Drug & Alcohol Rehab in Bootle

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Drug & Alcohol Rehab in Bootle

Bootle is a town in the Borough of Sefton, in Merseyside, Northwest England. Merseyside is a county that consists of Sefton, St Helens, Knowsley, Wirral, and Liverpool as a result of the Local Government Act of 1972. [1]

Bootle was hit hard and heavily damaged in the 2nd World War, and by the 1980s Bootle saw mass unemployment. Circumstances such as unemployment and economic struggle often feed drug and alcohol abuse.

An ONS report showed that Sefton and St Helens recorded their highest-ever rates of drug poisoning in 2021. The Northwest is the worst affected area of England, as drug-related deaths continue to rise. [2]

The registered number of substance deaths in 2021 rose by over 74% in the past 10 years. When individuals succumb to the disease of addiction, it is increasingly challenging to quit on their own.

With difficulties such as COVID lockdown and unemployment, people fall into addiction and pursue their toxic habits.

Understanding Addiction

Understood as a relapsing disorder, addiction is a disease of the brain. Addiction is characterised by both physical and psychological dependence on either/both drugs and/or alcohol.

Addiction negatively impacts the addict and those around them. Most addicts are aware they have a problem but are either stuck in denial or unaware of the tools available to help them cut down.

The DSM (Diagnostic and Statistical Manual of Mental Disorders), published by the APA states that substance abuse disorders revolve around the following criteria: [3]

1. Using more of a substance than intended or using it for longer than you’re meant to.
2. Trying to cut down or stop using the substance but being unable to.
3. Experiencing intense cravings or urges to use the substance.
4. Needing more of the substance to get the desired effect — also called tolerance.
5. Developing withdrawal symptoms when not using the substance.
6. Spending more time getting and using drugs and recovering from substance use.
7. Neglecting responsibilities at home, work, or school because of substance use.
8. Continuing to use even when it causes relationship problems.
9. Giving up important or desirable social and recreational activities due to substance use.
10. Using substances in risky settings that put you in danger.
11. Continuing to use despite the substance causing problems to your physical and mental health.

The substance use disorder (SUD) criteria all fall under the following patterns:

• Impaired control
• Physical dependence
• Mental dependence
• Social issues
• Risk-taking

Those struggling with SUDs tend to ignore their behaviour and its general effect on others. These negative consequences on their own are not enough to get them into rehab, as they may still be in denial.

Addiction in this context will worsen over time, referring to mental or physical health, social contexts, intake of substances, or effect on others. There are three main levels of addiction severity as it gets gradually worse.

This is generally determined by the presence of symptoms:

• A single symptom indicates an individual is at risk of addiction
• 2-4 symptoms of addiction indicate a mild SUD
• 4-5 symptoms of addiction indicate a moderate SUD
• 6 or more symptoms of addiction indicate a severe SUD

Knowing the severity of the addiction is useful to the person in question and the professionals trying to help. This will also help specialists determine which form of treatment and intervention will work best for someone, giving them the best chance at a successful recovery.

Common signs of addiction will vary according to severity, but look out for the following in yourself or others:

• Neglecting relationships and responsibilities
• Risk-taking
• Secrecy and lies
• Bloodshot eyes
• Unexplained injury and bruising
• Weight and mood changes
• Increased tolerance
• Memory loss
• Aggressive or irritable
• Depression
• Anxiety

Addiction Questionnaires

The best way to apply the DSM criteria of addiction is to take questionnaires from the comfort of your own home. Professor and clinician John Ewing developed the CAGE questionnaire.

This questionnaire screens patients’ behaviour for alcohol and drug-related criteria:

1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

If I patient responds to 2 or more questions with a YES, they are deemed to be displaying addictive behaviours.

These behaviours and destructive habits could be the start of severe addiction. These questionnaires help many people break out of denial and start to work on their addiction problems.

