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Differences between NHS & private rehab/detox


While there are a number of important differences between NHS and private rehab and detox services, accessibility and cost are perhaps the two most vital.

It is accepted among clinicians and regulatory bodies that residential rehab is the most effective form of treatment for alcohol and drug treatment, but financial restraints mean it is only available to a very few people via the NHS. 

Accessibility 

Of all people who accessed support with alcohol and substances via the NHS in 2019, only 4% of them received inpatient or residential support. It is only offered in very specific circumstances and most care is community based.

Availability of residential rehab via the NHS is extremely restricted and while there are excellent clinicians working in NHS-funded services to help people with drug and alcohol addiction, finances are stretched. 

The National Institute for Health and Care Excellence (NICE), the Department of Health and Social Care body with responsibility in this area, states that community care varies widely and there is not enough intensive support.

Another difficulty with NHS care is that, because it is limited, the more intensive support is often only available to people whose addiction has reached a serious stage, meaning people who want and need help at an earlier point can slip through the net.

Cost

Cost is the other obvious difference between NHS and private rehab and detox.

NHS services are broadly free, whilst private services may be a significant investment. 

Medical insurance, if you have it, may pay for recovery treatment. Employers are sometimes willing to help with or cover costs. Additionally, there are ways of keeping costs down without compromising on standards of care, such as in choosing a clinic that is more affordable but further afield or one that offers shared rooms.

The financial and personal cost of staying unwell with addiction is usually vastly greater than the cost of private rehab. 

The financial burden of continuing to fund an alcohol or drug habit is often significant and being addicted can affect your ability to work, impacting on earning potential.

There is also the devastating personal and social cost of remaining unwell both to you and your loved ones to consider.

Other things to consider

There are other important areas to consider when comparing NHS and private drug and alcohol treatment services, which we’ve analysed in detail below.

These include:

  • Accessibility
  • Outcomes
  • Cost 
  • Environment
  • Choice
  • Timescale 
  • Intensity of support
  • Regulation / quality of care

NHS vs private rehab – at-a-glance guide

Here’s a quick at-a glance guide to the factors to compare and consider in regard to NHS and privately funded detox and rehab.

NHSPrivate Residential Rehab
Accessibility Despite common acceptance that residential care leads to the best outcomes, very few people are referred for NHS residential treatment, due to squeezed budgets. 

About 4% of people who are awarded NHS drug or alcohol treatment get any inpatient care.

Community care is more widely available but the intensity and availability of it varies.
Instantly accessible, with the benefit of being able to choose where you get care.
OutcomesIn 2019, 48% of people who accessed NHS drug and alcohol treatment were classified as having successfully completed it and to be free from dependence.

A total of 38% of people who started NHS treatment in 2019 had already started treatment at least three times previously.

For drug treatment, Department for Health and Social Care guidance says structured day programmes can have comparable success rates to residential programmes if completed, but drop out rates are much higher.
NICE (the National Institute for Health and Care Excellence) states “Those who complete residential treatment programmes have better outcomes.”

Residential care is especially beneficial for people who have not had success via community-based treatment.
Cost£0Variable, but a standard 28-day programme may start at between £5,500 and £7,500.



Health insurance or employers will sometimes cover the cost.



We can advise on ways to make rehab more affordable.
IntensityNICE alcohol treatment guidance indicates community-based psychological interventions should usually consist of 12 one-hour weekly sessions of  Cognitive Behavioural Therapies (CBT), social network and environment based therapies or couples therapy.  Treatment programmes will vary from clinic to clinic but a residential stay allows 24-hour support and intense psychological intervention. including multiple group work and one-to-one sessions throughout your stay.



Certain drugs that can ease withdrawal symptoms are only recommended for use in a residential/inpatient setting.
EnvironmentFor 96% of NHS patients, treatment is community based. A wide variety of environments are available.



More affordable options may be in homely residential settings.



Discreet rural and prestige settings are also available, with all mod cons, quality catering and extensive facilities. 
ChoiceMuch effort has been put in to try to enable choice for people over where they receive care, but with the vast majority of NHS substance and alcohol treatment being community-based, the reality is the local offer is likely to be the only realistic option.



NICE says community-based programmes vary considerably. There is a lack of structured intense assisted withdrawal programmes and a shortage of psychological interventions.
Geography need not be a boundary.



You can book into the clinic that is most aligned to your means, circumstances, needs and preferences.
Quality of CareAll NHS and private detox and rehab services in the UK must meet clinical standards and are monitored by the same regulatory authority. All NHS and private detox and rehab services in the UK must meet clinical standards and are monitored by the same regulatory authority.

Is private rehab better than NHS treatment?

As shown in the table above, there are obvious benefits in accessing residential rehab and specifically private residential rehab. 

The main issue with NHS treatment, however, is not the quality of it but availability.

An Institute for Alcohol Studies report quoted Colin Drummond, professor of addictions psychiatry at King’s College London on the financial challenges facing NHS service providers.

He said: “Typically, addiction services in England have seen cuts of 30% but some areas are planning cuts of up to 50%. In Birmingham, for example, the addiction treatment budget was cut from £26m to £19m in 2015-16.”

The few people who get access to residential substance treatment via the NHS will, in many ways, have as good a chance of getting well as those who go for private treatment. NHS residential treatment may even be delivered in a clinic that primarily provides private care. 

