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Public Health England
Public Health England, 2016.
For the second time the annual accounting of the treatment caseload in England combines records of drug and alcohol use treatment, registering a continuing fall in total numbers and decreasing success with opiate users, while the treatment of drinkers appears to be improving.
Summary This report brings together information on people receiving specialist interventions for drug problems and for problem drinking in England, other than patients receiving this treatment in prison. While people who seek treatment for drug and alcohol use problems share many similarities, there are also clear differences, so this report divides the caseload into four mutually exclusive substance use groups:
• any mention of opiate use in any treatment episode during the year would result in the client being categorised as an opiate client, irrespective of other substances cited;
• clients who present for treatment related to non-opiate drug use (ie, not opiates or alcohol) are classified as non-opiate only;
• clients with non-opiate drug and alcohol use problems (but not opiates) recorded in any treatment episode during the year are classified as non-opiate and alcohol;
• clients who present with problems related to alcohol but no other substances are categorised as alcohol-only.
Other substance use categories may not be mutually exclusive.
In all, 288,843 individuals were in treatment at drug and alcohol services in 2015/16, a 2% reduction on the previous year. Of these, 138,081 commenced their treatment during the year either for the first time or after a break in treatment (which may have been during the focal year); the vast majority (97%) waited three weeks or less to do so.
Individuals presenting as dependent on opiates made up the largest proportion of the total number in treatment – 149,807 or 52%. This is a fall of 2% in the number since last year and a substantial reduction (12%) since the peak in 2009/10, when 170,032 opiate clients were in treatment. The decrease in opiate clients in treatment is most pronounced in the younger age groups, with the number aged 18–24 starting treatment for opiates having fallen by 79% from 11,351 in 2005/06 to 2,367.
Alcohol presentations make up the second largest group in treatment, with a total of 144,908 individuals exhibiting problematic or dependent drinking. Of these, 85,035 were treated for alcohol use problems only and 59,873 for alcohol use problems alongside other substances. The overall number of individuals in treatment for drinking problems fell by 4% compared to 2014/15, and alcohol-only numbers fell by 5%.
Alcohol-only and opiate use patients tended to be much older than those who presented for problems with other substances. The median (middle of the range) age of alcohol-only clients was 45 years, and 11% (9,451) were aged 60 or older. Opiate clients were on average younger with a median age of 39.
13,231 individuals aged 18–24 started treatment in 2015/16 either for the first time or after a break (which may have been during the focal year), most citing problems with cannabis, alcohol or cocaine (respectively: 7095, 54%; 5,799, 44%; and 3,137, 24%). The number of under-25s accessing treatment has fallen by 37% since 2005/06; this reflects the shifts in the patterns of drinking and drug use in this age group over the last 10 years.
New psychoactive substances were a presenting problem for 2,042 individuals starting treatment in 2015/16, 77% up on the previous year but only 1.5% of all presentations. In 2015/16 just over a quarter (546) of these individuals were also problem users of opiates. While relatively small, half this group reported housing problems and 41% had been referred from prison or probation.
Men made up 70% of the entire treatment population in 2015/16, 73% of patients using drugs, and 61% presenting with alcohol use problems only. White British people formed 85% of the caseload and a further 5% were recorded as from other white groups. No other ethnic group made up more than 1% of the total treatment population, though 5% in treatment for non-opiates were Caribbean, and Caribbean groups also composed 3% of ‘non-opiate and alcohol’ patients. The main non-opiate substances cited by individuals from Caribbean ethnic groups were cannabis and crack cocaine.
127,080 individuals left the treatment system in 2015/16, 50% (64,166) having successfully completed their treatment free of dependence compared to 52% in the previous year. Alcohol-only clients had the highest rate of successful exits; just under two thirds (62%) completed treatment successfully, slightly up from 61% in the previous year. Non-opiate only clients were next; 60% left successfully, down from 64% in 2014/15.
commentary Focusing on by far the largest two sectors of the treatment caseload – problem opiate users and problem drinkers – the broad themes introduced in the following paragraphs are explored under the subheadings below, largely relying on ‘unfoldable’ charts to reveal trends. The analysis covers the ten years from 2005/06 to 2015/16, the period for which consistent series of data have been back-calculated and published. An important caveat is that alcohol treatment providers were not fully incorporated into the monitoring system until 2009/10. That must partly and perhaps entirely account for the seemingly steep increase between 2005/06 and 2009/10 in patients for whom alcohol was their sole problem substance.
