Published 3 September 2026. Last reviewed 3 September 2026. Figures relate to England unless stated.
If you have been looking for help with drinking or drugs, you have probably spent most of that time reading about residential rehab. It is what the search results are full of, because it is the part of treatment that somebody is selling.
It is also the part that almost nobody gets.
In the year to March 2025, 329,646 adults in England were in contact with drug and alcohol treatment services. Ninety-nine per cent of them received community-based treatment. Two per cent had treatment in a residential setting, and four per cent in an inpatient setting. Those categories overlap, because one person can have more than one kind of treatment in a year, so the honest summary is this: essentially everyone in treatment gets community treatment, and a small minority also get a residential or inpatient episode. Two per cent is roughly 6,600 people out of 329,646.
So if you are not going to rehab, you are not in an unusual position. You are in the ordinary one.
The question that actually matters is whether the ordinary position is any good. This page is our attempt at an honest answer, including the parts that are uncomfortable.
What “community treatment” actually means
The phrase sounds like being handed a leaflet. It is not, and the vagueness of the language does real damage, because it makes the standard offer sound like a brush-off.
Here is what it is made of.
A named keyworker. One person who holds your case, reviews it with you, and is the route to everything else. This is the single most useful thing to establish early, because a named contact is what turns a service into a plan.
Structured psychosocial treatment. For harmful drinking and mild dependence, NICE recommends cognitive behavioural therapy, behavioural therapies, or social network and environment-based therapies focused specifically on alcohol, typically one 60-minute session a week for 12 weeks. That is a real course of treatment with a defined length, not a chat.
Medication. For alcohol, after withdrawal, NICE recommends considering acamprosate or oral naltrexone combined with an individual psychological intervention, and disulfiram where those are unsuitable. For opioid dependence, opioid agonist treatment, usually methadone or buprenorphine. These are prescribed in the community. They are not lesser versions of something you would get in a residential setting.
Assisted withdrawal at home. This surprises people. Community assisted withdrawal is offered to people drinking over 15 units a day, or scoring 20 or more on AUDIT, with staff contact averaging two to four meetings a week during the withdrawal. Detox is not automatically an inpatient event.
Mutual aid. AA, NA, and SMART Recovery, which is secular and built on cognitive behavioural principles for people who do not want a twelve-step approach. Free, and in most areas available more often than any professional appointment.
Not being sent to rehab is usually a clinical judgement, not a refusal
This is the part that most reading online gets wrong, and it changes how the conversation with your keyworker should go.
NICE sets out who residential rehabilitative treatment is for. Broadly, people who are seeking abstinence and who have significant additional physical, mental health or social problems such as housing difficulties, or who are planning to complete a detoxification programme, or who have not benefited from previous community-based treatment.
Read that last criterion again. Having tried community treatment without success is one of the things that makes residential appropriate. It is a step in a sequence, not a better product for people who ask the right way.
So if you have not yet had a proper course of community treatment, being offered that first is not a fob-off. It is the recommended order. And if you have had it and it did not work, that is directly relevant information to put in front of your keyworker, in those words.
When inpatient or residential withdrawal genuinely is indicated
Worth knowing precisely, because this is where self-advocacy has something to point at. NICE says to consider inpatient or residential assisted withdrawal for people who:
- drink over 30 units of alcohol a day
- score more than 30 on the SADQ
- have a history of epilepsy, or of withdrawal-related seizures or delirium tremens
- need to withdraw from alcohol and benzodiazepines at the same time
- drink 15 to 20 units a day alongside significant psychiatric or physical comorbidity, or significant cognitive impairment or learning disability
If any of those describe you, say so explicitly, and say which one. Alcohol withdrawal in some of these circumstances can be dangerous, and the setting is a safety decision rather than a preference.
Does the community stuff actually work
Here is where we would rather give you numbers than reassurance.
Opioid agonist treatment roughly halves the risk of dying. A meta-analysis covering 15 randomised trials and 36 cohort studies, together following more than 750,000 people, found all-cause mortality of about 11 per 1,000 person-years during treatment against about 24 per 1,000 out of it. There is no residential programme with a stronger claim on the outcome that matters most.
Mutual aid holds up in the strongest study design available. A 2020 Cochrane review of 27 studies covering 10,565 people found AA and twelve-step facilitation performed at least as well as established alternatives, and better on continuous abstinence. In the Project MATCH trial, 24% of outpatients assigned to AA or twelve-step facilitation were abstinent throughout the first year, against 15% for cognitive behavioural therapy and 14% for motivational enhancement. On drinking intensity and alcohol-related consequences the approaches were broadly equivalent. The same review found healthcare costs substantially lower in the twelve-step groups.
