Residential rehabilitation: literature review

3. Overview of Residential Rehabilitation in Scotland and Internationally

'Residential rehabilitation' for the treatment of Substance Use Disorders (SUD) or problematic use of alcohol and/or drugs encompasses a large number of programmes and models of care in residential settings, and is widely recognised as an important treatment option. Residential rehabilitation facilities offer programmes which aim to support individuals to attain an alcohol or drug-free lifestyle, and which provide intensive psychosocial support and a structured programme of daily activities that residents are required to attend over a fixed period of time. Research into residential rehabilitation is challenged by extensive variation in models of practices, including, for example, processes of candidate selection and preparation; philosophies of recovery; programme length, content and structure; and involvement in different types of aftercare programmes.

Significant disparities exist in the level of provision across and within different countries. According to a report on residential rehabilitation across Europe by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA 2014), six countries accounted for two-thirds of the 2,500 reported residential facilities in Europe in 2011. These were Italy (708 facilities); Germany (320 facilities); Sweden (311 facilities); Spain (207 facilities); the UK (138 facilities) and Ireland (108 facilities). Data on capacity across Scotland comes from a 2021 pathways survey by the Scottish Government (2021) of 20 residential rehabilitation facilities identified by a previous (2020) Scottish Government mapping exercise. Two of these 20 facilities are statutory, three are run by private providers and 15 are third-sector. The survey found 425 beds across these facilities, with an average of 15 beds per facility. Providers reported a total of 1,601 individual placements across these facilities in 2019/20, and 1,164 in 2020/21.

The EMCDDA report identified three main therapeutic approaches to residential treatment in Europe, including:

• Therapeutic Community (TC) principles, emphasising self-help, mutual self-help, peer mentorship and often co-residence of staff and residents.
• 12-Step, emphasising 12-Step programmes, group sessions and understandings of substance dependency as a chronic illness or disease.
• Psychotherapy, drawing on cognitive-behavioural therapy (CBT) or other psychotherapeutic models, and emphasising group sessions/learning coping skills.

As demonstrated in the Scottish context by the Scottish Government's pathways survey, the report notes that facilities often use a combination of the above, and may tailor interventions to the needs of the individual. Most approaches continue to be abstinence-based, though there is a growing recognition that there may be benefits of continuing medication-assisted treatment (MAT) in residential settings (Galanter et al. 2016). However, studies of continued methadone maintenance and other MAT in residential settings are few and this remains a significant gap in the literature (Schuman-Olivier et al. 2014; Global and Public Health 2017).