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Meet the team: Nick Hofford

July 29th, 2020

In this new series of videos, we introduce you to some of the team at Hay Farm. In this episode, we introduce Nick Hofford who is the manager at the clinic.

Online Alcohol Withdrawal Assessment Tool

April 20th, 2020

The Coronavirus crisis has had a devastating effect on all aspects of our society but for those whose problems are psychological and invisible, this might prove to be a tipping point.
Right now we are concerned that many people who already had some level of a drinking problem will find their use increasing in these horrible circumstances and with this, increase their risks of fitting in withdrawal. This is why we are now making an online withdrawal evaluation tool available to anyone in a simple and accessible format. It is also why we are doing everything we can to keep our clinics open to continue to be able to help people.

Alcohol withdrawals are medically the most dangerous detoxes that hospitals and clinics manage. Suddenly stopping drinking can cause people to have seizures with life-threatening consequences. People can start to go into withdrawals within a matter of hours after stopping drinking and hit their peak risk for having a fit is within a couple of days. This is why it is advisable to gradually reduce drinking rather than suddenly stop it. If you see someone going into withdrawal then the quickest way to ease the danger and the pain is for them to drink again and then consider reducing more slowly ( although obviously we still advice you seek medical advice and support ).

Treatment staff are medically trained to monitor alcohol withdrawal symptoms every few hours. This way they can judge when someone is going into withdrawals and lessen the risk of fitting by administering medication. The most commonly used scale for measuring withdrawals and the risk of fitting is the Clinical Institute Withdrawal Assessment for Alcohol ( CIWA ) which evaluates many of the common indicators of withdrawal. There are 10 questions and the maximum score is 76. In general, if someone has a score close to 10, a clinic will use medications to reduce the withdrawals. Scores between 10 and 16 are considered moderate and are a cause for concern and a score greater than 16 is considered severe.

People who drink regularly are advised to gradually reduce their alcohol intake over a few weeks rather than stop suddenly but it’s obvious that people in a crisis with their drinking may just suddenly stop. As a friend family or a loved one, it will be very worrying to watch someone risking going into withdrawal and so we feel it is important to share a quick clinical withdrawal evaluation tool on our website in an easy to use format.

The test works well on a smartphone web browser so it’s easy to use. At the end of the test you will see the score, all the answers you gave and to make it easy for you to re-reference the scores, we will let you have a link at the end of the test to be able to recall the score at a later date but please bear in mind that we will be clearing out data older than approximately 30 days in line with our GDPR commitment not to keep unnecessary data so please save your recordings if you want to store your results beyond a short time.

You are invited to enter a name or a reference at the beginning of the test but this isn’t necessary and we don’t record any data such as IP addresses so your scores shall remain anonymous.

Just to remind you again, if someone you know stops drinking suddenly and starts to exhibit these withdrawal symptoms, it is safer for them to return to drinking until the symptoms stop and then try and reduce their consumption more slowly than it is for them to go on into more severe withdrawal. It is also important to seek direct medical advice before detoxing.

To make it easy to access the form from a mobile phone we have created a short link for you:




COVID-19 preparedness

March 18th, 2020

From the outset of the current outbreak, PROMIS Clinics have been quick to respond to this emergency as it evolves. Both of our clinics offer a great deal of space (3 buildings in London and 12 acres with many separate areas in Kent) and we take only 9 clients in London and 14 in Kent. This means that clients all enjoy individual rooms with plenty of opportunities for privacy and the ability to decide the level of interaction they are comfortable with. In addition to this, we provide 24-hour nursing and our doctors are on call day and night to manage and oversee any medical needs you may have

We have also introduced a number of additional measures to ensure that our clients are safe and well cared for and to ensure that your experience at PROMIS will provide you with the positive start to recovery that we are renowned for:
– All clients are carefully screened for COVID-19 prior to admission.
– Both staff and clients are monitored continuously for any symptoms.
– We are minimising physical contact with the outside world whilst providing additional activities on site.
– We have restricted access to our sites to essential staff and clients only.
– We have also made additional preparations by securing other isolated properties as a precautionary backstop to safeguard against the possibility of interruption to the service we provide.

Our staff are experienced, responsible, dedicated healthcare professionals who take every care to ensure their own good health, thereby reducing the risk to our clients.

We are aware that this is an international problem that will be with us for some time to come and so we are ready to carry on providing first-class care and support through these challenging times.

