In 2008, the Welsh Government introduced a new plan to help address issues of substance dependency.
Referred to as the Substance Misuse Strategy Working Together to Reduce Harm, its aim is to reduce substance dependency across Wales.
To achieve this, the strategy places an emphasis on rehabilitation and treatment, mental health, housing issues, and providing support for families affected by substance dependency. (3)
For those suffering from substance dependency, there is a wide range of facilities and services available in Wales.
There are, generally, two ways to get admitted into rehab in Cowbridge: through the National Health Service (NHS) or to find a private facility.
Individuals seeking to enter rehabilitation through the NHS should contact their GP.
It is most likely that the patient will be referred to a medical specialist who will assess them and decide what treatment is best.
However, this can be a long process. Usually, only those whose symptoms are severe can enter rehab through the NHS. (4)
Alternatively, there are private facilities. However, these facilities are not free and can cost up to several thousand pounds.
There are several rehabilitation facilities within the surrounding areas of Cowbridge, such as the Brynawel Rehab facility.
These facilities provide inpatient detoxification and residential rehabilitation – which includes 24-hour medical support and care.
Once an individual has found a facility, there are several steps before admission: a referral – either from a GP or through an application form – an initial medical and psychological assessment to determine the best treatment, organising a start date then preparation for the stay. (5)
Addiction can be both psychical and psychological, with both interacting and influencing each other.
When an individual takes a substance, they will often experience some form of pleasure and euphoria. Prolonged use can require more of the same substance to achieve the same effect.
The brain and bodies adaptation to a substance is known as tolerance. Further, often prolonged use of a substance leads to an individual’s needing that substance to function properly.
Both tolerance and the need for a substance to function are factors that contribute to psychical addiction. Without the substance, individuals will begin to experience withdrawals.
The withdrawal symptoms experienced will often vary based on the substance and the period in which an individual has been taking a substance.
Commonly, however, withdrawal symptoms included headaches, nausea, anxiety, and restlessness.
When a substance enters the bloodstream, it affects an individual’s brain chemicals and functionality. Over a prolonged period, the brain also needs a substance to function properly.
This is referred to as a psychological addiction. As a result, individuals will experience cravings for the substance they are dependent upon.
Psychological addiction can impact moods and lead to mental health issues, such as anxiety and depression. (6)
The first step to overcoming substance dependence is overcoming both physical and psychological addiction.
This process is referred to as detox: the expelling of harmful substances and toxins from the body.
Detoxing will often lead to withdrawal symptoms, but as previously mentioned, this can vary based on the substance and the duration in which an individual has been dependent upon it.
Detoxing from Alcohol can lead to Alcohol Withdrawal Syndrome (AWS) and symptoms can range from mild to severe.
Symptoms can include anxiety, nausea, and vomiting. Severe symptoms can include hyperthermia, breathing issues and seizures.
Usually, such symptoms will occur within 6-12 hours and can last up to five days. (7)
For heroin, withdrawal symptoms will occur within 3-6 hours and last up to seven days. Withdrawal symptoms from heroin also range from mild to severe.
This can include vomiting, sweating, shaking, to severe symptoms such as impaired respiration and hypertension.
The severity of the withdrawal symptoms is often influenced by how the individual consumed it – injection versus inhalation, for example – and how long an individual was substance dependent. (8)
Withdrawal symptoms from cocaine usually occur within 8-12 hours and can last up to seven days.
Like both alcohol and heroin, cocaine withdrawal symptoms can vary from mild to severe. This can range from sweats, restlessness, and nausea to fatigue and fever. (9)
Alcohol treatment can vary depending upon an individual’s needs.
A more severe case of alcohol dependency can be treated at a facility where individuals will have on-hand medical care, medicine, and therapy.
When attending rehab, individuals will first be medically and psychologically assessed and then will go through a detox period. This will allow for the substance to leave the body.
Once completing their detox, patients will undergo a period of therapy. This will might involve psychotherapy, cognitive behavioural therapy, or the 12-step programme.
Residential treatment for alcohol dependency usually takes between 9 to 90 days. (10)
When entering rehab for cocaine dependency, individuals will first be assessed both physically and psychiatrically. This will uncover the severity of the dependency and if there are any mental health issues.
Individuals will then undergo a detox where they will be looked after by medical professionals.
Alongside their detox, individuals will participate in daily therapy sessions, such as group therapy or psychotherapy.
Residential treatment for cocaine usually takes between 10 to 28 days. (11)
Like both alcohol and cocaine rehabilitation, when entering a facility, individuals suffering from heroin dependency will be medically and psychologically assessed.
