Adult substance misuse services

We look at adult substance misuse services, analysing whether patient outcomes have improved over time.


Last updated: 31/03/2022

Access and waiting times Effective clinical care
Public health


Substance misuse services are key components of local authority alcohol and drug treatment and recovery systems. The interventions they deliver can improve the lives of individuals, their families and the community. They have a significant impact in reducing problems such as drug and alcohol-related ill health and death, the spread of blood-borne viruses, and crime. The harmful effects of alcohol and drugs are greater in poorer communities, so effective treatment services can help to address these inequalities.

The latest data presented here is from 2020/21, covering the first year of the coronavirus (Covid-19) pandemic. Since the onset of the pandemic and national lockdowns, concerns have been raised about increasing substance misuse, and survey data suggests that higher risk drinking has increased. The total number of people accessing substance misuse treatment services has increased from 270,705 to 275,896 – a 1.9% increase from 2019/20. Non-opiate only services have seen the biggest increase in numbers – a 9% increase from the previous year. 

How has the percentage of people waiting three weeks or less for a first treatment intervention changed over time? 31/03/2022

Chart QualityWatch

Read more

Between 2005/06 and 2020/21, the proportion of people waiting less than three weeks for their first treatment intervention has improved substantially. In 2020/21, 98.5% of people across all substance groups: “opiate”, “non-opiate only”, “non-opiate and alcohol” and “alcohol only” waited three weeks or less for their first intervention. 

In 2020/21, the average waiting time for a first intervention was 1.8 days (data not shown). The wait was shortest for “opiate” clients (1.2 days) and longest for “alcohol only” clients (2.3 days). Further, in 2020/21, 93.3% of people starting a subsequent intervention did so within three weeks, a slight decrease from 95.0% in 2019/20.

Why are people exiting substance misuse treatment and how has this changed? 31/03/2022

Chart QualityWatch

Read more

People leave drug and alcohol misuse services for a range of reasons, illustrated in the chart above. In 2020/21, 275,896 people were in treatment for substance misuse; 110,095 (40%) exited treatment in the same year (data not shown). 

For the first time since 2012/13, the proportion of people completing their treatment “free of dependence” increased, from 47% in 2019/20 to 50% in 2020/21. 

The next largest exit reason was 'dropped out/left', indicating that these people exited the system without completing their treatment. The proportion of people exiting with this reason had been increasing since 2011/12, from 25% to 36% in 2019/20, however in 2020/21 this decreased slightly to 33%. 

A worrying trend is the increase in the proportion of people whose treatment exit reason was because they died; this has doubled in the last decade from 1.5% in 2010/11 (1,840 lives) to 3.4% in 2020/21, when 3,726 deaths were recorded. 

How has the percentage of people completing treatment free of dependence changed over time? 31/03/2022

Chart QualityWatch

Read more

Overall, half of people leaving substance misuse treatment are discharged with the outcome 'treatment completed'. This is determined by clinical judgement that the individual no longer has a need for structured treatment, having:

  • achieved all the goals in their care plan
  • overcome dependent use of the substances that brought them into treatment, and 
  • ceased any pharmacological interventions.

In 2020/21, “opiate” treatment services had the lowest rate of successful completions (25%) and “alcohol only” treatment services had the highest rate (62%). Between 2010/11 and 2020/21, the rate of successful completions decreased for all substance groups except for “alcohol only” treatment services, which has seen a 6 percentage point increase.

About this data

The data for this indicator story comes from analysis of the National Drug Treatment Monitoring System (NDTMS), which collects information on adults (aged 18 and over) who are receiving help in England for problems with drugs and alcohol. Treatment centres returning data to NDTMS include community-based and specialist outpatient drug and alcohol services and GP surgeries, as well as residential rehabilitation centres and inpatient units.

People in treatment were divided into four substance groups:

  • Opiate – people who are dependent on or have problems with opiates, mainly heroin.
  • Non-opiate – people who are dependent on or have problems with non-opiate drugs, such as cannabis, crack and ecstasy.
  • Non-opiate and alcohol – people who are dependent on or who have problems with both non-opiate drugs and alcohol.
  • Alcohol only – people who are dependent on or have problems with alcohol, but don't have problems with any other substances.

The 'All other' category for reasons why people exited substance misuse treatment includes: prison, treatment withdrawn, exit reason inconsistent, referred on, moved away, no appropriate treatment, not known, and other.

As a result of a new reporting framework, comparisons of data published prior to 2014/15 are not valid. For more information about the NDTMS and comparability over time, please see Public Health England's Substance misuse treatment statistics – National Drug Treatment Monitoring System, Quality and methodology information paper.