Prison treatment trends
The Office for Health Improvement & Disparities has just (26 January 2024) published its annual “Alcohol and drug treatment in secure settings” report, covering the financial year 2022/23. The report contains information on both adults and young people in contact with treatment services in prisons, youth custody and immigration removal centre settings. This blog post covers the headline findings and main trends.
Treatment numbers and substance use
There were 46,551 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2022 and 31 March 2023. Numbers in treatment have increased 3% year on year for the last 2 years, with 43,607 reported in 2020 to 2021 and 45,096 in 2021 to 2022.
Around three-quarters (35,809, 77%) of these people started treatment during this year, an increase of 6 percentage points since 2020 to 2021 (71%). Of the people starting treatment, 47% said they had a problem with opiate use, a similar proportion to last year.
The proportion of adults starting treatment for opiates, crack or both increased slightly this year with 56% reporting problems with these substances compared to 54% in 2021 to 2022.
Pathways
Over half (52%) of the people starting treatment in an adult secure setting between 2022 and 2023 were taken directly into custody or detention from the community. The other 48% started treatment after being transferred from another secure setting.
Most people starting treatment for opiate use or alcohol use only came directly into custody from the community (59% and 62% respectively). In the non-opiate only and non-opiate and alcohol groups, the majority of people coming into treatment were transferred from another secure setting at 62% and 55% respectively.
Most of the adults starting treatment who were taken directly into custody from the community (56%) and started treatment when they arrived in secure settings – 86% started within 3 weeks of arrival. Of the people transferring from another secure setting, 41% took over 3 weeks to start treatment. These will often be people who have developed drug problems in custody or decide they want to access treatment before their release, rather than being just people who have a break in their treatment when they transfer from one prison to another.
Mental health
Nearly a third (30%) of people starting treatment were identified as having a mental health need. This proportion was consistent across the 4 substance groups, with the highest proportion in the non-opiate and alcohol group (32%) and the lowest (26%) in the alcohol only group.
Injecting behaviour
Most people starting treatment in 2022 to 2023 had never injected drugs (69%). This ranged from 48% of people in the opiate group to between 87% and 91% in the other substance groups. People in the opiate group were most likely to be currently injecting (16% compared to 1% or less for the other substance groups).
Treatment exits
A total of 28,065 people left treatment in secure settings last year3. Over a third (36%) of those were discharged after completing their treatment free of dependence.
The non-opiate only group (52%), non-opiate and alcohol group (50%) and the alcohol only group (48%) had the highest rates of successfully completing their treatment. The opiate group had the lowest rate of successfully completing treatment (16%).
Over half (52%) of adults leaving treatment were transferred for further treatment, either to community treatment (34%) or to treatment in another secure setting (18%).
The proportion of adults successfully starting community treatment within 3 weeks of release was 43% in 2022 to 2023.
This is a 5 percentage point increase from the proportion reported in 2021 to 2022 (37%) and is 12 percentage points higher than when this data was first reported in 2015 to 2016 (30%).
Rates of successfully transferring from prison to community treatment varied around the regions of England. The North East had the highest rate of continuing treatment (62%), and London had the lowest (26%).
The remaining 12% of adults left treatment without completing it, mainly by dropping out of treatment (5%) or being discharged due to being released from court (2%).
Trends
The chart reproduced above shows the proportion of adults starting treatment each year between 2015 to 2016 and 2022 to 2023 split by the 4 substance groups.
Around three-quarters (35,809, 77%) of the total adults in treatment started treatment during this year, an increase of 6 percentage points since 2020 to 2021 (71%). Of the people starting treatment, 47% said they had a problem with opiate use, a similar proportion to last year.
The number of adults starting treatment in secure settings in 2022 to 2023 was 8% higher than the previous year (35,809 compared to 33,275 in 2021 to 2022). This is the same proportional rise seen between 2020 to 2021 and 2021 to 2022 but is still 23% lower than the first year of reporting (46,784 in 2015 to 2016).
This increase was present in all substance groups with the opiate group rising 10% and all other groups seeing rises between 3% and 8%.
Conclusion
Although the number of people in drug and/or alcohol treatment in prison is still much lower than seven years ago, it is heartening to see a substantial increase from the lows of the COVID years.
Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here
