Adult substance misuse services

Background

Substance misuse services are key components of local authority alcohol and drug treatment and recovery systems. 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 more deprived communities, so effective treatment services can help to address these inequalities.

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 increased.

In 2019/20, 270,705 people were in contact with drug and alcohol services. This increased to 275,896 in 2020/21 and went up even further in 2022/23 to 290,635 adults. Almost half of those accessing treatment in 2022/23 did so for opiate use. More than two-thirds (71%) of those accessing substance misuse services in 2022/23 had an identified mental health need, highlighting a strong link between mental ill health and addiction. Here, we explore access to these services in terms of wait times and treatment completion.

Wait times for substance misuse treatment

Between 2005/06 and 2022/23, the proportion of people waiting less than three weeks for their first treatment intervention improved substantially. Notably, the percentage of people seeking alcohol-only related interventions who wait three weeks or less has exponentially increased (by 27%) since 2009/10. From 2017/18 onwards, the percentage of people waiting for three weeks or less for first intervention has stabilised at around 98% across all substance groups. In 2022/23, 98-99% 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. This trend could be explained by a multitude of factors such as the release of RSA’s 2007 report which suggested treating alcohol dependence in the same manner as drug addiction in the public health sphere or the increase of remote interventions as a response to the pandemic restrictions.  

In 2022/23, the average waiting time for a first intervention was about two (1.9) days (data not shown). The wait was shortest for ‘opiate’ clients (1.1 days) and longest for ‘alcohol only’ clients (2.4 days), slightly longer than 2021/22. Furthermore, in 2022/23, 90% of people starting a subsequent intervention did so within three weeks, which is 2% lower than the proportion in 2021/22. 

Reasons for leaving substance misuse treatment

People leave drug and alcohol misuse services for a range of reasons, illustrated in the chart above. In 2022/23, 290,635 adults were in treatment for substance misuse; 127,385 (44%) exited treatment in the same year (data not shown).

Between 2010/11 and 2022/23, roughly half of the people exiting treatment had completed it ‘free of dependence’. In 2022/23, 46% of people completed treatment ‘free of dependence’. While still the most common reason for exiting treatment, this is the lowest proportion it has been in the past decade.

The next most common reason for exiting was ‘dropped out/left’, indicating that these people exited the system without completing their treatment. Worryingly, the proportion of people exiting for this reason has increased over the past ten years, from 27% in 2010/11 to 37% in 2022/23. Reasons for dropping out should be investigated to improve the effectiveness of the service.

Another concerning trend is the increase in the proportion of people whose treatment exit reason was because they died; this has more than doubled in the last decade from 1.5% in 2010/11 (1,935 deaths) to 3.3% in 2022/23 (4,166 deaths).

Registered deaths related to drug poisoning have risen drastically for 11 years in a row. As a response to this growing issue and in line with the UK Government’s 10-year drug plan, the Department of Health and Social Care (DHSC) plans to provide £154.3 million in additional funding in 2023/24 to local authorities who are responsible for commissioning drug and alcohol treatment services and a further £266.7 million in 2024/25. Whilst the additional funding is well received, the strategy has received criticism for adopting a stigmatising approach and not involving people who use drugs in its development.

Completion of substance use treatment

Overall, slightly less than 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 2022/23, despite opiates being the most common drug type people sought treatment for, it had the lowest rate of successful completions (23%) continuing a downward trend from 2011/12. Between 2010/11 and 2022/23, the rate of successful completions decreased for all substance groups, except the ‘alcohol only’ group, which had the highest rate of successful completion in 2022/23 (58%). Nevertheless, since the pandemic, around 10% fewer people are completing treatment free of dependence across all substance groups.