Must Know: Treatment and recovery for people with drug or alcohol problems

Must Know: Treatment and recovery for people with drug or alcohol problems thumbnail
As elected members, you are ideally placed to champion investment into reducing drug and alcohol harm in your local area, engaging the local community and collaborating with officers. The purpose of this guide, developed in partnership with Public Health England (PHE), is to raise awareness about drug and alcohol related harms and empower councillors by providing an introduction to treatment and recovery services, key considerations, signposting to useful resources, as well as any questions you need to ask to support effective decision making.

Introduction

People with untreated drug and alcohol dependencies have a disproportionate impact on our communities.

In an average secondary school in England 40 pupils will be living with a parent with a drug or alcohol problem. About one in six Child in Need assessments carried out by local authorities last year record parental alcohol problems, with a similar proportion for drug use. And problem parental alcohol or drug use were each recorded in over a third (36 per cent) of serious case reviews where a child died or was seriously harmed. 

Last year 17,000 households assessed by local authorities as being statutorily homeless were recorded as being drug dependent, with 12,500 assessed as alcohol dependent.

Almost half of homicides every year are drug-related, and in almost a fifth, the suspect is under the influence of alcohol. Nearly half of acquisitive crime is drug-related and one-third of the people in our prisons committed drug-related crimes, including acquisitive crime. Analysis by the Ministry of Justice shows that over half (58 per cent) of offenders had been drinking at the time of the offence, and a third (32 per cent) said their offending was connected to their alcohol use.

More people die from drug misuse every year than from all knife crime and road traffic incidents combined. And more working years of life are lost in England as a result of alcohol-related deaths than deaths from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.

Local authorities commission drug and alcohol treatment services through the Public Health Grant. It is a condition of the 2021/22 grant that local authorities improve the take up of, and outcomes from, its drug and alcohol misuse treatment services, based on an assessment of local need and a plan which has been developed with local health and criminal justice partners.

These services, working in partnership with other local services, can and do help thousands of people to stabilise and turn their lives around every year; reducing the risks to the individuals, their families and wider community and the burden on a range of other local services. Every pound spent on drug treatment saves at total of £21 over the course of ten years.

Key facts

Drugs

In 2016/17, consumers in England and Wales spent approximately £9.4 billion on illicit drugs. This makes revenue from the drugs industry greater than the UK revenue of such household names as Alidi, Boots or EasyJet.

  • The harms from drug misuse cost society £19.3 billion per year, 86 per cent of which is attributable to the health and crime-related costs of the heroin and crack cocaine markets.
  • In 2019-20 approximately 3 million adults in England and Wales used illegal drugs. Of these, over half a million (588,000) reported drug use at least once a week.
  • Drug use by children aged 11-15 has increased by over 40 per cent since 2014, following a long-term downward trend. Two in five (38 per cent) of 15 year olds report having taken drugs at least once in their lives.
  • There were 160,000 adults receiving treatment for drug problems in local authority commissioned services between April 2019 and March 2020.  Of these 141,000 were being treated for opiate problems.
  • The number of reported county lines has quadrupled in three years and the numbers of children and young people getting drawn into this horrific exploitation continues to grow. In 2020 referrals of children suspected to be victims of county lines increased by 31 per cent.
  • Half of adults starting drug treatment are parents – while many don’t currently live with their children there were 19,000 children living with adults who started drug treatment last year.
  • There were over 14,000 young people under the age of 18 years in contact with alcohol and drug services between April 2019 and March 2020. This is a 3 per cent reduction on the number the previous year and a 42 per cent reduction on the number in treatment since 2008 to 2009.

Alcohol

  • There are around 10 million adults in England who drink above the UK Chief Medical Officers’ low risk guidelines, including more than two million who drink at higher risk and an estimated 587,000 who are dependent on alcohol.
  • The 4 per cent of the population who drink the most heavily are estimated to drink a third of all alcohol consumed in England. Their drinking is estimated to contribute 23 per cent of all of the alcohol industry’s revenue
  • There were 358,000 hospital admissions in 2018-19 where the primary diagnosis was a condition related to alcohol consumption, including 22 thousand for alcoholic liver disease and 41 thousand for mental and behavioural disorders.
  • 22 per cent of 15 year olds reported having been drunk at least once in the last four weeks, and of these a quarter (23 per cent) had vomited.
  • 105,000 people with alcohol problems were receiving treatment in local authority commissioned services last year, of whom 30,000 had non-opiate drug problems alongside their alcohol issues.
  • Half of those starting alcohol treatment last year were parents, while many don’t currently live with their children, there were 31,000 children living with an adult who started alcohol treatment last year.
  • The median drinker in treatment was consuming 400 to 599 units in the four weeks prior to starting treatment – this is the equivalent of between 10 and 15 litres of vodka. One in ten (9.7 per cent) drank over 1,000 units in the four weeks before they started treatment.

What investment has the government made to support drug and alcohol treatment?

The bulk of government investment in drug and alcohol treatment comes through the public health grant. Local authorities reported spending £623 million on drug and alcohol treatment in 2019-20, about a fifth of the public health grant for that year.

Funds for the NHS pay for the commissioning of drug and alcohol treatment in prisons, where last year 52,891 people received support for drug and alcohol problems – half of whom said they had a problem with opiate use.

What extra funding have local authorities had this year?

In January the government announced a major new package of funding to tackle drug related crime. This included an additional £80 million for drug treatment which added to the previously announced £52 million that is supporting treatment for people experiencing rough sleeping in 2021 to 2022.

The new money came in the form of universally available grants to provide more support to offenders with drink and drug problems, increasing the number of treatment places for prison leavers and offenders diverted into tough and effective community sentences. 