The moment you decide to work on your addiction is the moment your recovery starts. Drug and alcohol rehabilitation in Bootle are specifically designed to help people with differing levels of addiction.

Denial and rehab reservations usually delay critical treatment, leaving people either without help or at risk of worsening addiction. Once a questionnaire such as CAGE is completed, you may have a clearer view of whether you need help.

It may be useful to consider the following:

• The first step is acknowledging the fact that you may have a problem. Breaking the walls of denial is the hardest part of recovery. This process will be easier when you know that help is available in Bootle.
• You must understand that rehabilitation and therapy is a long-term process. For example, you couldn’t get into a car for the first time and pass your driving test on the same day. Living a life of sobriety takes time and patience, as each journey is slightly different from others.
• Education and research are critical if patients are to have the upper hand. Preparation for rehab, its admissions process, types of therapy, and personal aftercare goals are essential and will speed up your rehab treatment. It may also stop you from making mistakes that will lose you time and set you back; knowing what treatment will work for you will speed up recovery.

So, what do you do if you think someone you care about is struggling with addiction? Intervene.

Addiction Intervention in Bootle

Intervention is designed to help motivate someone to seek help and change something about their life. Addiction intervention aims to get patients into rehab and therapy, starting a life of sobriety. [4]

This can be extremely emotional, so be prepared for it to be a struggle. Every individual, along with their addiction is different from another. This is why there are multiple intervention techniques and types, as one may work better for one person and not for someone else.

For example, someone struggling with severe addiction may not benefit from a simple one-to-one conversation with a loved one. They will need more than a simple intervention; they might require a more planned and formal intervention with a psychologist or professional interventionist.

Intervention is the first step towards a sober life, and it has proven a successful technique to get this process started.

For those who remain unwilling or unmotivated to cut down or quit, it may help to give the patient vivid and detailed examples of the consequences of addiction:

• Explain what will happen if addiction continues
• Describe how the addiction has made others feel and its specific effects
• Explain the mental and physical effects of addiction

It is then useful to follow this up with treatment plans, goals, and therapy aims. This can be methodically done using a plan, including who will be taking part, when it will happen, where, and why.

Aim to gather information about treatment plans and forms of therapy that might prove extremely useful for some patients, such as cognitive behavioural therapy if they suffer from ill mental health.

If the intervention is successful, the patient will enter rehabilitation and specialist treatment. CRAFT is a popular intervention plan, short for ‘community reinforcement and family training’.

CRAFT uses the knowledge and experience of the concerned others to build motivation and determination in the patients. Concerned others are asked to positively reward desirable behaviour, such as a clean toxicology scan, therapy attendance, and being sociable.

If patients display habits of using or being antisocial, then concerned others are asked to remove any rewards. This will aim to rewire the brain’s reward pathways that have been damaged from substance abuse. [5][6][7][8]

Once the intervention has been successful, patients will enter a type of rehabilitation.

Types of Rehab in Bootle

There are two types of rehabilitation available to those suffering from SUDs in Bootle, inpatient and outpatient.

Whether inpatient or outpatient treatment is right for you will be determined by the severity of your addiction, based on the following factors:

• General mental and physical health
• The intensity of withdrawal symptoms
• Co-occurring mental health disorders
• How long you have been using/drinking
• What you have been using

Before you start inpatient or outpatient treatment, you will have to go through the process of detoxification. This process will clear the body of toxins through supervision and sometimes medication.

Removing toxins from the body is a critical starting point in recovery and the beginning of the rewiring of the brain. The National Institute on Alcohol Abuse and Alcoholism, NIAAA states that each patient ought to seek evaluation about detox from health professionals.

They will also help you select a treatment plan that will be the most useful for you.

Inpatient Rehabilitation for Addiction

You are likely to be recommended the inpatient rehab if you:

• Have a severe substance abuse disorder
• Have limited social support
• Have an unstable living situation
• Suffer from other health conditions

Inpatient programmes are residential, providing 24-hour care and services for patients. The length of time that patients move into these centres for many vary, from weeks to months, to over a year.

