Guidance

Residential drug and alcohol treatment: self-assessment guidance

Published 16 January 2025

Applies to England

Introduction

Residential treatment (also known as residential rehabilitation) is an intensive intervention that provides people with a safe and therapeutically effective environment to stop their drug and alcohol use, and help them to lead a life in recovery.

Residential treatment needs to be integrated in local community treatment and recovery systems. This means that frontline treatment staff should:

• be able to discuss residential options with people who might need residential treatment
• make sure there is a clear care pathway before and after a person’s residential treatment episode

Access to residential treatment is a vital part of having a good local drug and alcohol treatment system.

This residential treatment self-assessment toolkit is intended to help local partnerships:

• analyse the issues that might reduce access to residential treatment in their area
• develop a plan to improve access to residential treatment for people who will benefit from it

Although only a relatively small number of people are referred to residential treatment, local partnerships should consider referring more people to it, particularly those with complex needs. This includes people who:

• have problems related to their physical or mental health
• are struggling to remain safe in the local community
• have not achieved their treatment goals in community services
• are pregnant women or parents who need extra support to meet their children’s needs

The self-assessment toolkit

The Office for Health Improvement and Disparities (OHID) in the Department of Health and Social Care developed this self-assessment toolkit. It will help local partnerships improve access and develop effective pathways to residential treatment for people who use drugs and alcohol.

We produced the toolkit in partnership with a range of stakeholders, including residential and community drug and alcohol providers, commissioners and an expert reference group.

You can use the toolkit alongside existing guidance and resources, which we signpost to in the resources section below.

Who the toolkit is for

The toolkit is for local authority drug and alcohol commissioners and enables you to work with your local partners to identify how access to residential treatment is managed in your area. Where existing arrangements are complex, you might need to do some preliminary work to identify who needs to be involved in the self-assessment process.

The process will be most effective when partners from across your local treatment and recovery system work together through all elements, to rigorously assess policies and processes. It will help partners to identify what is working well, and where things could work better.

Partners to include

The local partnership’s involvement in the self-assessment will usually be led by the local drug and alcohol commissioner. Representatives from the partnership will need to include people:

• with authority to make decisions to change systems where it’s needed
• who understand the residential pathways in detail

The group involved in the self-assessment should include:

• other relevant commissioners, including from adult social care
• community and prison drug and alcohol treatment service providers
• residential treatment providers
• homelessness support service providers
• representatives from acute NHS trusts
• specialist primary care providers
• criminal justice partners
• representatives from local authority children and families’ services
• people from lived experience groups or organisations
• representatives from Jobcentre Plus

Local partnerships may also decide to include representatives from:

• National Drug Treatment Monitoring System (NDTMS) teams
• regional OHID drug and alcohol teams

Priorities and actions

You should identify actions you need to take to address concerns and maintain strengths in the local system. You should make it clear who will lead on those actions. The actions should then inform resource allocation planning as part of a wider needs assessment process.

You can ask another commissioner to assess your responses.

You should identify how often you will meet to review your actions. It may be helpful to set a timescale to re-evaluate when you can review whether your actions have improved your local access and pathways to residential treatment.

Evidence for residential treatment

Drug misuse and dependence: UK guidelines on clinical management recommends residential treatment as suitable for people with the most complex needs, because it can offer a range of therapeutic approaches. It can also be suitable for people who have not benefited from community treatment. However, some people might prefer to go straight to residential treatment, which could be helpful for them too. Clinicians will need to use their judgment to decide what is best for each person.

Residential treatment programmes are one of the longest-established forms of treatment for drug and alcohol dependence. It is an under-researched area in the UK.

However, research on long-term residential treatment published by the American Psychological Association suggests that if people stay in residential treatment for a minimum of 90 days, they will have better outcomes when they complete the programme.

Also, the National Institute for Health and Care Excellence (NICE) clinical guideline Drug misuse in over 16s: psychosocial interventions notes that people with clinically assessed high levels of complex needs are likely to benefit most from residential treatment.

NICE quality statement 10: residential rehabilitative treatment (part of the quality standard Drug use disorders in adults) describes the evidence for residential drug treatment and who is most likely to benefit from it.

NICE guideline Integrated health and social care for people experiencing homelessness describes the evidence for care for people experiencing homelessness.

Residential treatment for children and young people

This toolkit has been developed to help services plan their provision for adults aged 18 and over.

While interventions for alcohol and drug use are often similar for adults and children and young people, there are important distinctions. For example, there are differences in emotional and cognitive development, problem awareness and readiness for change, as well as consent and safeguarding issues.

This means that residential treatment in an adult service is not appropriate for children and young people. Unless children or young people are assessed as having sufficiently complex care needs, community-based treatments are more appropriate and effective for them than programmes that temporarily remove them from their family and support network.

Clinical and operational forums

You should use local multidisciplinary forums to support clinical decisions about access to residential treatment. When you have made the clinical decision, you need to arrange funding for the placement. Your local processes should enable quick decision-making, so there are no unnecessary delays in getting the person into treatment.

Good communication between residential treatment providers and community services will help the person to make a smooth transition to residential treatment.

It’s good practice for commissioners, community and residential treatment providers to work together to develop, review and maintain pathways and protocols between community and residential treatment. They should also do this for other pathways, including from prison.

Data and accessibility

The NDTMS website provides definitions for residential treatment, as well as monthly updated data at a national, regional and local level for residential treatment. You need to apply for permission to access the data.

Commissioners and residential services have a duty to ensure their services are accessible to people with protected characteristics. For more information, see:

• public sector equality duty page on the Equality and Human Rights Commission website
• government information and guidance on the Equality Act 2010