National statistics

Adult substance misuse treatment statistics 2022 to 2023: report

Updated 21 December 2023

Applies to England

Summary

Trends in treatment numbers

There were 290,635 adults in contact with drug and alcohol services between April 2022 and March 2023. This is a small rise compared to the previous year (289,215).

The number of adults entering treatment in 2022 to 2023 was 137,749, which is higher than the previous 2 years’ figures (130,490 and 133,704). The numbers of people entering treatment was relatively stable from 2016 to 2017 up to 2021 to 2022.

Trends in substance use treatment

Nearly half (48%) the adults in treatment were there for problems with opiates. Despite the number of people in treatment for opiate use slightly decreasing from last year (from 140,558 to 138,604), this remains the largest substance group. You can find more information about what the different substance groups are in the ‘People in treatment: substance, sex, age’ section.

People in treatment for alcohol alone make up the next largest group (30%) of all adults in treatment. The number of those rose by 2% from the previous year (from 84,697 to 86,257) but this is lower than the peak of 91,651 in 2013 to 2014.

There were increases in the other 2 substance groups (a 1% increase in the non-opiate group and 4% in the non-opiate and alcohol group). This follows a rise last year of 7% for the non-opiate group and 11% for the non-opiate and alcohol group.

After seeing a decline in the previous 2 years, there has been a rise in the overall number of adults entering treatment for crack cocaine. This rise includes people who are using crack with opiates (18,832 to 20,158) and those who are using crack without opiates (4,711 to 5,444).

People starting treatment in 2022 to 2023 with powder cocaine problems increased by 10% (from 21,298 to 23,529). This surpasses the previous peak number of 21,396 in 2019 to 2020.

New entrants to treatment with cannabis problems increased again this year, which saw a 2% rise (from 28,263 in 2021 to 2022 to 28,845 this year). New entrants with benzodiazepine problems fell 6% (from 3,848 in 2021 to 2022 to 3,620 this year), after increasing every year since 2018 to 2019 up until 2021 to 2022.

Although the numbers are relatively low, there was an increase in adults entering treatment in 2022 to 2023 with ketamine problems (from 1,551 in 2021 to 2022 to 2,211 this year). This is part of a trend in rising numbers entering treatment over the last 9 years. The total is now over 5 times higher than it was in 2014 to 2015.

Housing

For the first time in 2022 to 2023, services could record more detailed information about the current housing situation of people in treatment, including whether they were at risk of homelessness within the next 8 weeks.

A fifth (20%) of people starting treatment had no home of their own when data was recorded.

Thirty-seven per cent of people starting treatment with opiate problems had no home of their own, the highest proportion among the 4 substance groups.

Over 1 in 12 people (9%) starting treatment said they had a risk of homelessness in the next 8 weeks. For people with opiate problems, the proportion with this risk was 16%. And for people with alcohol problems only this proportion was 5%.

People in treatment for problems with psychoactive substances (mainly synthetic cannabinoids, previously recorded as ‘new psychoactive substances’) had the highest proportion of risk, with 24% saying they could be made homeless in the next 8 weeks when starting treatment.

Mental ill health

Over two-thirds (71%, or 97,685) of adults starting treatment said they had a mental health treatment need. This is a similar proportion to the previous year (70%), but a large increase from 2018 to 2019 (53%). At least two-thirds of new starters in all substance groups needed mental health treatment. This need ranged from 67% in the opiate group to 77% of the non-opiates and alcohol group.

Treatment exits and deaths in treatment

There were 127,385 people who exited the drug and alcohol treatment system in 2022 to 2023. Nearly half (46%) of those who left had successfully completed their treatment, free from dependence. This is similar to the proportion of people who successfully completed treatment in the previous year (49%).

The total number of people who died while in contact with treatment services in 2022 to 2023 was 4,166, or 1.4% of all adults in treatment. This represents an 11% increase of deaths in treatment compared to last year (3,742) and is an increase in the proportion of deaths of all adults in treatment (1.3% in 2021 to 2022).

Smoking among people in treatment

Over 40,000 people (49%) said they had smoked tobacco in the 28 days before starting treatment in 2022 to 2023. Across all substance groups, the level of smoking for men and women was substantially higher than the smoking rate of the general adult population in England, which was 14.5% for men and 10.9% for women.

Despite these high levels of smoking, only 4% of people were recorded as having been offered referrals for smoking cessation interventions, which is similar to the proportion recorded in 2021 to 2022.

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 year between 1 April 2022 and 31 March 2023.

Many people experience difficulties with, 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.

Figure 1: how people are classified into substance reporting group

Figure 1 shows how people are classified into a substance reporting group after entering treatment and undergoing initial assessment.