This type of programme is not usually offered by the NHS, so most patients pay the fee at once or fix a payment plan with the centre in Bootle.

This cost will cover:

• Medical detox
• Individual therapy and group therapy
• An array of support sessions
• Coping mechanism building
• Medication
• Addiction aftercare

The amount of time spent in one of these facilities depends on the severity of the SUD, how well the patient has taken to treatment, and whether there are any delays. The detoxification and stabilisation stages may last for around 10 days, and treatment will follow in accordance with both clinical and medical progress.

The main aim of inpatient rehab is to equip and provide patients with the tools and coping mechanisms to support themselves in recovery. This is a safe and secure way to begin the process of recovery.

Outpatient Rehabilitation for Addiction

Most inpatient patients will attend outpatient therapy once they are in active recovery. Patients may also enter outpatient therapy on their own if their addiction is less severe, they have a solid support network, and they are in good health.

Outpatient programmes are not residential, and patients are free to leave after a session. These programmes will vary in length, but their flexibility allows patients to keep a normal daily routine outside of treatment.

These treatment sessions may take the form of:

• Therapy
• Group counselling (Alcoholics Anonymous, Narcotics Anonymous)
• Substance abuse education
• Stress management
• Communication skills
• Relapse prevention

Typically, outpatient treatment lasts anywhere from 3 months to several years. Standard treatment consists of 1-hour sessions from 1 to 5 days a week.

Types of Therapy in Bootle

Bootle offers a range of treatment options for substance abuse, most of which are offered by either outpatient or inpatient treatment.

One of the most popular forms of therapy is behavioural therapy. Originally designed to treat mental health disorders such as anxiety and depression. Mainly, behavioural therapy aims to change the way patients react to their thought processes, replacing addictive behaviours. [9]

One popular form of behavioural therapy is cognitive behavioural therapy, commonly used by many therapists to date. Cognitive behavioural therapy, or CBT, is grounded on the idea that addiction arises from a series of dysfunction and negatively ingrained thoughts.

Thoughts then breed processes and beliefs that undermine positive and healthy behaviour. These may also create doubt in someone’s ability to recover at all. To change addictive behaviour, thought processes must be changed first. Treatment can then be adjusted accordingly.

A specific type of CBT is DBT, dialectical behavioural therapy. This talking therapy is based on CBT but adapted for those struggling with difficult feelings and emotions. DBT helps patients manage these emotions and learn skills to manage them to make positive changes.

DBT focuses on helping patients accept who they are, whilst involving the key aspects of CBT.

Another form of behavioural therapy is Eye Moment Desensitisation and Reprocessing (EMDR), and Rational Emotive Behavioural Therapy (REBT). EDMR is also a mental health technique, based on eye movements to help the processing of trauma. The goal of REBT and EDMR is to heal traumatic experiences that have contributed to or directly caused addiction.

Contingency Management treatment focuses on motivation. Therapy specifically targets what each patient sees as motivation to continue treatment and uses that to their advantage.

Clinicians reward patients who show their targeted behaviour, using tools that motivate them.

For example, some patients may be motivated by supermarket vouchers. These conditioning principles are used as an incentive for anti-addiction behaviour, such as a clean toxicology screen and increased therapy attendance.

Much like CRAFT, positive rewards are removed following addictive behaviour, intended to reconfigure the brain’s reward pathways.[10]

If the patient prefers group therapy, 12-step facilitation therapy is a good option for addiction.

Groups like Alcoholics Anonymous and Narcotics Anonymous help anonymous patients by:

• Sharing stories
• Mutual support
• Explaining different coping mechanisms
• Sharing risks and relapse stories
• Provides a safe and secure environment

These 12-step facilitation groups work on principles designed for each group. The AA work on the following principles:

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. Made a decision to turn our will and our lives over to the care of God 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 to do 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 to practice these principles in all our affairs.