The problem is that very few people qualify for residential treatment on the NHS and, when they do, choice is limited. This means they may end up in a one-size-fits-all style environment that is not necessarily the best suited to them.

There are some excellent free community-based treatments and support, both from the NHS and via charities and peer-led groups, that work for many people and allow them to leave addiction behind. 

Sadly, a lot of people find community treatment isn’t intense enough and they drop out, relapse or cannot achieve their recovery goals. Those people are often left not knowing where to turn or find themselves caught in a spiral of repeating treatment only to fail to maintain recovery long term again.

Who qualifies for NHS residential detox and rehab?

There is huge demand for NHS drug and alcohol treatment, but finite resources.

Four out of five adults estimated to be in need of alcohol treatment are not receiving it at all, according to Public Health England’s latest ‘Adult substance misuse treatment statistics’. 

This is due to people not representing for treatment as well as restrictions on the treatment on offer.

Despite acceptance that residential alcohol and drug treatment produces better outcomes, only 4% of people who received NHS drug and alcohol treatment in England in 2018/19 did so in an inpatient setting. That number has been in consistent decline.

In 2014/15, there were 25,847 people receiving NHS treatment in inpatient and residential settings, compared to 16,757 people in 2018-2019.

The National Institute for Health and Care Excellence (NICE) implies the situation is worse.

It’s Alcohol-use disorders: diagnosis, assessment and management of harmful drinking report says: “Of the one million people aged between 16 and 65 who are alcohol dependent in England, only about 6% per year receive treatment. 

“Reasons for this include the often long period between developing alcohol dependence and seeking help and the limited availability of specialist alcohol treatment services in some parts of England.”

Community care makes up the vast majority of NHS substance abuse treatment.

NICE advises residential alcohol treatment is considered if a person:

  • drinks over 30 units of alcohol per day
  • has a score of more than 30 on the Severity of Alcohol Dependence Questionnaire
  • has a history of epilepsy, or experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes
  • needs concurrent withdrawal from alcohol and benzodiazepines
  • regularly drinks between 15 and 30 units of alcohol per day and also has:
    • significant psychiatric or physical issues, such as, chronic severe depression, psychosis, malnutrition, congestive cardiac failure, unstable angina, chronic liver disease, or
    • a significant learning disability or cognitive impairment.

Homeless or older people may be more likely to qualify for residential help.

For drug treatment, Department of Health guidelines only lists as a consideration for those who qualify for ‘enhanced care,’ such as those most at risk of dropping out of treatment or who have mental health needs.

Mental health support for people addicted to drugs or alcohol

Mental health issues, including anxiety and depression, are common among people who misuse drugs and alcohol.

More than half of adults (53%) who started in NHS drug and alcohol treatment in 2019 had a mental health need.

The figure is highest among those who have alcohol and non-opiate problems, with 59% of those people saying they also had a mental health need, according to Public Health England’s 2019 adult substance misuse treatment statistics report.

However the presence of addiction can prevent people from getting NHS support with mental health issues. Abstinence from alcohol and drugs is often required before mental health treatment will be offered, which creates a vicious circle for some. 

Alcohol and drugs are often the self medication people are using to cope with their mental health troubles and trying to remove it without some form of replacement either via therapy or medication can prove extremely difficult.

NICE guidance states: “For people who misuse alcohol and have comorbid depression or anxiety disorders, treat the alcohol misuse first as this may lead to significant improvement in the depression and anxiety. 

“If depression or anxiety continues after 3 to 4 weeks of abstinence from alcohol, assess the depression or anxiety and consider referral and treatment.”

It adds: “Service users who have been dependent on alcohol will need to be abstinent, or have very significantly reduced their drinking, to benefit from psychological interventions for comorbid mental health disorders.”

Private residential treatment tends to take a more holistic approach and allows the introduction of intensive support to help people with all of the troubles and hurdles they are facing in order to allow abstinence to be a realistic possibility.

How effective is residential addiction rehab?

Accurate figures on the genuine outcomes achieved by private residential rehab facilities are very hard to find.

Some reports claim to demonstrate how effective services are but, when you scratch the surface, it is possible to see that the statistical sample is not representative, making the figures of little use.

An NHS National Treatment Agency for Substance Misuse showed the best residential services see more than 60% overcome dependence.

The percentage of positive outcomes is skewed by people who don’t complete treatment. People who are committed to treatment are much more likely to succeed.

That said, overcoming addiction is difficult and there is no solution that will offer a 100% success rate. 

There are less effective services that only recorded 20% of guests overcoming dependence, demonstrating the vital need to be careful in choosing which clinic to attend. 

Different people will respond better to different treatments. Finding a flexible and dedicated treatment provider, who works closely with individuals to tailor care, will vastly increase the chances of success.

The Care Quality Commission regularly inspects all the private rehab clinics we work with to ensure the treatment they provide is effective.

We’re here to answer all your questions about private rehab via our free, no obligation,  advice and booking service.

Call today for free & confidential advice on 08000029010 (International: +44 161 674 9049)

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About the author: Martin Preston

Martin is our Founder and Chief Executive. Martin is himself in long term recovery and started Port of Call to help families navigate treatment options. In 2020 Martin will open Delamere Health Ltd, the UK’s first purpose built addiction treatment clinic.


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