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.
After the onset of the pandemic and national lockdowns, concerns were raised about increasing substance misuse, and survey data suggests that higher-risk drinking increased. Indeed, alcohol-related deaths have been on the rise since 2020, and a rise in older heavy drinkers who are less likely to be in treatment could be a factor.
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 2023/24 to 310,863 adults. Almost half of those accessing treatment in 2023/24 did so for opiate use. Almost three-quarters (72%) of those accessing substance misuse services in 2023/24 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 2024/25, the proportion of people waiting less than three weeks for their first treatment intervention has improved substantially, especially for people seeking alcohol-only related interventions. From 2017/18 onwards, the waiting time of three weeks or less for first interventions has stabilised at around 98% across all substance groups. In 2024/25, 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.
In 2024/25, the average waiting time for a first intervention was about one and a half (1.3) days (data not shown). The wait was shortest for ‘opiate’ clients (0.7 days) and longest for ‘alcohol only’ clients (1.8 days), shorter than in previous years. Furthermore, in 2024/25, 93% of people starting a subsequent intervention did so within three weeks, which is similar to the proportion in 2023/24 (data not shown).
Reasons for leaving substance misuse treatment
People leave drug and alcohol misuse services for a range of reasons, illustrated in the chart above. In 2024/25, 329,646 adults were in treatment for substance misuse; 152,067 (46%) exited treatment in the same year (data not shown).
Between 2010/11 and 2024/25, roughly half of the people exiting treatment had completed it ‘free of dependence’, including 47% of people in 2024/25, making it the most common reason for those exiting treatment for that year.
The second most common reason for exiting was ‘dropped out/left’, indicating that these people did not complete their treatment. Worryingly, the proportion of people not completing treatment has increased, from 27% in 2010/11 to 37% in 2024/25. 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 being treated who died; this has more than doubled from 1.5% in 2010/11 (1,935 deaths) to 2.8% in 2024/25 (4,273 deaths), which is about 200 more deaths than in the previous financial year. 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) announced it would 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 been criticised for adopting a stigmatising approach and not involving people who use drugs in its development.
Success in completing 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 a 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 2024/25, despite opiates being the most common drug type for which people sought treatment, it still had the lowest rate of successful completion (23%), continuing the downward trend from 2011/12.
Since the pandemic, around 8% fewer people are completing treatment free of dependence across all substance groups. Between 2010/11 and 2024/25, the rate of successful completion only improved for the ‘alcohol only’ group, which also had the highest rate of successful completion in 2024/25 (58%).
About this data
The data for this indicator 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.
For more information about the NDTMS, please see Public Health England's Substance misuse treatment statistics – National Drug Treatment Monitoring System, Quality and methodology information paper.