All these therapy types referred to on this page are likely to be offered in both inpatient and outpatient therapy.

Rehab Aftercare: Follow Up

Rehabilitation is a long-term commitment, and there are no immediate solutions. Therefore, aftercare is very important, helping patients develop the skills they learnt during therapy. [11][12]

This is a practice of relapse prevention, building on coping mechanisms. Rehab aftercare in Bootle focuses on the following 3 aspects:

• Preventing lapse and relapse
• Harm reduction treatment
• Developing management techniques

A lapse is when someone briefly resumes their risky addictive behaviour but quits addiction once again to resume sobriety. This is risky, and many people that lapse are at higher risk of relapse.

Relapse is when someone goes back to active addiction and returns to their patterns of original behaviour.

Preventing these two possible paths takes time and risk management, something that is worked on during rehab aftercare.

Harm reduction is a practice based on a set of principles aimed to reduce the negative consequences associated with addiction. [13]

Harm reduction focuses on:

• Safer use of drugs and alcohol consumption
• Managing use
• Developing abstinence
• Meeting other addicts, past and present
• Intervention and public policy
• Reflecting on individual and community needs

The following 8 principles are central to harm reduction:

1. Accept that addiction is part of life, and work to manage and minimise the effects rather than ignore them
2. Understand the complexity of drug use and the behaviours that develop or condemn addiction
3. Develop a quality of life that fits into the life of the community and the individual
4. Practice a non-judgemental and non-coercive practice
5. Act as a voice for those with a history of addiction
6. Reiterate that users are the primary agents in reducing their own risk
7. Recognise the catalysts for addiction, talking about poverty, race, sexuality, trauma, and other social inequalities
8. Limit attempts to minimise and ignore harm and danger associated with addiction

These principles can then be implemented into real life, helping patients move on and work towards sobriety every day.

References

[1] https://www.citypopulation.de/en/uk/northwestengland/

[2] https://www.liverpoolworld.uk/news/drug-related-deaths-hit-record-high-in-parts-of-merseyside-3793250

[3] https://www.gatewayfoundation.org/addiction-blog/dsm-5-substance-use-disorder/

[4] Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 4, EARLY INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424859/

[5] https://www.robertjmeyersphd.com/craft.html

[6] Smith, J.E. & Meyers, R.J. (2004): Motivating Substance Abusers to Enter Treatment: Working with Family Members, Guilford Press: New York, NY.

[7] Meyers, R.J. & Wolfe, B.L. (2004): Get Your Loved One Sober: Alternatives to nagging, pleading and threatening, Hazelden Publishing & Educational Services, Centre City MN.

[8] Meyers, R.J., (Author), & Yu, J. (Director) (2007): “Getting an Addict into Treatment: The CRAFT Approach” [television series episode]. In J. Hoffman & S. Freke (Producers), The HBO Addiction Series; Why Can’t They Stop? HBO New York, New York.

[9] https://www.sciencedirect.com/topics/nursing-and-health-professions/behaviour-therapy

[10] https://www.healthaffairs.org/do/10.1377/forefront.20200305.965186/full/#:~:text=Contingency%20management%20is%20a%20behavioral,them%20to%20not%20use%20drugs

[11] Menon J, Kandasamy A. Relapse prevention. Indian J Psychiatry. 2018 Feb;60(SUPP 4): S473-S478. DOI: 10.4103/psychiatry.IndianJPsychiatry_36_18. PMID: 29540916; PMCID: PMC5844157.

[12] Marlatt GA, Witkiewitz K. Relapse prevention in Alcohol and drug problems Relapse Prevention: Maintenance Strategies in Treatment of Addictive Behaviours. In: Marlatt GA, Donovan DM, editors. 2nd Edition. Guilford Press; 2005

[13] https://harmreduction.org/about-us/principles-of-harm-reduction/