That result deserves a caveat we would rather state than bury: mutual aid works for many people and not for everyone, the twelve-step approach does not suit everyone, and none of it replaces medical treatment for physical dependence. SMART Recovery exists precisely because one framework does not fit all.
Waiting times are not the barrier people expect. Ninety-nine per cent of people starting treatment in England in 2024 to 2025 did so within three weeks of referral. Getting into community treatment is, for most people, a matter of weeks. Getting funding for residential rehab is a different and much longer story.
The completion figures, without spin
Of the 152,067 people who left treatment in 2024 to 2025, 46% had successfully completed and were free of dependence. 37% dropped out or left early. The rest were transfers, declines and deaths.
By group, successful completion was 58% for people in treatment for alcohol only, 49% for non-opiate drugs only, 46% for non-opiate drugs and alcohol, and 23% for opiates.
That opiate figure looks alarming and needs explaining rather than hiding. Opioid dependence is often long-term, and opioid agonist treatment is frequently a maintenance treatment rather than a course with an end. Someone stable on methadone or buprenorphine for years, working, housed and not using illicitly, is not counted as a successful completion, because the measure is being free of dependence. On the outcome that matters, staying alive, they are doing well. A low completion rate in that group is partly a measurement artefact, not simply failure.
We would rather you knew that than took 23% at face value in either direction.
The thing nobody selling rehab will lead with
Detox reduces your tolerance. If you use again afterwards at anything like your old dose, the risk of overdose is far higher than it was before.
The clearest illustration comes from prison release, where the same loss of tolerance applies. A meta-analysis found drug-related deaths in the first two weeks after release running at three to eight times the rate of the following ten weeks, with a UK relative risk of 7.5. Risk stayed elevated into the third and fourth weeks.
The implication is direct. A detox without aftercare is not a safer choice than staying in community treatment. It can be a considerably more dangerous one. If you are considering a residential detox, the question to ask is not how good the facility is. It is what happens in the four weeks after you walk out, and who is responsible for it. If the answer is vague, that is the answer.
What to actually do next
We have written a separate step-by-step guide to the routes into treatment, including self-referral, what happens at an assessment, how funding decisions are made and what to do if you are refused: Most drug and alcohol treatment happens at home, not in rehab. Here is how to get help.
The short version:
Self-refer to your local service. You do not need a GP referral in most areas. Search for your council area plus “drug and alcohol service”. It is free.
Ask for these things by name. A named keyworker. An assessment of whether you meet the NICE criteria for residential or inpatient withdrawal, and if not, why not. A structured psychosocial intervention with a defined number of sessions. Whether relapse prevention medication is appropriate for you. What the aftercare plan is.
Ask for the answer in writing if a decision goes against you. A written reason is what you need to challenge it or to take it to a second opinion.
If it is gambling rather than substances, the route is different. The National Gambling Helpline is on 0808 8020 133, free, any hour, and NHS gambling clinics take referrals.
Outside England, the systems differ but the principle holds. In Wales, DAN 24/7 is on 0808 808 2234, free and open at any hour. In Scotland and Northern Ireland, contact your local alcohol and drug partnership or trust service.
Why we are writing this
The Recovery Trust publishes a directory of residential treatment providers. It would be commercially useful for us to tell you that residential rehab is what you need. We are not selling anything, so we would rather tell you what the evidence says, which is that for most people, most of the time, community treatment is the recommended treatment and not a consolation prize.
We check whether the providers we list appear on their regulator’s public register, we publish what that record says, and we note the date we last looked. We do not inspect services, we do not assess quality, we do not take referrals, and we cannot tell you what is right for you. A listing is not a recommendation.
If you need help now
In an emergency, call 999. Samaritans are on 116 123, free and open at any hour. FRANK is on 0300 123 6600. NHS 111 can help you find local support.
Sources. Office for Health Improvement and Disparities, Adult substance misuse treatment statistics 2024 to 2025. NICE CG115, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE QS23, Drug use disorders in adults, quality statement 10. Santo et al., Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence, JAMA Psychiatry, 2021. Kelly et al., Alcoholics Anonymous and other 12-step programmes for alcohol use disorder, Cochrane Database of Systematic Reviews, 2020. Merrall et al., Meta-analysis of drug-related deaths soon after release from prison, Addiction, 2010.
This article explains how treatment and eligibility work. It is not clinical advice, and it is not an endorsement of any service. If any detail here has changed, please tell us and we will correct it.