There is also money to support regional and sub-regional collaborative commissioning of medically managed inpatient detox programmes. Inpatient detoxification is suitable for those with the most complex health needs – including severe alcohol dependence – and helps to stabilise or stop drug (or alcohol) use completely. It should then be followed by a period of residential or community delivery support to sustain the changes.

Elected members as systems leaders

As elected members, you are ideally placed to champion this investment into reducing drug and alcohol harm in your local area, engaging the local community and collaborating with officers.

Your understanding of local communities will enable you to work effectively with officers to ensure that the existing and new funding is applied to meet the needs of local people. This will be vital in achieving the ambition for radically reducing the harms that drugs and alcohol do to our communities.

The provision of active involvement and ongoing and visible support will send a clear signal that tackling drug and alcohol problems is a priority for the local area. The commitment and support of members will also help to ensure that sufficient time and resource will be available to maintain momentum.

Problem alcohol and drug use impacts on a wide range of local services and resources that must work together, they include mental health services, job centre plus, schools, maternity services, health visitors, GPs, police, youth offending teams, prisons, fire and rescue, drug and alcohol services, early help, social care and housing services.

How does Public Health England support local authorities?

Nationally, Public Health England (PHE) provide a range of guidance and data to support effective local commissioning and delivery of drug and alcohol treatment.  Drawing on data collected in the National Drug and alcohol Treatment Management System (NDTMS), PHE is able to provide a picture of each treatment system and how it compares to those with similar characteristics as well as regional and national averages. 

PHE’s regions and centres work closely with Directors of Public Health and their teams to support local implementation and learning. 

The benefits of treating drug or alcohol dependence

Drug and alcohol treatment reduces the burden on local authority services. Dame Carol Black’s independent review estimates the costs of drug use to social care at £630 million a year and noting that treatment for dependent drug users can reduce the cost of drug related social care by 31 per cent.

PHE estimate that there are over 310,000 adults who are dependent on opiates (mainly heroin) and crack cocaine, and about 600,000 who are dependent on alcohol.  Most are not being treated for their addiction – about half of opiate and crack users (OCUs) and only one in five dependent drinkers.

Being in treatment reduces offending behaviour – up to half for alcohol users – reduces drug and alcohol related deaths, and the spread of blood borne diseases such as Hepatitis C.

Investing in treatment for all problem alcohol and drug users saves money. It can save £2.4 billion in terms of combined benefits of drug and alcohol treatment, social return in every £1 invested in drug treatment is worth a total of £21 over 10 years and a total of £26 over 10 years for alcohol treatment.

Key questions for members

How many drug and alcohol users do we have in our area – and how many of them are currently getting treatment?

Providing welcoming, easy to access, and flexible services reduce risk of harms, raise recovery-orientated ambitions and facilitate service users’ progress towards recovery goals.

  • how many people started treatment in the last year and how does this compare with previous years?
  • which relationships with other systems and services (such as the police, prisons, primary care, rough sleepers, and children’s services) are most important for encouraging people who have problems to get treatment?
What is the profile of people in our treatment system?

High levels of unmet need will have a disproportionate impact on the community.

  • what level of unmet need is there estimated to be in your local area, is it different for drugs and alcohol and has that changed recently?
  • has there been a needs assessment for drug and alcohol treatment done in the last few years? Who contributed to it?  When will it be reviewed?
What interventions do we offer to people as part of our treatment system?

The National Institute for Health and Care Excellence (NICE) have a comprehensive suite of NICE guidelines on drug and alcohol treatment. This includes guidance on which treatment systems are expected to be complied with, and a high-level technology appraisal system on methadone and buprenorphine. This guidance is useful to combat non-compliance which can lead to a legal challenge. This is reinforced by clinical guidance from the UK government and guidance from PHE. Clinical services are regulated by the Care Quality Commission.

  • how are clinicians involved in the decision making around which interventions to offer?
  • how do services decide whether someone needs detoxification or residential rehabilitation?
  • does the local treatment system cover the full range of evidence-based interventions recommended by NICE?
  • what were the most recent judgements of services that we commission (including inpatient detoxification placements and residential rehabilitation facilities)?
What do we do to support people make plans for their recovery?

Recovery from drug and alcohol dependence is enhanced and is more likely to be maintained if it includes support for people’s co-occurring mental health problems, ensuring they have stable and secure housing, something positive to do, and they have family and friends who are supportive and engaged in their recovery.

  • what links are there with the mental health system (including Improving Access to Psychological Therapies (IAPT) services?
  • how many people in drug and alcohol treatment in our area have insecure housing?
  • what links are there to the employment support sector, including opportunities for training, education and voluntary work?
  • what links do with have with mutual aid organisations like Alcoholics Anonymous and Narcotics Anonymous?

 

Resources for further information

Independent review of drugs by Professor Dame Carol Black – part 1 focuses on the ways in which drugs are fuelling serious violence and part 2 covers treatment, recovery and prevention

Helping to support and transform the lives of people affected by drug and alcohol problems – LGA (2018) – case studies showing how local authorities are supporting people with drug and alcohol problems

Alcohol and drug misuse and treatment statistics – PHE – statistics to support improvements in decision making when planning alcohol and drug misuse treatment services

Misuse of illicit drugs and medicines: applying All Our Health – PHE - evidence and guidance to help health professionals identify, prevent or reduce drug-related harm

Statistics on alcohol – NHS Digital – an annual report on a range of information relating to alcohol use and misuse drawn from a variety of sources for England

Statistics on drug misuse – NHS Digital – information on hospital admissions attributable to drugs

Public Health Dashboard – PHE – tool to support local decision-making by bringing existing comparative data into one place, including drug and alcohol treatment.

Parents with alcohol and drug problems: support resources – PHE – resources to support understanding of the extent of problem parental alcohol and drug use and support needs in a local area