Treatment Trends
Yesterday (14 December 2023 – one month earlier than last year), the Office for Health Improvement & Disparities published the adult substance misuse treatment statistics for 2022/23. In this blog post, I summarise the main trends in treatment numbers. There were 289,215 adults in contact with drug and alcohol services between April 2021 and March 2022. This is a rise compared to the previous year (275,896).
However, the number of adults entering treatment in 2021 to 2022 was 133,704, which is similar to the previous 2 years’ figures (130,490 and 132,124), showing some impact of the uplift in funding following the Dame Carol Black review. The numbers of people entering treatment continues to be relatively stable after falling steadily since 2013 to 2014.
Treatment users by substance
Nearly half (48%) the adults in treatment were there for problems with opiates. Despite the number of people in treatment for opiate use slightly decreasing from last year (from 140,558 to 138,604), this remains the largest substance group. People in treatment for alcohol alone make up the next largest group (30%) of all adults in treatment. The number of those rose by 2% from the previous year (from 84,697 to 86,257) but this is lower than the peak of 91,651 in 2013 to 2014.
There were increases in the other 2 substance groups (a 1% increase in the non-opiate group and 4% in the non-opiate and alcohol group). This follows a rise last year of 7% for the non-opiate group and 11% for the non-opiate and alcohol group.
After seeing a decline in the previous 2 years, there has been a rise in the overall number of adults entering treatment for crack cocaine. This rise includes people who are using crack with opiates (18,832 to 20,158) and those who are using crack without opiates (4,711 to 5,444).
People starting treatment in 2022 to 2023 with powder cocaine problems increased by 10% (from 21,298 to 23,529). This surpasses the previous peak number of 21,396 in 2019 to 2020.
New entrants to treatment with cannabis problems increased again this year, which saw a 2% rise (from 28,263 in 2021 to 2022 to 28,845 this year). New entrants with benzodiazepine problems fell 6% (from 3,848 in 2021 to 2022 to 3,620 this year), after increasing every year since 2018 to 2019 up until 2021 to 2022.
Although the numbers are relatively low, there was an increase in adults entering treatment in 2022 to 2023 with ketamine problems (from 1,551 in 2021 to 2022 to 2,211 this year). This is part of a trend in rising numbers entering treatment over the last 9 years. The total is now over 5 times higher than it was in 2014 to 2015.
Housing
For the first time in 2022 to 2023, services could record more detailed information about the current housing situation of people in treatment, including whether they were at risk of homelessness within the next 8 weeks.
A fifth (20%) of people starting treatment had no home of their own when data was recorded.
Thirty-seven per cent of people starting treatment with opiate problems had no home of their own, the highest proportion among the 4 substance groups.
Over 1 in 12 people (9%) starting treatment said they had a risk of homelessness in the next 8 weeks. For people with opiate problems, the proportion with this risk was 16%. And for people with alcohol problems only this proportion was 5%.
People in treatment for problems with psychoactive substances (mainly synthetic cannabinoids, previously recorded as ‘new psychoactive substances’) had the highest proportion of risk, with 24% saying they could be made homeless in the next 8 weeks when starting treatment.
Treatment outcomes
A total of 127,385 people left drug and alcohol treatment in 2022 to 2023. Of the people who left treatment, 46% completed their treatment successfully and were discharged as ‘treatment completed’. The alcohol only group had the highest rate of treatment completed at 58%. This was followed by the non-opiate group (51%) and the non-opiate and alcohol group (49%). The opiate only group had a completion rate of 23%.
Over a third (37%) of people dropped out or left treatment without completing it. The remaining 16% of exits included:
- 10% who left due to unsuccessful transfers between services or to treatment in prison
- 2% who declined treatment
- 3% who died while in treatment
On average (mean), people who completed treatment successfully did so within a year of starting treatment (323 days). The average time in treatment for people with opiate problems who completed treatment successfully was 3.3 years (1,209 days) and around 6 months for the other substance groups (172 days for non-opiate only, 205 days for non-opiate and alcohol and 206 days for alcohol only).
Deaths in treatment
These statistics also sadly cover deaths in treatment. Every year, people die while they are in an alcohol and drug treatment programme, although these deaths might not be alcohol or drug related.
There were 4,166 recorded deaths in treatment in 2022 to 2023, which was 1.4% of all people in treatment. Compared to 2021 to 2022, this is an 11% increase in the number of deaths (from 3,742) and is an increase in the proportion of people in treatment dying (from 1.3%). This is a higher proportion than the previous peak in 2020 to 2021 (1.35%).
People with opiate problems accounted for nearly two-thirds (64%) of these deaths, and the alcohol only group had a further 28% of deaths.
As we know, the number of deaths from drug misuse registered in 2021 was 2,846, which is the highest level since records began.
Treatment over time
OHID provides an interesting longitudinal insight into drug and alcohol treatment over the last 18 years, starting from 2005 to 2006. There has been a total of 1,153,514 people in contact with drug and alcohol treatment services over this time period. By 31 March 2023:
- 152,994 (13%) were still engaged in treatment
- 460,356 (40%) had left before they completed their treatment and had not returned
- 540,164 (47%) had completed their treatment and not returned