The Lifecycle of Addiction and Recovery

November 27th, 2019

The Lifecycle of Addiction and Recovery

Addiction problems seem to be something that comes to everyone’s attention because of the crises that it causes. Possibly the first few crisis situations pass by and are excused to circumstances but soon enough of a series of crisis shows there is a deeper problem. At the time that people first become aware that addiction could be an underlying cause of these crises, it is really important to understand as quickly as possible how recovery works. Failing to understand this in a comprehensive way early will allow the problem to persist for much longer than it needs to with devastating and debilitating consequences. Unfortunately, getting friends and family to agree on what needs to be done can be quite a challenge, which we will reference in another article. Let’s focus here on what the ‘lifecycle’ of addiction looks like and what we can learn from that in terms of the correct interventions we should make.

At the point when someone first develops a problem with addiction, there is a phase where they encounter problems from the addiction and make a series of attempts to stop on their own. On average this period lasts about 5 years. These first few crises could be things like being caught drunk driving, being caught in possession of drugs, being repeatedly late for work etc. Any one of these on their own could just be bad luck, but a succession shows there is a deeper problem. After an average of 5 years of these ‘self-initiated cessation attempts’, the person asks for outside assistance

At the point where someone first accepts the need for outside help, they may have a number of treatment episodes, residential treatment, day-care and self-help support. From here it takes on average about 8 years before someone can successfully achieve one continual year of sustained abstinence. That may sound a bit dispiriting but it must be emphasised that the overwhelming majority of this period of time is spent abstinent, it’s just that getting to the point where that lasts consistently for more than one year takes time. 

Finally, once one year of abstinence has been achieved, it takes a further 5 years until the risk of relapse drops below 15%. The reason this figure is so significant is that 15% is that this is the same risk percentage that the general population have of ever developing an addiction problem in the first place, so if our group have gotten down to a risk of 15%, then at this point in their recovery they are at no more risk than the general population.

So what can we learn from understanding this Lifecycle of Recovery?

  1. In the first phase, there is a good opportunity for outside agencies such as doctors surgeries, lawyers offices, A&E departments and even friends and families to help bring the problem into someone’s consciousness earlier. The earlier that they can be helped to see it is a problem, the sooner they can get to the next stage and ask for help.
  2. During the second ‘treatment’ phase ( the 8 years of early recovery ) it is important not to become to dispirited or to be dragged up and down by the relapses. Don’t distract the process by looking for miracle treatments. This is a process, it will take time and lessons can be learned as they progress but rather than feeling that it isn’t working or something completely new has to be tried, it is more helpful to congratulate them for the progress made so far and to move back to recovery as quickly as possible. The sufferer may feel shame and the family may feel angry and frightened. These are times for cool heads and kind hearts.
  3. Even once a year of recovery has been achieved, the first five years are still a risky period. It is important to maintain recovery during this time and for everyone to be aware of the risks. After 5 years continued abstinence, it is also important to acknowledge that the sufferer can be trusted to be in remission from their problem and trusted to behave as responsibly as any other member of society. Constantly monitoring or treating with suspicion will have a negative consequence. We must all embrace this new life.

References: This chart and data is taken from a talk given by Professor John F Kelly of Harvard Medical School


Are we getting good enough advice about antidepressants?

May 29th, 2019

Last year, Prof John Read and Dr James Davies published a paper in the scientific journal ‘Addiction’ reviewing the withdrawal effects of antidepressants and suggesting these are worse than most people have been informed.

They raise concerns that symptoms of withdrawal are both more common, affecting nearly half of people trying to come off them, and last much longer, up to 4-6 weeks ( rather than the one or two suggested in the government guidelines ). They are also concerned that the symptoms of withdrawal people experience when trying to stop taking the medication may be mistaken for a relapse of their illness, causing them to go back onto the medication without good reason. Finally, they argue that the withdrawal symptoms are so severe that the clinical guidelines around their use should be revised.

Antidepressant medications are being used more and more, rising by 170% since 2000. As many as 16% of the UK population were prescribed antidepressants last year and half of all users have been taking them for more than 2 years. Looking further, 36% have been on antidepressants for more than 5 years and 26% expect to stay on them for life. Alarmingly, 65% had never had a discussion with the person who prescribed them about coming off and, perhaps in a connected way, 45% of those who had stopped the drugs had done so without consulting their doctor. Indeed, about 1 / 3 people taking antidepressants for more than 2 years have no clinical indications for taking them.

