Adult substance misuse services

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

Indicator

Last updated: 26/02/2019

Access and waiting times Effective clinical care
Public health

Background

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


How has the percentage of people waiting three weeks or less for a first treatment intervention changed over time? 26/02/2019

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Between 2005-06 and 2017-18, adult waiting times for a first treatment intervention improved substantially. In 2017-18, in all four substance groups, nearly all individuals (98%) waited three weeks or less from first being identified as having a treatment need to being offered an appointment to start an intervention. The greatest improvement was seen in people in treatment for alcohol only, where the proportion waiting three weeks or less increased from 73% in 2005-06 to 98% in 2017-18.

In 2017-18, the average waiting time for a first intervention was 2.2 days (data not shown). The wait was shortest for opiate clients (1.7 days) and longest for alcohol only clients (2.6 days). Further to this, the majority of people starting a subsequent intervention did so with three weeks (96%).


Why are people exiting substance misuse treatment and how has this changed? 26/02/2019

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The main reasons for people exiting substance misuse treatment are shown in the chart above. In 2010-11, a total of 126,383 individuals exited treatment, and this decreased slightly to 121,338 in 2017-18.

The proportion of people who exited treatment free of dependence increased from 49% in 2010-11 to 53% in 2012-13, but over the last five years has decreased again to 48% in 2017-18. Differences in the proportion of each substance group successfully completing treatment can be seen in the next chart below.

The next largest discharge reason was 'dropped out/left', indicating that these people exited the treatment system without completing their treatment. The proportion of people exiting with this reason increased from 27% in 2010-11 to 35% in 2017-18. The percentage of service users who were transferred to another treatment provider within in the community or were transferred to treatment in prison decreased from 16% in 2010-11 to 11% in 2017-18. The same trend was seen in the proportion of people declining treatment. There were 2,660 recorded deaths in treatment in 2017-18, representing 2% of all those discharged from the treatment system.


How has the percentage of people completing treatment free of dependence changed over time? 26/02/2019

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Overall, around half of people leaving substance misuse treatment are discharged as 'treatment completed'. This is determined by clinical judgement that the individual no longer has a need for structured treatment, having achieved all the care plan goals and having overcome dependent use of the substances that brought them into treatment and any pharmacological interventions have ceased.

In 2017-18, opiate users had the lowest rate of successful completions (26%) and alcohol only users had the highest rate (61%).

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 sugeries, 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 prior to 2014-15 are not valid. For more information about the NDTMS and comparability over time, please see Public Health England's Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS).

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