Drug and Alcohol Rehab in Walthamstow

Between 2019 and 2020, Waltham Forest had over 793 new patients present for addiction treatment: [1]

• Over 22% of the 793 patients were parents living with their children
• 26% of the 793 new presentations were parents not living with their children
• 51% of the new presentations were not parents and have no contact with children

79% of alcohol-dependent adults in Walthamstow have unmet treatment needs. This was made up of 84% of males, and 69% of females. We are here to make sure that you receive the help you need for the addiction you are struggling with in Walthamstow.

Breaking addictive habits and the negative thought cycle behind it can be difficult and daunting to do on your own, so we are here to provide tailored guidance.

What is Addiction?

Defined by the NHS, ‘addiction’ is defined as a lack of control, taking, or doing something to the point where it may become harmful to you or others. [2] This is most commonly associated with alcohol, drugs, and gambling.

Many factors cause or contribute to addiction, mainly due to the way substances and activities make you feel.

Drugs and alcohol produce euphoric effects that present powerful cravings each time you use them. These ‘highs’ are followed by urges to recreate the same feelings, making it difficult to stop or cut down.

This is followed by unpleasant withdrawal symptoms, or ‘come downs’. Due to their severity, addicts often re-use or carry on their harmful habits to reduce withdrawals, causing the cycle of addiction to start again.

The DSM-5 similarly defines addiction, referring to the constant want and need for alcohol and/or drugs. This type of compulsion is so strong that addicts cannot control it. [3]

Withdrawal symptoms are often different for each person, relating to what the substance is, how long it was used for, how much was consumed, and how often. They are physical and mental withdrawal symptoms, commonly consisting of:

• Anxiety and depression
• Memory loss and confusion
• Panic attacks and disorientation
• Irritability and agitation
• Sweating and shaking
• Nausea and vomiting
• Diarrhoea
• High temperatures
• Change in sleep and weight
• Heart palpitations
• Muscle and joint pain

The severity and length of withdrawals can depend on family history, genetics, and general health. The first few symptoms often appear as the substance wears off, around 6-12 hours after ingestion. Withdrawals can often be at their worst at around 72 hours but will wear off with perseverance.

Withdrawals can be life-threatening if your addiction is severe, so get in contact with us to discuss a medical detox and rehabilitation with our guidance.

If you are worried about showing signs of withdrawal or addiction in Walthamstow, take an at-home questionnaire.

Questionnaires for Addiction

The most common addiction questionnaire is called ‘CAGE’, developed for both alcohol and drug addictions: [4]

CAGE Questions for Alcohol Use:

1. Have you ever felt you should CUT down on your drinking? YES/NO
2. Have people ever ANNOYED you by critiquing your drinking? YES/NO
3. Have you ever felt bad or GUILTY about your drinking? YES/NO
4. Have you ever had a drink first thing in the morning to steady your nervetoer to get rid of a hangover(EYE-OPENER)? YES/NO

CAGE Questions Adapted to Include Drug Use (CAGE-AID)

1. Have you ever felt you ought to cut down on your drinking or drug use? YES/NO
2. Have people annoyed you by criticizing your drinking or drug use? YES/NO
3. Have you felt bad or guilty about your drinking or drug use? YES/NO
4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)? YES/NO

If you answer ‘YES’ to a CAGE question, you will score 1 point, and each ‘NO’ answer is 0 points.

If you are accumulating 2 or more points per 4 questions, you are showing signs of addiction.

If you are looking for a purely alcohol-related questionnaire, the AUDIT might be more suitable.

AUDIT questions: [5]

1. How often have you had 6 or more units of female or 8 or more if male, on a single occasion in the last year?
2. How often during the last year have you failed to do what was normally expected from you because of your drinking?
3. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
4. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut it down?

Once you have completed the first 4 questions, you might be classed as ‘fast+’. If so, complete the remaining 6 questions.

1. How often do you have a drink containing alcohol?
2. How many units of alcohol do you drink on a typical day when you are drinking?
3. How often during the last year have you found that you were not able to stop drinking once you had started?
4. How often during the last year have you needed an alcoholic drink in the morning to get going after a heavy drinking session?
5. How often during the last year have you had a feeling of guilt or remorse after drinking?
6. Have you or somebody else been injured as a result of your drinking?

Addiction Intervention

Those struggling with addiction often face denial as the first hurdle. Addicts sometimes ignore or fail to acknowledge addiction‘s harmful social, mental, physical, and personal side effects.

Addicts believe solutions won’t work, and often find so many solutions that it seems impossible to pick one.

Intervention is the first step in getting help. This is a plan to help you or someone that you love to seek help, stop using, and get into rehabilitation. This is not confrontation like it used to be, intervention is a healthy, and safe environment, rather than a shameful and judgemental situation.

How do you know when it’s the right time to intervene? Timing is crucial when you are getting ready for intervention. Interventions are often postponed or cancelled when people are in fear of upsetting someone, or you are not sure whom to involve in the process.

