Drug and alcohol treatment in England in 2014–15

You may have seen that Public Health England’s annual report about drug and alcohol treatment came out yesterday. This is the first time that they have chosen to report drug treatment and alcohol treatment collectively — which has some benefits, but means that it is difficult to make comparisons with previous years’ reports.

The press release which accompanied the report urged local authorities to continue to invest in drug and alcohol treatment and said:

For adults, this latest data provides further evidence that there is an ageing population of heroin users in drug treatment who have wide ranging health and social problems that they need help with, alongside their treatment. This may be contributing to the slow-down in rates of recovery as this older group are more likely to lack employment, accommodation and social networks that long-term recovery depends on. Drug related deaths in England have risen in recent years and are now at the highest recorded. An increasing number of those dying are older heroin users and reflects today’s treatment figures.

Numbers in treatment

PHE report that 295,224 individuals were in contact with drug and alcohol services last year.

This is the lowest number of people in the treatment system since 2009/10, largely caused by fewer people being treated for opiates (down by 18 thousand over the period).

Nevertheless, the majority (52%) of people in the treatment system have a dependence on opiates. Of these 40% are also dependent on crack, and 20% are alcohol dependent.

PHE say:

Over the ten years, 779,554 unique individuals have been recorded in contact with substance use treatment of whom, 157,306 (20%) were retained in treatment on 31 March 2015.

Of this group about just over a third (273,898) have been opiate users.

Across the treatment system over 150 thousand were receiving treatment for their alcohol dependence — of which 33 thousand were primarily being treated for opiate problems, and a further 22 thousand were being treated for non-opiate drugs (primarily cannabis and cocaine).

Only 513 people were recorded as being treated for their use of synthetic cannabinoids — this seems remarkably low given the scale of the problems that prison services and homelessness services are reporting with use of these drugs.

Age, gender and ethnicity of people in treatment

The median age for people being treated for non-opiate drugs was 29 years, 34 years for those being treated for non-opiates and alcohol, 38 for opiate users, and 45 for those being treated for alcohol alone.

70% of those in treatment were men, but amongst individuals in treatment for alcohol only that fell to 62% of clients.

85% of people in treatment identified as White British, with a further 4% being ‘White Other’. No other ethnic group made up more than 2% of the population in treatment; this was true across the range of substances recorded.

Getting into treatment

There are a variety of ways that people access treatment, the largest proportion (47%) were self-referred or were brought to treatment by family or friends.

22% of individuals referred into treatment came via the health system (13% via their GP). However, this was heavily skewed towards people needing alcohol treatment — one in three people needing alcohol treatment came through a health route compared with just one in ten opiate users. [NB, there is no record of whether mental health services referred patients to substance misuse treatment — this is despite the current guidance on dual diagnosis being clear that mental health services should coordinate care where a dual diagnosis is made.]

17% were referred by the criminal justice system, this time skewed towards opiate users — 28% of referrals compared with 8% of alcohol only clients.

Complex and higher levels of need

One in every four new entrants into drug and alcohol treatment have ever injected drugs. As you would expect only a tiny proportion (4%) of those seeking treatment for alcohol have ever injected,

One in four people presenting for opiate dependence were current injectors, as were 3% of non-opiate drug users — PHE suggest that “the majority of non-opiate clients who inject are likely to be individuals using methamphetamine and mephedrone.”

Amongst individuals presenting to treatment last year one in five (19%) had some level of housing need — with 7% in urgent need because they were rough sleeping. There was a much higher proportion of rough sleepers amongst opiate users than other clients 5.3 thousand out of a total of 9 thousand.

Only one in four (23%) people entering treatment last year had employment, this had increased to 25% at the six month review. Opiate users were much less likely to be working (16% in employment) than others in the treatment system.

We know from previous studies that dual diagnosis — where people have both a substance misuse issue and a mental ill-health condition — is common. So, the most significant — to my mind at least — hole in the report is the lack of any data on the mental health of people in touch with the treatment system.

Treatment outcomes

Just over half (52%, c. 68 thousand people) left treatment free of dependence last year. Those with an opiate problem were half as likely to do so as other clients.

7.2 thousand were transferred to treatment in custody and a further 1 thousand went to prison without being transferred into treatment.

The number of people who died while in contact with services in 2014–15 was 2,360. Most of these (61%, 1,428) were opiate clients who tended to be over 40 (median age 43) and were likely to have been using heroin for a long time.

At the six month review most opiate users were either abstinent (41%) or had reduced their use of drugs (25%). Cannabis (39%) and alcohol (34%) were less likely to be abstinent or to have reduced their use (19%).

Over the last ten years 42% of people have completed treatment and not represented to services, and 20% remain in treatment.

Keep investing

We know that the recent spending review means that the public health budget will go down by 20% in real terms over the course of this Parliament. However, Rosanna O’Connor, the Director of Alcohol, Drugs and Tobacco at Public Health England urged local authorities to continue to invest in treatment services.

It is clear that while substance misuse treatment is working well for many, there is a need for increasingly specialist approaches to support a range of complex needs, especially among the more vulnerable in our communities.
It’s vital that local authorities continue to invest so those in need of help are supported on the road to recovery, giving them the best possible chance of living a better, healthier life.