In the 2010s treatment become a choice made by older opiate users and turned away from by younger users
Reflecting earlier trends in users in the population, numbers of opiate users in treatment fell from 2009/10 and their ages increased as younger adults turned away from heroin use. However, changes in the age composition of opiate users in the population was not the whole story. Relative to previous years, in the 2010s treatment seems to be becoming a choice made by older opiate users and one turned away from by younger users. Also reflecting general population trends, numbers and proportions of younger problem drinkers in treatment have been falling while the older groups have become more prominent.
The main indicators of treatment success – successful completion and even more so successful completion and no return within six months – rose for drinkers, but from 2011/12 fell for opiate users, presumed due to an ageing caseload more entrenched in their addiction and with few resources left to enable them to manage outside treatment. Why the same kind of trends have not on the same yardsticks made alcohol treatment less successful remains to be explained.
Since 2007/08 to the latest estimates in 2011/12, most problem opiate users in the population have been in treatment at some time during the year, primarily being prescribed opiate-type medications like methadone which substitute for heroin or the other illegal opiate-type drugs, along with psychosocial support. A corresponding estimate for dependent drinkers is that in 2014/2015, about a fifth were in treatment, based on the assumption that all patients primarily with a problem with alcohol were dependent.
The treatment caseload has slowly been shrinking since around 2009. By 2015/16, 288,843 individuals were recorded as having been in treatment at drug and alcohol services, the lowest figure since 2009/10 when the total was 311,667. Of these individuals, 138,081 had started treatment during the year (blue line in chart) either for the first time or after a break rather than continuously from the year before, down from the highest figure recorded of 147,578 in 2008/09. Increasing recruitment of alcohol-only patients into the figures ( below) helped create the impression up to 2009/10 of a more dynamic system with patients more likely to leave treatment and to do so after recording a successful exit, but even since that year both proportions have crept up, largely due ( below) increasing success with drinkers. Unfold chart.
One reason for falling overall numbers was fewer patients starting treatment for the first time, leaving a caseload composed largely of patients continuing in or returning to treatment. In 2015/16, 50,923 patients were entirely new to treatment (or at least, to structured treatment recorded by the monitoring system), just 18% of all patients in treatment. When alcohol services came fully on board in 2009/10, the corresponding figures were 73,240 and 23%. Unfold chart.
In finer grain, the shrinking caseload largely reflected the fall in the number of opiate users in treatment from a peak of 170,032 in 2009/10 to 149,807 in 2015/16, down 12%. Numbers of alcohol patients have remained fairly stable since alcohol services fully joined the system in 2009/10. At 144,908, by 2015/16 problem drinkers were nearing the opiate total of 149,807. However, many of these patients combined problem drinking with problem drug use, which may have included opiate use, and it is unclear how many can be considered primarily dependent on alcohol. For just 85,035 was drinking their sole substance use problem. Unfold chart.
The previous figures related to patients in treatment at some time during the year, including those continuing in treatment from previous years. More indicative of current and future trends in the ‘demand’ for treatment are patients who started treatment during the year.
In 2015/16, 62% of all treatment starters cited drinking as a problem
Even before alcohol treatment services had been fully incorporated, on this score alcohol as a primary or secondary problem substance dominated. In 2015/16, 84,931 patients started treatment citing drinking as a problem, 62% of all treatment starters. Far behind were the diminishing numbers of patients with opiate use problems, at 43,465, just 31% of all treatment starters, down in numbers from 55,493 in 2009/10 and in proportion from 38%. Notably the dip in opiate use starters coincided with the ‘heroin drought’ of (roughly) 2010 to 2012, thought via changes in the availability and price of heroin to have reduced its consumption. Since new heroin users can take several years to enter treatment, another factor may ( below) have been the reductions in the number of problem opiate users in the population from 2005/06. Unfold chart.
Since the ageing opiate-using caseload and the ageing set of problem drinkers ( below) constitute the great majority of all patients in treatment in England, the total caseload too has also been ageing. From 42% in 2005/06, by 2015/16 those aged 35 or more constituted 67% or just over two-thirds of the caseload, while the under 25s fell from 17% to 7%. To the challenges of treating dependence are increasingly being added the challenges of dealing with the aftermath of many years of substance use and the diseases of age. Unfold chart.
Among all patients starting treatment either for the first time or returning the picture was very similar. From 41% in 2005/06, by 2015/16 those aged 35 or more constituted 62% or nearly two-thirds of the caseload while the under 25s fell from 19% to 10%. Unfold chart.
By clicking the headings below you can choose to see a detailed account of the figures and trends for opiate users and/or for drinkers.
Last revised 11 May 2017. First uploaded 03 May 2017
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