Depression is a horrible problem to have to suffer with and, if antidepressants are providing effective treatment, it may well be worth tolerating some side effects and withdrawal symptoms. The main problem is that it seems as though these downsides and side effects are being understated and people may not be being given full and accurate information about them. Nearly half of people experiencing withdrawal effects describe them as ‘severe’, and it is not uncommon for people to continue experiencing withdrawals for several months. This is quite different from the current guidelines which describe ‘discontinuation symptoms’ as ‘mild and self-limiting, resolving over 1-2 weeks’.

All of this is not to say that people should stop medications they are finding helpful or that others shouldn’t explore medications as a good treatment option but it does sound like the advice and management around medication needs a lot more care and attention. Firstly, people need more detailed advice about the difficulties they might experience when they try and stop their medication and secondly their cases need regularly reviewing to see if, when and how they might consider stopping.

Finally, it should be emphasised that although we are discussing some of the side effects of medications, many still find them extremely helpful. Also, there are a number of new medications for depression showing great promise so the outlook for sufferers will only improve in the coming years and maybe even months. We shall report on some of these new treatments in articles very soon.


“A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?”:


The ‘Lifecycle’ of Addiction and Recovery

March 11th, 2019

Whether you have an addiction problem, care about someone with an addiction problem or even if you work with people who have addiction problems, I think it helps to step back for a minute and understand how this problem and it’s recovery unfolds. It’s too easy to get blinkered, judgemental of ourselves and others, and not see the overall patterns of what we are looking at.

Professor John Kelly, addiction professor at Harvard Medical has produced a slide which really neatly summarises how these problems evolve and how recovery ensues. Please bear in mind that we are talking about averages here and we are talking about severe addiction problems. When you have an average, of course, there are going to be people who have very different experiences but this shouldn’t stop us from looking at averages to get an understanding of the course of recovery.

Addiction Onset

The first period that Professor Kelly described was the ‘onset’ of the problem. From the point at which it could be said that the addiction was first recognisably a problem, there was an average of a 4-5 year period where people have tried a series of self-initiated cessation attempts before they ask for outside assistance or help.


The next period could be described as an average of 8 years of Help-Seeking after which they are able to achieve full sustained recovery for more than one year. When I first heard Professor Kelly describe this he was very quick to point out that this period had a lot of recovery time in it, it’s just that it was taking this time to achieve an average of one full sustained year abstinent. On average people may have 4 or 5 treatment episodes and engagements with Mutual Help organisations ( AA, SMART etc.. ) during this stage.

5 Continuous Years of Abstinence.

During the first 5 years of abstinence, there is a need for continued care and mutual help. At the end of this first 5 years, the risk of relapse drops below 15%. This is significant because 15% of the population will develop an addiction problem so Professor Kelly has argued this is like saying that after 5 years of recovery, people return to having the same risk of addiction that the rest of the population have.

Conclusions and lessons to be learned

So, standing back and looking at this data, what conclusions can we draw?

It takes time

From the point of view of having an addiction problem, I think it is helpful to see that it takes time to get into recovery. There is this frightening saying that ‘relapse is part of the process of recovery’ and it can be disappointing to hear this. Of course, there are many people who achieve sustained recovery ‘first time’ but equally, there are many who struggle longer. I don’t think this should be very surprising. Addiction problems are the tip of the iceberg, underneath and around are many other social and psychological issues that interplay and so it really can’t be any surprise that it takes practice to get all these elements into the right alignment for recovery. If you reflect on any other skill you have developed, I bet there were times when you felt your learning was going backwards instead of forwards. The important thing here is not to feel like you just can’t get it if you have a slip or a relapse.
Overwhelmingly in this research data you can see a pathway that people with severe addiction problems are taking to come into recovery and long term remission from their problems. It’s important for everyone involved to keep the faith that this is where you are all heading.

Early intervention

You can see from the first period that there is this long stretch of 5 years after addiction becomes a problem but before someone seeks outside assistance. If it is apparent to the sufferer then it must also be apparent to those around them. Why is it taking so long to start asking for help? Perhaps there is still some embarrassment and shame? Perhaps friends and families think it’s none of their business. Somehow we need to make asking for help an easier thing and we should also encourage friends and families to bring this subject up. The sooner someone can get started with this, the sooner they will recover.

