Sam left the detox unit on a Thursday with a plastic bag of belongings, a leaflet and a feeling he couldn’t name. For nine days, everything had been structured: meals, checks, a timetable on the wall. Now he was standing at a bus stop in the rain, and no one was telling him what came next.
“I thought I’d feel finished,” he told his sister later. “Instead I felt like I’d just got to the starting line.”
If you or someone you love has been through detox, or is about to, that feeling is worth understanding. Detox deals with the first stage. What happens afterwards is where talking therapies, support and practical help often come in. This guide explains what those can look like, in plain terms, using public health guidance rather than marketing.
Why Detox Is a Beginning
Detox is often described as getting a substance out of the body. It can be an important first step, but it isn’t treatment on its own. People usually also want help with the reasons they started using, the habits built around it, the relationships and routines that need rebuilding, and the feelings that no longer have somewhere to go.
That’s where talking therapies come in. They are not a magic switch. They are a way of working through things with someone trained to help.
What the NHS Says
The NHS page on getting help for drug addiction starts with a reassuring line: you’re entitled to treatment in the same way as anyone else who has a health problem. It suggests that a GP may be a good place to start, and says that if you’re unsure what help you need, you can call the Frank drugs helpline on 0300 123 6600.
It describes a first appointment where staff ask about your drug use, work, family and housing, and where you’re given a keyworker who will support you throughout your treatment. The options it lists include:
- Talking therapies, such as CBT, which help you see how your thoughts and feelings affect your behaviour
- Medicines in some cases, such as substitute medicines for people dependent on opioids
- Detox for people who want to stop opioids completely, to help them cope with withdrawal
- Self-help groups, such as Narcotics Anonymous and SMART Recovery
- Harm reduction, including testing and treatment for conditions like hepatitis or HIV
Treatment may take place at home, as a hospital inpatient, or in a residential rehabilitation service. The page’s last review date is February 2023, with a further review listed as due in February 2026, so it’s worth checking the NHS site for the latest version.
What National Guidance Says About Therapy
Clinical guidance in England adds some useful nuance. The National Institute for Health and Care Excellence (NICE) guideline on psychosocial interventions for drug misuse says that routine CBT or psychodynamic therapy focused on drug misuse is not recommended for people being treated for cannabis or stimulant misuse, or those on opioid maintenance. It suggests CBT should instead be considered where someone also has depression or anxiety.
That may sound surprising, but it’s a good reminder that “therapy” isn’t one thing. The guideline also describes other approaches, such as reward-based programmes to encourage positive behaviours, and interventions involving partners, families and carers, with guided self-help offered to families. It says that inpatient and residential settings should offer the same range of psychosocial interventions as the community, and that people who relapse after inpatient or residential treatment should be offered an urgent assessment.
Guidance is updated over time, so check the date on NICE’s site, and remember this is English guidance, so details differ elsewhere. The takeaway is the principle: the right kind of support depends on the person, the substance and what else is going on.
A Familiar Scenario: What Sam Did Next
Sam’s keyworker met him within the week. She asked about his work, his flat and who he could call at 2 a.m. They talked about what kind of support might fit: a weekly session with a counsellor, a group he could try, and a plan for the first month. He tried SMART Recovery and didn’t like it. He tried Narcotics Anonymous and found one meeting that felt right. The counselling took three sessions before it felt useful, and he nearly quit before then.
None of this was dramatic. It was repetitive, practical and occasionally dull. That, he said later, was the point.
Questions Worth Asking a Therapist
If you’re looking for a talking therapist, whether through the NHS, a charity or privately, a few questions can help:
- Do you have experience working with people in recovery from drug use?
- How will we work out what kind of therapy fits me?
- How do you work with other people involved in my care, such as a keyworker or GP?
- What happens if I miss a session or have a setback?
- How will we know whether it’s helping?
Understanding Detox First
Some people reading this will be earlier on the path. If you’re researching what detox involves in a complicated situation, Renewal Springs, a detox centre in Oklahoma City, publishes an article about meth detox when it overlaps with fentanyl use. It’s a US provider’s explainer, so treat it as an introduction, and speak to a doctor or local drug service about what applies to you.
Getting Help Now
In England, you can call the Frank helpline on 0300 123 6600 or speak to your GP. If someone is in immediate danger, call 999. If you’re struggling emotionally, Samaritans are free on 116 123. In the US, call or text 988.
Back to the Bus Stop
Sam still remembers the rain. What he remembers more is the next Tuesday, when he walked into a small room with a box of tissues on the table and sat down across from a stranger. He didn’t say much. He said enough. It was the first appointment of a long list, and he is quick to say that none of them were glamorous.
Sources
- NHS. Drug addiction: getting help (last reviewed 13 February 2023; next review listed as due 13 February 2026). https://www.nhs.uk/live-well/addiction-support/drug-addiction-getting-help/
- National Institute for Health and Care Excellence. Drug misuse: psychosocial interventions (CG51), recommendations (publication date not shown in the excerpt read). https://www.nice.org.uk/guidance/cg51/chapter/Recommendations
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