About the data
How the data is organised
There are two over-arching categories, with four sub-categories:
1. Prevalence and Risks
- An estimate of the extent of opiate and crack use in a given area and the proportion of those who inject them. Opiates (e.g. heroin) and crack have historically been the most prominent drugs used by people seeking specialist drug treatment and are closely linked to poor health. People who inject drugs are particularly vulnerable to a wide range of viral and bacterial infections and experience elevated risk of overdose.
- The number of alcohol-related admissions to hospital in a given area – this number is considered the most robust measure of prevalence of alcohol-related ill health at a local level. It describes the impact alcohol has on the health of a population. It should be noted that alcohol related admissions to hospital will include people who may not be dependent on alcohol but are admitted to hospital with conditions in which alcohol is known to be a contributory factor (e.g. high blood pressure). This measure is included within the Public Health Outcomes Framework (number 2.18) and can assist areas to monitor the impact of actions they are taking to reduce alcohol-related harm. Detailed definitions are available from the PHOF website.
2. Treatment and Recovery
- Two indicators measuring waiting times for people who need drug and alcohol treatment. Prompt access to treatment is vital, and long waiting times can be an early sign of problems with the availability and/or effectiveness of treatment.
- Three indicators measuring recovery rates for people in drug and alcohol treatment. These are indicative of the effectiveness of treatment and other local services that support alcohol and drug recovery (e.g. local employment and housing services).
Detailed technical definitions are available from here (pdf).
What the latest available data tells us
Prevalence and Risks
Data estimating the number of opiate and/or crack users (OCU) in England is now available going back to 2004/05 (see http://www.nta.nhs.uk/facts-prevalence.aspx for historic data and detailed methodology). The OCU population in England in 2011/12 is estimated to be just under 300,000, a fall of around 10% since 2004/05, but nevertheless a significant number of current OCUs. There has been a much larger decline in opiate/crack injectors: a reduction of over a third since 2004/05, from nearly 140,000 to just under 90,000.
The general downward trend in prevalence in England masks some regional variation, although there is a need to interpret this cautiously as the estimates tend to be subject to broad confidence limits. The estimated number of OCUs in London fell significantly, by a quarter between 2004/05 and 2011/12, while in two regions (the North East and East Midlands) the estimated numbers of OCUs for 2011/12 were higher than in 2004/05, although in neither region were the changes statistically significant. There were significant decreases in injecting of these drugs in most regions.
The latest data shows that the areas with high prevalence of opiate and crack use tend to be urban, broadly correlating with measures of socio-economic deprivation, although there are exceptions. The urban centres in the North East and parts of West Yorkshire (Bradford, Leeds and Wakefield) are notable as they experience significantly high rates of both use and injection of these drugs compared to the national average.
The rate of alcohol-related hospital admissions varies significantly across the country, with all areas in the North East and most in the North West experiencing significantly high rates, while many areas in London and the South East experience rates that, while comparatively low are nevertheless significantly higher than 20 years ago. A detailed suite of indicators concerning alcohol harm is available from the Local Alcohol Profiles for England (http://www.lape.org.uk/).
Treatment and Recovery
Ensuring quick and easy access to treatment for those who need it is vitally important and can make all the difference to those affected. In 2014/15, 98% of those seeking help for their drug use waited less than three weeks from the time they were referred to the time they started a structured treatment programme. The figure was only slightly lower than that, for those referred for help with their alcohol use with 95% waiting less than three weeks from the time of the referral to when their treatment began, indicating that there is general ready availability of drug and alcohol treatment in England. Areas with longer waiting times seem to have no obvious pattern of connections between them.
Recovery from drug or alcohol dependence is achievable and local areas can do much above and beyond commissioning drug and alcohol treatment to ensure that all services they provide, commission or support, promote a positive message of recovery from dependence. Where this is done well recovery is more likely to be achieved and sustained. Access to mutual aid is known to be of particular benefit.
Successful completion of drug treatment is used as the key proxy measure of recovery, because an individual is only recorded as having completed treatment successfully if they are assessed by the clinician treating them as free from dependence. The measure includes a non-representation element meaning that individuals don’t get counted if they come back into treatment within six months. This is the key proxy measure of recovery included within the Public Health Outcomes Framework.
Nationally, 7% of opiate users in treatment in 2014/15 completed treatment successfully in that year by this measure. It is important to note that this does not mean that only 7% of opiate users recover. This is the in-year proportionate rate - and tells us something about the effectiveness of the treatment and the area in general in promoting recovery - rather than telling us about an individual’s likelihood of recovery. Recovery from dependent use, particularly of opiates is known to be a long-term process and for many it may take longer than one year.
Over the ten years between April 2005 and March 2015, 24% of opiate users successfully completed treatment and have not returned to it. For users of other drugs, the annual successful treatment completion rate in 2014/15 was 39%, with the longer term recovery rate again higher at 51%. The annual successful treatment completion rate for those in alcohol treatment is similar, at around 38%, with a longer term recovery rate of 52%. There is a clear message here: people can and do recover from drug and alcohol dependence.
When considering opiate successful completion rates across the country, most areas do not deviate significantly from the national average, while there is more variation in the rates for users of other drugs and for alcohol. Some areas in London may see their local successful completion rate for users of other drugs affected by high numbers of crack cocaine users in treatment. Users of crack cocaine (without opiates) generally experience lower successful completion rates than others in the 'other drugs' category.
Several areas are identified as having significantly lower completion rates compared to the national average across all three populations, opiates, other drugs and alcohol.
Detailed statistics on alcohol and drug treatment, including a wide range of additional information collected by the National Drug Treatment Monitoring System (NDTMS), are published on NDTMS.net with official statistics released annually by PHE (see http://www.nta.nhs.uk/statistics.aspx).
Actions to tackle alcohol and drug problems
Locally, alcohol and drug problems are best addressed by a range of evidence-based interventions comprising prevention activities, early interventions targeted at those who are particularly vulnerable to the harms associated with alcohol and drug use, and the delivery of recovery-focused treatment and support. Local Authorities are responsible for the commissioning of drug and alcohol treatment for their population.
Effective interventions require partnership working between a range of organisations. Local authorities, including elected members, directors of public health, children and family services, NHS and adult social care; police and other criminal justice agencies; specialist treatment providers, Jobcentre Plus and the Work Programme, and many others, all have a vital role to play.
Public Health England (PHE) promotes a balanced and ambitious approach to reduce the harm to health and wellbeing caused by alcohol and drugs. PHE supports local areas by providing expertise, evidence, data and guidance on effective interventions. Evidence-based resources supporting the commissioning and delivery of recovery-focused treatment can be found on the Recovery Resources website and the Alcohol Learning Resource.
Investing in alcohol interventions for adults has been shown to be very good value. Investment in screening in primary care, alcohol care teams in secondary care and providing treatment for those who are dependent all save money by reducing the burden on the NHS and other public services (see Why Invest). There are wider savings to Local Areas to be made in reduced social care, safeguarding and community safety costs.
Every £1 spent on young people’s drug and alcohol interventions is estimated to save between £5 and £8, while £1 spent on adult drug treatment is estimated to save £2.50. The savings are largely made in health, crime and welfare costs.