Individuals will then undergo the detox process. For heroin, this can be a much more arduous process. Therefore, 24-hour care is often provided.
Individuals might also receive medication to help with the withdrawal, such as methadone or buprenorphine.
Individuals will then begin therapy and counselling sessions that explore addictive behaviours and potential triggers.
Dual diagnosis refers to an individual that has both a substance dependency and mental health issues.
Studies have shown that both substance dependency and mental health issues often interact in various ways and can perpetuate each other negatively.
For example, it is not uncommon that those suffering from mental health issues, such as anxiety or depression, will use substances to help cope.
The use of substances to deal with mental health issues increases the risk of substance dependency.
Those that use substances for a prolonged period are also at risk of developing mental health issues.
Studies indicate that substances such as alcohol, cannabis, cocaine, and heroin can lead to anxiety, depression, and personality disorders. (13)
The length of time that an individual will stay at a rehab facility is dependent upon several factors, such as the substance an individual is dependent upon and the period an individual has been taking a substance.
Usually, however, rehab takes between several weeks to several months.
Brynawel Rehab facility, for example, offers two programmes: a 16-week programme for referrals and an 8-week residential stay for private clients.
However, it should be noted that these are estimates. Treatment may take longer. (14)
Group therapy allows for patients to interact with others undergoing similar treatments. It also provides a space to receive constructive feedback and increase self-awareness through shared experiences.
Experiential therapy is part of group therapy but often occurs outside, where the group will engage in psychical and emotional challenges.
The goal of experiential therapy is to help individuals gain skills in life activities that will help them after rehab. (15)
Psychoanalysis involves an individual talking about their substance dependency and exploring the possible reasons as to why it occurred.
This can involve talking about childhood experiences, past relationships, and traumatic events.
CBT is a combination of both cognitive and behavioural psychology. Essentially, CBT suggests that if an individual can positively change their thought processes, this will lead to positive behaviour changes.
The positive behaviour changes will then help encourage positive thinking.
It seeks to swap negative thought processes, emotions, coping strategies and behaviours, with positive ones. (16)
DBT is like CBT but focuses on moods, ways to cope with and manage stress, emotional regulation, such as cognitive reappraisal, and how to improve relationships. (17)
Contingency Management is a behaviour-oriented therapy that uses a reward system to encourage positive behaviour changes.
When an individual behaves in a positive way they are rewarded – for example, with money or a gift – but when they engage in negative behaviours, the reward is withheld. (18)
The 12-step programme was invented by Alcoholic Anonymous.
Because many individuals that are substance dependent believe that they cannot overcome addiction on their own, the 12-step programme encourages them to submit their substance dependency to a higher power.
This higher power provides something greater than addiction. Through this, the 12-step programme encourages accountability and maintaining sobriety.
Individuals can choose their own higher power, such as a deity or a spiritual connection with life. (19)
The 12-steps are as follows:
1. You have no control over your addiction
2. Only a higher power can overcome addiction
3. The higher power can take control over addiction
4. The need for an individual, moral ethos
5. The need for accountability
6. Overcoming characteristic flaws
7. Using the higher power to help overcome these flaws
8. Making amends for wrongdoings
9. If possible, repairing the relationship with those you have hurt
10. A continued willingness to end and reflect upon wrongdoings
11. Maintaining a connection with a higher power
12. Sharing the 12-steps with others
Most rehabs will work with patients, before the completion of their treatment, to devise a relapse prevention plan.
It is not uncommon for those that have had a substance dependency to relapse after rehab. Several things that might cause this are mental, emotional, social, or locational triggers.
To prevent this, rehab facilities will put in place services that can help an individual avoid relapse.
This usually involves continued therapy and attending counselling that will help identify potential triggers and develop coping strategies.
In addition, both Alcoholics Anonymous and Narcotics Anonymous are available in Wales, and both offer group therapy and fellowship programmes. (20)
Give our team a call today on 0800 140 4690.
(3) substance-misuse-treatment-framework-guidance-for-the-provision-of-evidence-based-tier-4-services-in-the-treatment-of-substance-misuse.pdf (gov.wales)
(6) Johnson, B., 2003. Psychological Addiction, Physical Addiction, Addictive Character, and Addictive Personality Disorder: A Nosology of Addictive Di. Canadian Journal of psychoanalysis, 11(1), pp.135-160.
(9) Wallace, B.C., 1987. Cocaine dependence treatment on an inpatient detoxification unit. Journal of Substance Abuse Treatment, 4(2), pp.85-92.
(15) Hatala, E., 1992. Experiential Learning and Therapy.