Counselling provision in specialist drug treatment services

Background - Counselling is one of the most common treatment options in drug services, and recent research has convincingly demonstrated its effectiveness if certain quality parameters regarding intensity and qualifications of those providing it are observed. However, there is a remarkable paucity of literature on the nature of counselling provision in UK drug treatment.

Aims - To describe the extent and nature of counselling provision in UK drug treatment services.

Method - A national survey of specialist drug services in England and Wales was carried out, and information was obtained from 326 services.

Results - Levels of counselling provision were very similar in nonstatutory, community-based, residential day care and statutory, community-based services (around 90%), with slightly lower levels in inpatient services (78%, difference not significant). In the majority of services (74%), individual sessions were provided by drug workers without counselling accreditation. In 32% of agencies, counselling was provided only by drug workers, whereas 36% of agencies employed both drug workers and accredited counsellors. In 17% of agencies, sessions were run by accredited counsellors only. Volunteers without formal training provided one-to-one sessions in 27% of agencies, mostly in agencies also employing counsellors and drug workers. Most agencies (66%) operated a schedule of weekly sessions; 12% of agencies offered fortnightly or less frequent sessions, whereas 15% of agencies offered several sessions a week. More than three-quarters of all sessions were scheduled to last between 50 and 60 minutes.

Conclusion - Typically, counselling is provided on a weekly to fortnightly basis by drug workers without formal counselling qualifications. In-depth research is needed to examine whether and how sessions provided by drug workers differ from sessions provided by counsellors, as past research has only demonstrated the effectiveness of counselling in studies using highly trained counselling staff.