Posted on July 5th

Trends in treatment numbers

There were 275,896 adults in contact with drug and alcohol services between April 2020 and March 2021. This is a small rise compared to the previous year (270,705).

The number of adults entering treatment in 2020 to 2021 was 130,490, which is similar to the previous year’s figure (132,124). The number of people entering treatment continues to be relatively stable after falling steadily since 2013 to 2014.

Trends in substance use treatment

The number of people in treatment for opiate use was very similar to last year (going up slightly from 140,599 to 140,863). Over half (51%) of the adults in treatment were there for problems with opiates, and this remains the largest substance group. Section 2 (People in treatment) has more information about what the different substance groups are.

People in treatment for alcohol alone make up the next largest group (28%) of all adults in treatment. The number of those rose by 3% from the previous year (from 74,618 to 76,740) but this small increase comes after a decline from a peak of 91,651 in 2013 to 2014.

There were increases in the other 2 substance groups (a 9% increase in the non-opiate group and 1% in the non-opiate and alcohol group). This follows a similar small rise last year.

In contrast to previous years, there has been a fall in the number of adults entering treatment for crack cocaine. This includes people who are using crack with opiates (25,043 to 21,308) and those who are using crack without opiates (4,651 to 4,545).

The number of people entering treatment for crack is now at the lowest level since 2016 to 2017.

People starting treatment in 2020 to 2021 with powder cocaine problems decreased by 10% (from 21,396 to 19,209). This ends a rising trend over the last 9 years, which began in 2011 to 2012.

New entrants with cannabis and benzodiazepine problems increased again this year, with a 5% increase in cannabis (from 25,944 in 2019 to 2020 to 27,304 this year) and a 6% increase in benzodiazepines (from 4,083 in 2019 to 2020 to 4,321 this year).

Although the numbers are relatively low, there was an increase in adults entering treatment in 2020 to 2021 with ketamine problems (from 1,140 in 2019 to 2020 to 1,444 this year). This is a 27% rise in one year and is part of a trend in rising numbers entering treatment over the last 7 years. The total is now nearly 3.5 times higher than it was in 2014 to 2015.

Housing and mental ill health

Over one-sixth (17%, or 22,493) of adults entering treatment last year said they had a housing problem. This proportion varied by substance group, ranging from 1 in 10 (10%, or 4,941) of those starting treatment for alcohol problems alone, to almost a third (30%, or 11,286) of those starting treatment for problems with opiate use. As in previous years, people starting treatment for problems with new psychoactive substances (NPS) had the highest proportion of housing need of any substance group (45%).

Nearly two-thirds (63%, or 82,613) of adults starting treatment said they had a mental health treatment need. This is part of a trend of rising numbers over the previous 2 years (from 53% in 2018 to 2019). Over half of new starters in all substance groups needed mental health treatment. This need ranged from 57% in the opiate group to nearly three-quarters (71%) of the non-opiates and alcohol group.

Treatment exits and deaths in treatment

There were 110,095 people who exited the drug and alcohol treatment system in 2020 to 2021. Half (50%) of those left having successfully completed their treatment, free from dependence. This is an increase in the proportion of people who successfully completed treatment since the previous year (47%).

The total number of people who died while in contact with treatment services in 2020 to 2021 was 3,726 (1.4% of all adults in treatment). This represents a 27% increase of deaths in treatment compared to last year (2,929, or 1.1% of all adults in treatment).

Last year, all substance groups except opiate users saw a decrease in deaths in treatment compared to the previous year. By contrast, there were increases in the proportion of people dying while in treatment in all substance groups this year. There were increases in the:

• opiate group by 20%
• non-opiate only group by 36%
• non-opiate and alcohol group by 37%
• alcohol only group by 44%

Drug use is a significant cause of premature death in England, as the Office for National Statistics (ONS) drug poisoning data has shown. In England, the number of deaths from drug misuse registered in 2020 was 2,830, the highest level since records began.

Smoking among people in treatment

Over 51,000 people (56%) said they had smoked tobacco in the 28 days before starting treatment. Across all substance groups, the level of smoking for men and women was substantially higher than the smoking rate of the general adult population (15.9% for men and 12.5% for women).

Despite the high levels of smoking, only 2% of people were recorded as having been offered referrals for smoking cessation interventions. This was down from 3% in 2019 to 2020.

The effect of the coronavirus (COVID-19) pandemic

Like other services, drug and alcohol treatment services were affected by the need to protect their staff and service users in the pandemic, especially in the early stages. Most services had to restrict face-to-face contact, which affected the types of interventions that service users received. For example, most patients whose opioid substitute consumption was supervised before the pandemic were given take-home doses from March 2020, after a risk assessment. Fewer service users were able to access inpatient detoxification for alcohol and drugs. Testing and treatment for blood-borne viruses and liver disease were also greatly reduced.

These and other changes to service provision during the pandemic may have affected many of the indicators included in this report.

It’s likely that a number of factors will have contributed to the increase in the number of service users who died while in treatment during 2020 to 2021. These include changes to alcohol and drug treatment, reduced access to other healthcare services, changes to lifestyle and social circumstances during lockdowns, and COVID-19 itself.

People in treatment: substance, sex, age

Overview

The National Drug Treatment Monitoring System (NDTMS) statistics report presents information on adults (aged 18 and over) who were receiving help in England for problems with drugs and alcohol in the period between 1 April 2020 and 31 March 2021.

Many people experience difficulties with alcohol and drugs and receive treatment for both substances. While they often share many similarities, they also have clear differences, so this report divides people in treatment into 4 substance groups:

1. Opiate: people who are dependent on or have problems with opiates, mainly heroin.
2. Non-opiate: people who have problems with non-opiate drugs only, such as cannabis, crack and ecstasy.
3. Non-opiate and alcohol: people who have problems with both non-opiate drugs and alcohol.
4. Alcohol only: people who have problems with alcohol but do not have problems with any other substances.

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