Intervention is needed when someone shows these signs of addiction:

• Secretive behaviour and financial issues
• Aggression and mood swings
• Distancing themselves from close friends and family
• Responsibility issues
• Built up a tolerance
• Physical and mental withdrawal symptoms

Seeking help early and staging an intervention will give someone the best chance of a successful recovery.

There are 4 types of intervention available in Walthamstow, so research each one to make sure you are staging the right one:

1. Simple intervention
2. Classical intervention
3. Family system intervention
4. Crisis intervention

1. A simple intervention is a one-to-one conversational approach to addiction, where the addict and one other are present. This other person can be a professional interventionist, family member, or close friend. This is normally used when the addiction in question is less severe.

2. Classical intervention, or the ‘Johnson Model of Intervention’ involves the main people affected, and not the user themselves. The ‘concerned others’ gather together to discuss addiction, including its impacts, effects, and roles in the user’s recovery.

3. A Family System Intervention focuses on family bonds that have been broken or bruised by addiction. CRAFT intervention is one form of Family System Intervention, standing for ‘community reinforcement and family training’. [6]

The ‘concerned others’ are asked to educate themselves and others on addiction and the routes of rehabilitation. Family and friends are asked to positively reward good behaviour, such as being sociable and remaining sober.

If the user starts to use again or exhibits negative social behaviour, concerned others are to let the scenario play out and negative consequences take hold.

Research suggests this is the most effective form of intervention, getting over 72% of their patients into rehabilitation.

4. Crisis intervention is designed for people to get immediate help when the user becomes either a danger to themselves or harmful to others.

For an intervention to be successful, everyone should be aware of the different forms of addiction therapy offered through rehabilitation in Walthamstow.

Rehab for Addiction in Walthamstow

There are two types of rehabilitation, inpatient treatment, and outpatient treatment. Both are highly successful, and each one has different benefits.

Inpatient treatment is residential, so you will temporarily move into an inpatient centre to carry out your treatment. This is full-time rehab, designed for the most severe forms of addiction. Inpatient treatment consists of 24-hour care with medical professionals.

Residential rehab is all-inclusive, meaning that the price covers everything from medically assisted detox torent and utilities. This is not usually provided through the NHS and can cost between £10,000 and £100,000 a week depending on the clinic chosen. [7]

The main benefits of inpatient therapy include:

• A safe and easy detox process, with medication paid for
• An enclosed space to completely focus on addiction
• Tailored and structured 24-hour help
• All-inclusive (everything is paid for)
• Low risk of relapse due to minimal temptation
• Easy transition into different therapies

Outpatient rehab is offered through the NHS and is best suited to those with a less severe form of addiction. It is also a flexible option for those who have a strict routine or important responsibilities to work around.

There are three different types of outpatient programmes:

1. Outpatient
2. Intensive Outpatient
3. Partial hospitalisation

Intensive outpatient programmes (IOP) are designed specifically for addiction, eating disorders, and mental health disorders. IOP does not require you to detox and can be used in addition to inpatient treatment as a smooth transition back to your daily life. [8]

Partial hospitalisation (PHP) is a programme specifically designed for mental health, but it is not the same as psychiatric hospitalisation (inpatient treatment). [9]

A professional will assess whether you are right for this type of treatment, based on the following criteria:

• Do you find it difficult to function during responsibilities (such as work or school)?
• Are you medically stable?
• Are you at risk of harming yourself and/or others?
• Do you have a good support system at home?
• Are you self-motivated to attend outpatient treatment?
• Do you suffer from a mental health condition?
• Do you suffer from a substance use disorder?

Partial hospitalisation is temporary, improving your addiction to a standard that allows you to transfer to outpatient treatment. Outpatient treatment is the most flexible, requiring a minimum of 10-12 hours of attendance a week. [10]

The main benefits of outpatient rehab are:

• Works alongside inpatient treatment
• Total flexibility
• There are multiple levels of rehab
• Offers real-life experience that means you can remain sober at home
• Cheaper than inpatient treatment

Both inpatient and outpatient rehabilitation offer similar forms of therapy, and which one chooses will be dictated by the severity of your addiction and medical assessments.

What does Rehab Offer?

Psychotherapy counselling involves a specialist therapist. This is designed specifically for alcoholism, helping you understand your emotions and the reasoning behind your drinking habits.

Counselling teaches you to implement the coping skills and mechanisms learnt in therapy into your daily life.

Cognitive Behavioural Therapy, known as CBT, is one of the most effective forms of therapy for addiction. CBT focuses on the negative thought patterns that lead to addiction, helping you break the cycle you are stuck in.

CBT is also designed for co-occurring mental health conditions, helping you work on destructive thought patterns and irrational beliefs. To change our behaviour, we have to change the way we think, so CBT often works on how people respond to different emotional situations.

Rational Emotive Behavioural Therapy started in the 1950s. REBT, a form of CBT, is an approach working with irrational beliefs that directly link to destructive behaviour. To understand the true impact of addiction, we must first discuss the emotional impacts of addiction.