Family and friends

Addiction brings with it a series of crisis and during these episodes, it is very easy for any and all of us to lose hope. Looking at this outcome data you can see the evidence that the long term prognosis is in fact very good. The period that everyone must find very stressful is that middle period, averaging 8 years, where people are trying to find that first year of continuous abstinence. This is the time when there can be such tremendous recovery and hope and then, terrible setbacks. It is understandable to lose hope and feel very frustrated during this phase but it is such a shame if people can’t see what lies beyond. Ultimately, people could have any number of possible medical or psychiatric problems, addiction is just one of these, but the recovery rates for addiction are very similar for nearly any other chronic problems, medical or psychiatric. One of the statistics that Professor Kelly quotes is an outcome study ( White 2013 ) which calculated that 60% of individuals with addiction will achieve full sustained remission. Perhaps it’s the continued shame and judgement that surrounds addiction as so many still consider it a moral or character problem rather than understanding it’s medical and psychiatric dimensions. This is the time to set our sights on the long term outcome and outlook.

Carers and professionals.

From the perspective of someone who helps people with addiction problems, there are quite a few lessons here. One is the importance to try and find ways of helping people access help at earlier points. There is that beginning 5 year period where people are attempting to stop on their own before asking for help. Why aren’t they asking for outside assistance when this will so massively increase their success? I have another article about this very point so I won’t elaborate on it now but it’s worth us all reflecting on this. I would also ask people to consider how the expectation of recovery is phrased. It’s clearly important to study and discover what was working for them vs what wasn’t, but I do hear people being highly critical of treatments/people or methods as if there was ‘one’ other simple key which this new person/clinic/treatment centre can now offer. I see this in self-help groups, I see it amongst professionals and I see it between clinics. I suggest it’s important that we help people see this as a process of coming into recovery rather than one singular. To this point, it is most important that we be sure to offer the widest range of evidenced treatments rather than just one based on ‘opinions’. Let’s focus on the research evidence and share a range of skills and let’s help sufferers be less punishing of themselves and let’s help others be less punishing of them also.

It will be the focus of another article I am writing to look at how to minimise relapse.

In summary, let’s help people by sharing with them the bigger picture of this process of the recovery ‘Lifecycle’.

Does a longer stay help?

September 19th, 2018

How long should someone stay in Rehab?

This depends on so many things, how many problems are being treated, how intense they are and so on. Some people come to stay for a brief respite and others stay longer so it’s interesting to know if there is any evidence for different benefits for different lengths of stay.

People come to clinics with many different problems, depression, addiction, alcoholism, eating disorders and so on. Unfortunately people rarely have just one problem and so treatment needs to be tailored to help with all these problems at the same time.

Equally, there are many different treatments, Psychiatry, Medicine, Psychology, Psychotherapy and so on. Understanding exactly which one works best for each individual and in what combination, is a very complicated process and makes research outcome quite tricky. To do some research then, it would help to find one common measurable factor and see how it is affected by the combined treatments.

Depression is a common problem for our patients and so in this study we looked at how depressed people were when they arrive and how this changed through treatment. The Becks Depression Index was created by the co-founder of CBT, Dr Aaron Beck. Thankfully it’s a fairly brief questionnaire but it has the benefit that it has been used in so many different clinical situations that there is very good evidence for its ability to measure depression.

The BDI scores different ranges for depression you can see here:

1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40_________________Extreme depression

We decided to look at the scores of all the patients in the last year who came in with a score greater than 31, indicating Severe Depression. We then wanted to compare the average score on admission with the average score before leaving depending on how long the individual stayed. This is a small sample group since the research was conducted in a small clinic and we only took the data from the last year, but it was still an interesting first analysis.

What we found was that for those who only stayed one week, the average score on admission was 37, so close to extreme depression, and the score on discharge, after that one week, was 26, so in the middle of the range of moderate depression. Not a bad shift in just one week!

In the group who stayed two weeks, the scores were quite similar to those who stayed just one week, the admission score was a bit higher, this group were scoring an average of 41 which is categorized as Extreme Depression but after just two weeks the scores came down two categories to 25, described as Moderate Depression.

It is really interesting to note what happened in the next two groups. For the clients who stayed for 3 weeks, the average admitting score was 40, so still very close to the Extreme Depression category, but the score after three weeks of treatment came down to just 13, described as ‘mild’ mood disturbance. Equally, the group who stayed four weeks also had a very high average score on admission of 38 and were just 14 on discharge, four weeks later.

So what can we conclude from this? Again, we have to be careful to draw too many conclusions from such a small sample of patients but it does seem as though, although a one week and two weeks stay is beneficial, three and four week stays are where we see much more significant shifts.

Myth busted, a small amount of alcohol isn’t good for you

September 3rd, 2018

Drinking any amount of alcohol is harmful

Alcohol is the leading attributable cause of death amongst the adult population ( between the ages of 15-49 ) and yet the message people have heard from doctors and the media has been that drinking a small amount of red wine may be good for your health. This was never true but it led to a lot of vulnerable people being given a validation for their drinking by the medical profession. This week, the medical research journal “The Lancet” has finally exposed this myth and made clear it’s advice that drinking anything at all is harmful.

