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Prison drug treatment trends
The proportion of people starting treatment in prison for opiates, crack or both keeps falling.

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Downwards trend in prison drug treatment

The Office for Health Improvement & Disparities yesterday (16 March 2023) published its annual “Alcohol and drug treatment in secure settings” report, covering the financial year 2021/221. 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

There were 45,096 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2021 and 31 March 2022. Numbers in treatment had been decreasing year on year until this year, which saw a 3% increase from the 43,607 reported in 2020 to 2021. Unfortunately, this increase is misleading since numbers in treatment in the previous year dropped by almost 10,000 as a result of the pandemic. The number of adults in treatment in secure settings is down by a worrying 25% on the 2015/16 figure just six years ago.


Of the people starting treatment, 46% said they had a problem with opiate use, the lowest proportion seen since reporting began. The proportion of people starting treatment for opiates, crack or both has been decreasing steadily from an all-time high recorded in 2017 to 2018 (60%). Fifty-four per cent reported problems with these substances in 2021 to 2022.


Ninety-one per cent (40,954) of the people in treatment in adult secure settings were men and 9% (4,142) were women. This is more than double the proportion of women in prison, which was 4% at the end of March 2022. The proportion of women in each substance group ranged from 13% in the opiate group to 5% in the non-opiate only group. You can see full details in the infographic I have reproduced from the report below.

The most common age range for adults in treatment in a secure setting was 30 to 39 years old, followed by 40 to 49 years old. These groups together made up around two-thirds (64%) of the total adults in treatment.

The largest drug group in both of these age groups was opiates. Opiates was also the largest drug group in the next oldest category, 50 to 59 year olds. The largest substance group for adults aged 18 to 29 was non-opiates, and the largest substance group for those aged 60 or older was alcohol only.

Nearly a third (32%) 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 (34%) and the lowest (29%) in the non-opiate only group.

Treatment outcomes

A total of 27,520 people left treatment in secure settings between 1 April 2021 and 31 March 2022. A third (32%) of those were discharged after completing their treatment free of dependence. The non-opiate only group (46%), non-opiate and alcohol group (45%) and the alcohol only group (45%) had the highest rates of successfully completing their treatment. The opiate group had the lowest rate of successfully completing treatment (15%).

Over half (56%) of adults leaving treatment were transferred for further treatment, either in the community (39%) or in another secure setting (18%).

Continuity of care

The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 37.4% in 2021 to 2022. This is a slight decrease from the proportion reported in 2020 to 2021 (38.1%) but is still 7.1% higher than when this data was first reported in 2015 to 2016 (30.3%).

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 (57%) and London had the lowest (21%).

Young people

There were 553 young people receiving treatment for drug and alcohol problems in secure settings in 2021 to 2022, the lowest number since reporting began. This is a 17% decrease compared to the previous year (669 in 2020 to 2021), continuing an overall downward trend since 2015 to 2016 (1,428). Part of this downward trend is, of course, accounted for by the continuing fall in the numbers of children in custody.

Cannabis was the most common problem substance for young people in secure settings, with 92% saying they had a cannabis problem. This proportion has remained at similar levels since 2015 to 2016.

Of the 402 young people who left treatment in secure settings in 2021 to 2022, 33% completed their treatment successfully. This is a significant decrease from 41% in 2020 to 2021, which was the highest rate since reporting began.


There is continuing concern about the strong downwards trends in the numbers of adults in particular in treatment in prison. Next year’s figures will be revealing as there will be no lingering impact from the pandemic and the prison population, regrettably, has increased considerably in 2022/23, meaning that we should expect a rise in the numbers of people receiving help for their alcohol and drug use inside.


Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here

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