Adult substance misuse services

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


Last updated: 26/02/2020

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.

How has the percentage of people waiting three weeks or less for a first treatment intervention changed over time? 26/02/2020

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Between 2005/06 and 2018/19, adult waiting times for a first treatment intervention improved substantially. In 2018/19, in all four substance groups, nearly all individuals (98.4%) 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 73.2% in 2005/06 to 98% in 2018/19.

In 2018/19, the average waiting time for a first intervention was 2.1 days (data not shown). The wait was shortest for opiate clients (1.6 days) and longest for alcohol only clients (2.5 days). Further to this, the majority of people starting a subsequent intervention did so within three weeks (96.9%).

Why are people exiting substance misuse treatment and how has this changed? 26/02/2020

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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 to 118,995 in 2018/19.

The proportion of people who exited treatment free of dependence increased from 48.9% in 2010/11 to 53.3% in 2012/13, but over the last six years it has decreased again – falling to 47.6% in 2018/19. Differences in the proportion of each substance group successfully completing treatment can be seen in the chart below.

The next largest discharge reason was 'dropped out/left', indicating that these people exited the system without completing their treatment. The proportion of people exiting with this reason increased from 26.9% in 2010/11 to 36.2% in 2018/19. The percentage of service users who were transferred to another treatment provider within the community, or were transferred to treatment in prison, decreased from 15.9% in 2010/11 to 10.6% in 2018/19. The same trend was seen in the proportion of people declining treatment. There were 2,889 recorded deaths in treatment in 2018/19, representing 2.4% of all those exiting the treatment system.

How has the percentage of people completing treatment free of dependence changed over time? 26/02/2020

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Overall, around 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 care plan goals
  • overcome dependent use of the substances that brought them into treatment, and
  • ceased any pharmacological interventions.

In 2018/19, opiate users had the lowest rate of successful completions (24.6%) and alcohol only users had the highest rate (59.8%). Between 2010/11 and 2018/19, the rate of successful completions decreased for all substance groups except for alcohol only users, where it increased from 55.7%.

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 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.