Summary:
1 Residential rehab is an integral part of any drug treatment system, a vital option for some people requiring treatment for drug dependence. Anyone who needs it should have easy access to rehab, whether close to home or further away.

2 Many different types of residential rehab are available. The most common factor is that residents have to stay overnight to receive treatment, and are expected to be abstinent before they start the programme.

3 Residential rehab currently accounts for 2% of people in adult drug treatment but 10% of central funding. On average a period in rehab costs £600 a week, making it much more expensive than non-residential treatment services.

4 An audit of annual data returns shows that residential rehab is not an automatic exit door from the treatment system, but an integral part of a network of services. Three-quarters of residents come from community-based treatment services before accessing residential rehab, and the majority return for further structured support afterwards.

5 For every ten people who go to rehab each year, three successfully overcome their dependency, one drops out, and six go on to further structured support in the community. Of those six, two overcome dependency with the help of a community provider, at least two are still in the system, and at least one drops out.

6 Almost two-thirds of those who drop out from residential rehab do so in the first few weeks, suggesting that referring services and receiving facilities need to ensure people are better prepared before entering residential programmes and better supported during their stay.

7 Outcomes vary across the residential sector. The best performers see more than 60% of their residents go on to overcome dependence, while the poorest struggle to enable 20% or fewer to overcome addiction. All services will have to demonstrate value for money in an increasingly outcomes-focused healthcare landscape.

8 The best-performing rehabs do well with complex users, who often do not benefit from cheaper community treatment. To justify the extra cost of residential placement, rehabs will in future have to focus on the complex cases, where they can add value to the treatment system.

9 Rehabs are more successful at retaining and treating residents with severe alcohol dependency than drug addicts – possibly because dependent drinkers have more personal and social capital to invest in recovery.

10 In the light of the 2010 Drug Strategy, the NTA is collaborating with the Recovery Partnership and others to help residential rehab providers adapt to the shift to an outcome-focused local public health system in which they are paid by results. Some providers will need to improve their performance in order to meet the future needs of commissioners and service users.