Alcohol Treatment - the facts
The National Audit Office has just (21 February 2023) published a briefing on alcohol treatment services. The briefing collates publicly available evidence on alcohol treatment services, which, as most readers know, affect only a small number of heavy drinkers. The briefing describes:
- the background of alcohol consumption and associated harm
- spending on, and commissioning of, alcohol treatment services
- access to, and outcomes from, treatment services
The NAO recognises that a fuller consideration of alcohol harm could include an evaluation of policies, implementation and prevention. However, in the continuing absence of a government strategy for reducing alcohol harm against which it could assess progress, they have instead set out the facts about alcohol treatment services. Anyone who wants definitive information on the current state of alcohol treatment in England and Wales will find this a useful resource.
Spending on alcohol treatment services in England
As readers will know, most alcohol treatment provision is now provided within an integrated substance misuse treatment system. The briefing details the extra £533m to rebuild substance misuse treatment on the back of Dame Carol Black’s reports. The NAO clarifies that although every local authority area will receive funding, priority will go to areas in most need, defined, in the main by illegal drug-related issues: the rate of drug deaths, deprivation, opiate and crack cocaine prevalence, and crime.
One key fact is the wide variation in the reported spending on alcohol treatment services between local authorities. Local authority spending on alcohol treatment services ranged from £4,000 per 100,000 people to £1.12 million per 100,000 people in 2021-22. Three local authorities reported spending zero on alcohol treatment services. Details are in the chart below reproduced from the briefing.
Trends in alcohol treatment
The number of people receiving treatment for problems with alcohol has been trending downwards since 2013-14; it increased slightly in 2020-21 and further in 2021-22. Between 2013-14 and 2020-21, the total number of people receiving treatment for problems with alcohol fell by 16% from 91,651 to 76,740. In 2021‑22 the number rose to 84,697, a 10% increase from 2020-21. In 2021-22 there were 56,995 new patients, an increase of 9% from 52,220 in 2020-21, but 12% lower than the 65,110 in 2013-14. The NAO estimates that less than one in fie (18%) people who are alcohol dependent and in need of treatment are actually in alcohol treatment.
The briefing discusses the 2018 PHE Inquiry into the fall in numbers of people in alcohol treatment, which reported that the context in which treatment was being commissioned and provided at the time, including financial pressures and service reconfiguration, had affected alcohol treatment more than treatment numbers for other substances. The report said that alcohol treatment can be delivered effectively by integrated substance misuse services. However, it said that by integrating their drug and alcohol services into a single substance misuse service, local authorities with sharp falls in numbers had generated some unintended consequences including:
- a loss of focus on the specific needs of alcohol users;
- a prioritisation of limited resources on opioid substitute treatment;
- barriers to alcohol users approaching the service, including a perception that the service focused on the needs of drug users;
- barriers to alcohol users engaging in treatment after initial contact, including a lack of alcohol-specific treatment pathways within integrated services and a loss of alcohol-specific expertise among staff; and
- referral pathways and multi-agency working that had become less effective.
NDTMS data show that the most common reason for patients leaving treatment is because it has been successful and they are no longer dependent on alcohol. Other reasons for leaving treatment include dropping out, death, transferring to another provider and treatment withdrawal. In 2021-22, 59% of patients left treatment because they had successfully completed it, 33% dropped out, and 3% transferred. For those who successfully completed treatment in 2021-22, the average treatment duration was 201 days.
Interestingly, this summary data hides huge local variation with the percentage of people successfully completing alcohol treatment ranging from 29% to 90% across different local authorities.