for 28 years
I've been addicted to lots of things: alcohol, heroin, methadone and benzos [benzodiazepines]. I was eight when I started gambling. Then it was glue-sniffing, then speed and benzos and heroin. I've been taking stuff for 28 years.
I was a horrible person: conning and fraud and shoplifting. I needed my drugs. Nothing would get in my way. If I had £200 it would be gone by the next day. Drugs and alcohol made me stop being lonely.
I had just had enough. I used to wake up in the morning, saying 'Oh no, do I have to go through this again?' I was sick and tired of being sick and tired. I just broke down in front of my mum one day. She must have seen something different. Normally I would be after her money.
I found the TTP course on the internet. They don't give you funding where I come from, so it was my mother who paid for me. I did a Subutex and Diazepam detox over 14 days. I was a chronic junkie.
Since the beginning of the programme I haven't taken anything mind-altering at all. I feel good now. I feel as if I have a chance. I feel as if I have some hope in my life. It was what I was given here. If I put any drugs in my body again I would be off and running. I still say I'm an addict. Now I'm out. My girlfriend's going to have a kid. So life is all right; sometimes it's brilliant. It took me a wee while. I was ill to begin with. Now I know that taking drugs will take me to a horrible, dark place.
Life begins at 40. What I have got today is absolutely amazing. Never could I have dreamt that I would be where I am today. Some people, though, are just not ready to stop.
• Steve, not his real name, is now a trainee counsellor at TTP.
# Owen Bowcott
# The Guardian
# January 3, 2009