60,000+ receive substance misuse treatment inside
The week before Christmas (19 December 2017), Public Health England published the latest stats from the National Drug Treatment Monitoring System (NDTMS) on drug and alcohol treatment delivered in secure settings; the stats are for the financial year 2015/16.
This report brings together for the first time information on people receiving specialist treatment interventions for drugs and alcohol misuse in a secure setting. The report contains information on adults (aged 18 and over) in contact with treatment services in prisons, Youth Offending Institutions (YOIs), and Immigration Removal Centres (IRCs), and a separate section on young people receiving treatment within the children and young people’s secure estate. This blog post summarises the main findings, split into adult and young people’s sections.
Main findings – adults
In all, 60,254 adults were in contact with drug and alcohol treatment services within secure settings during 2015-16, and most (56,803) of these were within a prison setting, with 3,124 within YOIs and 327 within IRCs. Just under half (48%) of those in contact with treatment in adult settings presented with problematic use of opiates, a further 37% presented with problems with other drugs (non-opiates) and 14% presented with alcohol as their only problem substance. Clients accessing treatment in IRCs were mostly opiate clients (77%), while YOIs mostly treated non-opiate drugs (79%).
Overall, nearly half (49%) of all adults in treatment in 2015-16 presented with problematic alcohol use, either on its own or alongside opiates or non-opiates. After opiates (48%), the next most commonly cited substance was cannabis, reported by 34% of individuals in treatment, followed by crack cocaine (31%) and cocaine powder (22%). Benzodiazepines (14%) and amphetamines (8%) were also reported by a sizeable minority of adults in treatment.
Over half of the opiate users also presented with crack cocaine use (54%). The other most common substances used by opiate users were alcohol (31%), benzodiazepines (25%) and cannabis (19%). Cannabis was the substance that the majority of non-opiate only clients and non-opiate and alcohol clients presented to treatment with (71% and 61%, respectively).
Six percent of all adults in treatment cited New Psychoactive Substances (NPS) as one of their problem substances, or their only problem substance — of course, we know that rates of use of NPS in prison are much higher than those presenting for treatment.
Ninety percent of the total treatment population in adult secure settings in 2015-16 were male (54,257) and ten percent (5,997) were female. This represents just over double the proportion of women within the total prison population (4.5% as at 31 March 2016). Problematic opiate use was reported by almost half of the male treatment population (47%), compared to nearly two-thirds of women in treatment (65%).
Almost two-thirds (63%) of treatment interventions received by adults in treatment in the year were structured psychosocial interventions. The remaining interventions were pharmacological interventions, 22% to address opiate use, 9% for alcohol and 6% were other pharmacological interventions to address other drug misuse.
Reflecting the relatively short periods spent incarcerated, the majority of clients (94%) were receiving continuous prescribing for less than one year, while around 1% were continuously prescribed for two or more years. Overall, the average (median) length of continuous prescribing was 44 days, but ranged from 9 days for alcohol only clients to 56 days for opiate clients. (For a service user perspective on Opioid Substitution Treatment in prison, see this recent research.)
Nearly 40,000 adults left treatment in a secure setting during 2015-16. Almost a quarter (23%) were discharged as having completed treatment, based on a clinical judgement that the individual no longer needed structured treatment, having achieved all of their care plan goals and overcome dependent use of the substance/s that bought them into treatment. The lowest rate of successful completions was amongst opiate users (13%), compared with 31-32% for the other three substance groups.
The majority of opiate clients discharged from treatment were referred to treatment services in the community on release (63% of discharged opiate clients), while a lower proportion of alcohol only (43%), non-opiate and alcohol (31%) and non-opiate only (29%) had this onward community referral. Dropout rates for those in treatment in secure settings, across all substance groups, were low (4% or less).
However, in 2015-16, less than a third (30.3%) of adult prisoners in need of treatment following release from the secure estate were successfully engaged in community-based treatment within 21 days.
The number of adults who died while in contact with treatment services in a secure setting in 2015-16 was 41, representing 0.1% of adults accessing treatment. Most of these deaths were from the opiate drug group (22 deaths), followed by alcohol only clients (11 deaths). Females accounted for 12% (5 deaths) of the total deaths amongst adults in treatment.
Main findings – young people
There were 1,541 young people in specialist substance misuse treatment in a secure setting in 2015-16. The majority (69%) of young people in treatment in secure settings reside in YOIs, with a further 16% residing in Secure Children’s Homes (SCHs), 12% in Secure Training Centres (STCs) and 3% in Welfare Only Homes (WOHs).
Cannabis was the most commonly cited problem substance amongst young people in treatment in secure settings (91% of all in treatment). Around half cited problematic alcohol use (51%). Other substances reported by young people included nicotine (19%), cocaine (19%), amphetamines (9%), ecstasy (8%) and NPS (8%). Two percent of young people cited problematic opiate use.
Of the treatment interventions delivered to young people in 2015-16, 83% received a harm reduction intervention, followed by motivational interviewing (47%) and relapse prevention (22%).
Of the 1,143 young people in secure settings who exited treatment in 2015-16, 32% completed treatment in custody, 41% were released from custody and were referred for further treatment in the community and 19% were transferred to another secure setting establishment with the intention that treatment would continue. The remaining 9% either dropped out or withdrew from treatment, or declined to participate in treatment. There were no deaths amongst young people in secure settings during specialist substance misuse treatment.
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