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2020 Drug & alcohol treatment figures
The number of adults entering treatment for crack cocaine goes up for the fifth year in a row

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Treatment trends

Last week (26 November 2020) Public Health England published its annual report on adult substance misuse treatment statistics, covering the 2019/20 financial year. There were 270,705 adults in contact with drug and alcohol services between April 2019 and March 2020. This is similar to the previous year (268,251).

The number of adults entering treatment in 2019 to 2020 was 132,124, which is also very similar to the previous year’s figure (132,210 in 2018 to 2019). The numbers of people entering treatment for the first time now seem to have stabilised after falling steadily since 2013 to 2014.

The main trends are set out below:

  • The number of people in treatment for opiate use was similar to the previous year (going up slightly from 139,845 to 140,599). Over half (52%) the adults in treatment were there for problems with opiates, and this remains the largest substance group. 
  • People in treatment for alcohol alone make up the next largest group (28%) of all adults in treatment. The number of those fell by 1% since the previous year (from 75,555 to 74,618) and follows a large year-on-year decline from a peak of 91,651 in 2013 to 2014.
  • There were increases in the other 2 substance groups (a 4% increase in the non-opiate group and 6% in the non-opiate and alcohol group). This follows a similar small rise last year.
  • There has been a rise in the number of adults entering treatment for crack cocaine. This includes people who are using crack with opiates (24,363 to 25,043) and those who are using crack without opiates (4,535 to 4,651). This is the fifth year in a row that the numbers of people entering treatment for crack have risen. The number is now 36% higher than in 2013 to 2014.
  • People starting treatment in 2019 to 2020 with powder cocaine problems increased by 7% (from 20,084 to 21,396). This continues a gradual rise over the last 9 years, with numbers of new treatment entries for powder cocaine now 52% higher than in 2011 to 2012.
  • The increases in people coming to treatment with crack and powder cocaine problems are likely to be related to a surge in global cocaine production. This surge has lowered prices and increased purity. There have also been changes in distribution and supply, such as ‘county lines’ drug dealing operations.
  • Although the numbers are relatively low, there was an increase in adults entering treatment in 2019 to 2020 with ketamine problems (from 960 in 2018 to 2019 to 1,140 this year). This is a 19% rise in one year and is part of a trend in rising numbers entering treatment over the last 6 years. The total is now more than two and a half times higher than it was in 2014 to 2015.

Housing and mental ill health

Nearly one fifth (19%, or 24,369) of adults entering treatment last year said they had a housing problem. This proportion varied by substance group, ranging from 1 in 10 (10%, or 4,942) of those starting treatment for alcohol problems alone, and almost a third (32%, or 13,315) of those starting treatment for problems with opiate use. People starting treatment for problems with new psychoactive substances (NPS) had the highest proportion of housing need of any substance group (45%).

For adults starting treatment, 59% said they had a mental health treatment need. This is an increase on the previous year (from 53% to 59%). Over half of new starters in all substance groups needed mental health treatment. This need ranged from 54% in the opiate group to nearly two-thirds (65%) of the non-opiates and alcohol group.

Treatment exits and deaths in treatment

There were 117,678 people who exited the drug and alcohol treatment system in 2019 to 2020. Just under half (47%) of those left having successfully completed their treatment, free from dependence. This is a small reduction in the proportion of people who successfully completed treatment since the previous year (from 48% to 47%).

The total number of people who died while in contact with treatment services in 2019 to 2020 was 2,929 (1.1% of all adults in treatment). This is a similar number to last year (2,889, or 1.1% of all adults in treatment).

There was a 6% increase in deaths of opiate users in treatment this year (from 1,897 to 2,010). All other substance groups saw a decrease in deaths compared to last year. The non-opiate and alcohol group had a 6.1% decrease, while the alcohol only group had a 7.3% decrease and the non-opiate only group had an 11.3% decrease.

Drug use is a significant cause of premature death in England, as the Office for National Statistics drug poisoning data has shown. In England, the number of deaths from drug misuse registered in 2019 was 2,685, which is the highest level since records began. [For more detail on drug-related deaths, see my recent blog post here.]


It is a matter of some relief to see that the number of people in treatment did not fall again last year. In recent years it has been clear that the 17% cuts in treatment budgets which England has seen since 2015 (with some local areas making reductions of over 40% to treatment budgets) had resulted in fewer people in treatment.  However, the impact of COVID and likely renewed public expenditure cuts means that there is already considerable concern about next year’s figures.

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