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The latest figures on alcohol and drug treatment in secure settings

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Over 50,000 people in custody in alcohol/drug treatment

Public Health England just (28 January 2021) published its annual “Alcohol and drug treatment in secure settings” report, covering the financial year 2019/20. 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.


There were 52,891 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2019 and 31 March 2020, a slight fall of 0.6% on the previous year but down 12% on four years ago. Around 62% (32,988) of these people started treatment during this year.  Of the people starting treatment, half (50%) said they had a problem with opiate use, the same proportion as the previous year. Of the people starting treatment with opiate problems, 78% also had a problem with crack cocaine, a 3% increase from the previous year.

Ninety-one percent (48,080) of the people in treatment in adult secure settings were men and 9% (4,811) were women. This is more than double the proportion of women in the total prison population.

The substance groups showed large differences by sex. Three-quarters of women (75%) in treatment had problems with opiate use compared with 49% of men. The other 25% of women were split almost evenly across the other treatment groups with 9% in both the alcohol only group and the non-opiate and alcohol group, and 8% in the non-opiate only group. Non-opiate drug use was the second most common among males, with 40% reporting this (20% in both non-opiate and non-opiate and alcohol groups). Eleven percent of males reported using alcohol only.

Over a third (37%) of people starting treatment were identified as having a mental health need. The highest proportion was seen in the opiate group (41%), compared to 30% in the non-opiate only group.

Most people starting treatment in 2019 to 2020 had never injected (64%). People in the opiate group were most likely to be currently injecting (32%) compared to less than 2% for all other groups. Just over a quarter (27%) of people in the opiate group reported previously injecting compared to 9% in the non-opiate only group, 10% in the non-opiate and alcohol group, and 5% in the alcohol only group.


Almost all adults in treatment in secure settings (94%) received psychosocial interventions. Four percent received prescribing interventions only and 2% either did not start an intervention or an intervention was not recorded.

Psychosocial intervention only was the most common treatment type in the non-opiate only (92%), non-opiate and alcohol (82%) and alcohol only (65%) groups. Only 19% of people using opiates received psychosocial intervention only.

Almost half (49%) of adults in treatment received a prescribing intervention. There was 80% of the opiate group receiving these, 32% of the alcohol only group and just 6% of the non-opiate only group. These interventions are summarised in the infographic below.


A total of 34,378 people left treatment in secure settings between 1 April 2019 and 31 March 2020. Just over a quarter (26%) of those were discharged after completing their treatment free of dependence. Adults in treatment for opiate problems had the lowest rate of successful completion (12%) compared to the other substance groups where the rate was 40% or higher.

Two-thirds (66%) of adults leaving treatment were transferred for further treatment either in the community (42%) or in another secure setting (23%).

Continuity of care between treatment services in prisons and the community remains poor; the proportion of adults successfully starting community treatment within 3 weeks of release was 34.5% in 2019 to 2020.

The remaining 8% of adults left treatment without completing it, mainly by dropping out of treatment (3%) or being discharged due to being released from court (2%).

Young people

There were 1,186 young people receiving treatment for drug and alcohol problems in secure settings in 2019 to 2020. Most (74%) of these were in young offender institutions, with a further 16% in secure children’s homes, 7% in secure training centres and 4% in welfare-only homes.

Of the young people starting treatment in secure settings in 2019 to 2020:

  • 93% said they had a problem with cannabis
  • 40% said they had a problem with alcohol
  • 24% said they had a problem with nicotine
  • 16% said they had a problem with cocaine powder
  • 5% said they had a problem with ecstasy
  • 5% said they had a problem with opiates
  • 2% said they had a problem with crack cocaine


Most young people in treatment (80%) received a harm reduction intervention. These interventions include support to manage risky behaviour associated with substance use, such as overdose or accidental injury.

Over half (57%) received motivational interviewing while nearly a third (30%) received relapse prevention. A further 32% received cognitive behavioural therapy and counselling (14% and 18% respectively). Less than 1% of young people received a pharmacological intervention (this involves medication prescribed by a clinician).


There were 946 young people who left treatment in secure settings in 2019 to 2020. Of these, 28% completed their treatment successfully. This is a small reduction in the proportion of young people who successfully completed treatment since the previous year (from 29% to 28%).

Just under a quarter (23%) were released from custody and referred for further treatment in the community and 20% were transferred to another secure setting with the intention that their treatment would continue. A further 18% of young people declined treatment and 7% left treatment due to being released from court.

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