Do psychiatrists make a difference? : impact of levels of medical input to the range of treatment provided in in-patient drug detoxification services

Aims: There is limited research evidence about the role of in-patient detoxification for drug users and in determining where this form of treatment should occur and with what level of medical support and supervision. Methods: The current study is based on a national survey of National Health Service (NHS) providers of drug detoxification in residential settings in England. Of the 76 services identified, 56 (74%) completed and returned the survey, including 19 specialist providers and 37 general medical or psychiatric wards that had beds available for residential drug detoxification. Findings: There was marked variability across providers in the level of medical and non-medical staffing, and in the characteristics of the treatment programmes available. These factors differed systematically by whether the unit was a specialist provider, particularly with regard to levels of medical input. There was greater medical input in the specialist units (statistically significant for staff grade and SHO psychiatrists) while there was greater input from occupational therapy on the general medical or psychiatric wards. There was also a higher ratio of nursing staff for each drug bed in the specialist units. Conclusions: Although better medical support is available in specialist units, the marked variability across participating units suggests an inconsistency in residential drug treatment that is worrying and requires further investigation.