There is nothing wrong with doing harmful things of course. Riding horses is harmful, and yet, people make an educated decision that riding their horse is fun and it is what they choose to do. You could say the same about riding a motorbike or many other activities that people do to enjoy themselves. They are prepared to take the risks that they know go along with it.

The same might be said for alcohol. People drink and enjoy it and can do so knowing the risks involved. So what is the big fuss with this new report in the Lancet?

Well, there is a massive difference when half of the alcohol is consumed by people with a mental health problem which gives them a pathological dependence on alcohol. In this case, every bit of information needs to be as clear as possible.

If you do a quick Google for ‘red wine is good for your heart’ you will find a long list of articles that have come out over the years where people tried to make the case that drinking ‘one glass a day of red wine’ was good for your health, specifically, it was supposed to be good for your heart. Unfortunately, these studies were flawed because they compared moderate drinkers against abstainers without taking into account the health reasons that may have led people to abstain. When you take this factor out, there were never any health benefits to drinking even just one glass of wine per day ( https://www.jsad.com/doi/10.15288/jsad.2016.77.185 ) Every drink did some damage.

So, no health benefits, but on the other hand, among the population from 15-49, alcohol was the leading attributable risk factor in deaths! So there is a massive risk that needs to be communicated about heavy alcohol consumption even though, for some strange reason, it seems to be hard to have that message communicated clearly.

Of course, the average person who drinks just one glass of wine per day probably doesn’t care if they take it or leave it and probably doesn’t care about the minimal impact it might have on their health, positive or negative. Unfortunately, the group who paid most attention to the ‘supposed’ health benefits of alcohol were the group I mentioned earlier who were drinking substantially more than one glass of wine per day and who are experiencing devastating consequences from drinking on all fronts, not least health. Having information which was misleading had the terrible effect of reinforcing denial about the need to stop drinking.

Finally, the truth is made clear. Any drinking is harmful and excessive drinking is excessively harmful.
( https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext ) These are the facts. If you choose to drink moderately and accept those risks then that is great and absolutely your right, but please help us communicate more clearly with the 10% who are hurting themselves and others terribly.

The Fundamental Attribution Error

September 13th, 2017

What can Psychology teach us? 

A series of short articles about useful ideas from psychology.

The Fundamental Attribution Error

This is a psychological phenomenon coined by the Stanford Psychology professor Lee Ross based on a psychology experiment by Psychologists Jones and Harris (1967).
Read the rest of this entry »

Interview with Clare Kennedy, founder of Kennedy St & Co

June 6th, 2017

Robin Lefever’s Interview with Clare Kennedy, founder of Kennedy St & Co


For many of us in recovery, the idea of going out to a bar is a terrifying prospect. Will I be laughed at for ordering an orange juice? Will the shelves stacked with spirit bottles be too tempting to resist?

But Brighton based entrepreneur Clare Kennedy has found a solution in Kennedy St, a meeting point where the message of recovery can be shared over a non-alcoholic drink, as Robin Lefever found out when he visited.


Edited by Laura Cox


ROBIN: Thank you so much for the invitation to your meeting at Kennedy St & Co CiC
Clare. Can you please tell me a bit about how you got it going and what the evenings are like?


CLARE: At Kennedy St we aim to address a variety of needs, whilst also contributing to positively de-stigmatising recovery & impacting our social culture blueprint. We will offer community, healthy lifestyle information, a safe space to be yourself, involvement, retraining, employment, and self-employment opportunities, showing that recovery and wellbeing are fun, real and attainable. After all, not drinking and using doesn’t stop us living, loving and thriving).
We currently have no funding, bid writing is not my area of expertise, but people achieving their very best, is. So we run our drybar party nights 4 times a year and are so very blessed at the moment to have [Brighton restaurant] Skyfall as our sponsors. They allow us to run our drybar party nights without charging us a rental, but of course, there are still costs we have to cover, so we are currently looking for sponsors or partners to work with so we can grow our community ideas. Of which we have many.

The idea of dry bars began in the United States where there is a long tradition of sobriety clubhouses and hangouts, often associated with 12-step programs. People gather to share soft drinks, food, play games and enjoy each other’s company. Dry bars have popped up all over the States, such as The Other Side in Illinois, The Counterfeit Bar in Arizona and The Shine in LA and New York which regularly sells out on alcohol-free events involving live music, meditation and film. Read the rest of this entry »

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