Motivational Interviewing is behavioural therapy. This helps patients address their behaviour by exploring their avenues of motivation and reasons for change. MI is designed to empower you, helping you transform your life and give you back full autonomy. [11]

Motivational interviewing works on 6 core skills, implemented through 4 processes:

Core skills:

1. Open questions
2. Affirmation
3. Reflections
4. Summarising
5. Attention to language
6. Exchanging information

Fundamental processes of MI:

1. Engage
2. Focus
3. Evoking
4. Planning

Contingency Management therapy also focuses on the motivation behind the behavioural change. Users are rewarded in therapy for positive behaviour, reinforced by incentives such as cash or vouchers.

Once the patient fails a drug test or fails to attend therapy, these incentives are removed immediately. [12]

Common incentives include:

• Low-value cash
• Vouchers (e.g., supermarket vouchers)
• Prize-draw
• Clinical privileges

Holistic therapy focuses on the patient as a whole, rather than addressing one symptom of addiction. Holistic therapy, also known as CAM, ‘complementary and alternative medicine’, focuses on energy balance and spiritual awakenings. [13]

Holistic therapy focuses on general well-being and mental health. There are many forms of holistic therapy, such as:

• Art and adventure therapy
• Tai chi
• Reflexology
• Acupuncture
• Equine therapy
• Massage therapy
• Swimming therapy

There are many 12-step facilitation therapies available in Walthamstow. The most popular group therapy is Alcoholics Anonymous (AA), where people gather together to discuss stories, struggles and coping mechanisms. They abide by 12 important steps: [14]

These are the 12 steps followed by AA, often incorporated into other therapy treatments:

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Decided to turn our will and lives over to God’s care as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when doing so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and practice these principles in all our affairs.

These group therapy sessions are also important for relapse prevention.

Addiction Aftercare: Walthamstow

Relapse is when a patient starts to use drugs or drink alcohol again after they have chosen to become sober or start treatment. Relapse prevention and aftercare are important ingredients in living a full and happy life in recovery.

The best way to prevent relapse is by working on techniques and skills learnt during treatment. Alongside this, patients must be aware of the common triggers of relapse, such as:

• Boredom and stress
• Financial issues
• Relationship struggles
• Arguments and emotional distress
• Certain people or places

If you find yourself tempted by relapse, try to follow these relapse prevention tips:

1. Implement daily self-care
2. Mindfulness and meditation
3. Understand your triggers
4. Join support groups such as AA
5. Deep breathing
6. Form an emergency contact list
7. Contact us today

Addiction is a disease, meaning it can be treated and managed like diseases can.

Get in touch with us as soon as you start to notice signs of addiction or withdrawal symptoms. The earlier you receive help, the more chance you have of a successful recovery.

References

[1] https://www.ndtms.net/resources/public/Parental%20substance%20misuse/London/LN_Waltham%20Forest_2019-20_Parental_substance_misuse_data_pack.html

[2] https://www.nhs.uk/live-well/addiction-support/addiction-what-is-it/

[3] Center for Substance Abuse Treatment. Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2012. (Treatment Improvement Protocol (TIP) Series, No. 54.) Exhibit 2-6, DSM-IV-TR Criteria for Substance Abuse and Substance Dependence. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92053/table/ch2.t5/

[4] https://www.mdcalc.com/calc/1729/cage-questions-alcohol-use

[5] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684823/Alcohol_use_disorders_identification_test__AUDIT_.pdf

[6] https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/community-reinforcement

[7]  https://www.sgu.edu/blog/medical/inpatient-versus-outpatient/

[8] McCarty D, Braude L, Lyman DR, Dougherty RH, Daniels AS, Ghose SS, Delphin-Rittmon ME. Substance abuse intensive outpatient programs: assessing the evidence. Psychiatr Serv. 2014 Jun 1;65(6):718-26. doi: 10.1176/appi.ps.201300249. PMID: 24445620; PMCID: PMC4152944

[9] Blevins CE, Abrantes AM, Kurth ME, Gordon AL, Stein MD. Alcohol treatment outcomes following discharge from a partial hospital program. J Subst Use. 2017;22(6):643-647. DOI: 10.1080/14659891.2017.1296041. Epub 2017 Mar 28. PMID: 30881219; PMCID: PMC6419972.

[10] Substance Abuse: Inpatient and Outpatient Management for Every Clinician. Alan David Kaye, Nalini Vadivelu, Richard D. Urman. Springer, 1 Dec 2014 – Medical – 658 pages

[11] https://motivationalinterviewing.org/understanding-motivational-interviewing

[12] Petry NM. Contingency management: what it is and why psychiatrists should want to use it. Psychiatrist. 2011 May;35(5):161-163. DOI: 10.1192/PB.bp.110.031831. PMID: 22558006; PMCID: PMC3083448.

[13] https://www.therapy-directory.org.uk/content/what-is-holistic-therapy.html

[14] https://www.alcoholics-anonymous.org.uk/about-aa/the-12-steps-of-aa