People with an opiate problem are placed in the ‘opiate’ substance group regardless of whether other substances are also problematic. For all other individuals, they are categorised as ‘non-opiate only’, ‘non-opiate and alcohol’ or ‘alcohol only’.

Question 1: Does the person have problems with opiates?

• Yes: person is classified into the opiate substance group.
• No: go to question 2.

Question 2: Does the person have a problem with non-opiate drugs?

• Yes: go to question 3.
• No: go to question 4.

Question 3: Does the person have problems with alcohol?

• Yes: person is classified into non-opiate and alcohol substance group.
• No: person is classified into non-opiate only substance group.

Question 4: Does the person have problems with alcohol?

• Yes: person is classified into alcohol only substance group.

Substance use, sex and age of people in treatment

Figure 2: breakdown of people in treatment by sex and substance group

There were 290,635 people in contact with drug and alcohol services between 1 April 2022 and 31 March 2023.

Substance group	Male	Female	Total
Opiate	100,629 (72.6%)	37,975 (27.4%)	138,604
Non-opiate only	20,369 (67.9%)	9,632 (32.1%)	30,001
Non-opiate and alcohol	25,332 (70.8%)	10,441 (29.2%)	35,773
Alcohol only	51,115 (59.3%)	35,145 (40.7%)	86,257
Total	197,442 (67.9%)	93,193 (32.1%)	290,635

Nearly half of all adults (48%) received treatment for problems with opiates. A further 23% had problems with other drugs, and over a quarter (30%) had problems with alcohol only. These proportions are similar to previous years, and you can find more detailed information on trends in the ‘Trends over time’ section.

More than two-thirds of people in treatment were men and less than one-third were women (68% men to 32% women). This proportion varies greatly by substance group. For the drug groupings, men make up just over two-thirds (opiate 73%, non-opiate only 68%, non-opiate and alcohol 71%). But in the alcohol only group the divide is smaller with men making up 59% and women 41%.

Problem substances for people in treatment

Figure 3: substances by group for people in treatment (count of problem substances reported)

Substance group	Opiate	Non-opiate only	Non-opiate and alcohol	Alcohol only	Total
Opiates (not crack cocaine)	68,322	0	0	0	68,322
Both opiates and crack cocaine	70,282	0	0	0	70,282
Crack cocaine (not opiates)	0	4,248	3,797	0	8,045
Cannabis	22,124	17,011	18,046	0	57,181
Cocaine	7,621	10,862	18,773	0	37,256
Alcohol	23,172	0	35,773	86,257	145,202

Figure 3 shows a breakdown of the substances reported by people in treatment in 2022 to 2023, split into the 4 substance groups. Up to 3 substances can be recorded at the start of treatment, so one person could be counted for several substances in their substance group (for example, somebody who uses cocaine, cannabis and alcohol, would appear in the non-opiate and alcohol group for these 3 substances).

The numbers show that opiates were the most frequently reported drug with slightly more people using opiates along with crack compared to opiates alone. Out of all people in treatment, 50% said they had a problem with opiates, crack or both. Half (50%) of people said they had problems with alcohol, with most of these being in the alcohol only group. One-fifth (20%) said they used cannabis, most commonly in the opiate substance group. Cocaine (non-crack) was reported by 13% of people, the largest proportion of these being categorised into the non-opiate and alcohol substance group.

You can find a more detailed breakdown of reported substances in the data tables that accompany this report.

Age groups

Figure 4: age of people in treatment

Age group	Opiate	Non-opiate only	Non-opiate and alcohol	Alcohol only	Total
18	93	866	619	232	1,810
19	131	847	550	268	1,796
20 to 24	1,751	4,948	3,725	2,268	12,692
25 to 29	5,410	5,648	5,121	4,554	20,733
30 to 34	13,338	5,802	6,926	8,243	34,309
35 to 39	22,838	4,540	6,369	11,084	44,831
40 to 44	31,051	3,029	4,752	12,115	50,947
45 to 49	26,244	1,911	3,194	12,149	43,498
50 to 54	19,899	1,251	2,434	12,548	36,132
55 to 59	11,080	684	1,365	10,467	23,596
60 to 64	4,511	263	545	6,754	12,073
65 to 69	1,610	116	137	3,316	5,179
70+	648	96	36	2,259	3,039

Figure 4 shows that the age of people in treatment has continued the trend from previous years showing an increase in older age groups. Three-fifths of people in treatment (60%) were over 40 years old (compared to 58% in 2021 to 2022 and 51% in 2016 to 2017), with:

• 17.5% of people in the 40 to 44 age group
• 15% of people in the 45 to 49 age group
• 12.4% of people in the 50 to 54 age group
• 8.1% of people in the 55 to 59 age group
• 7% of people aged 60 and over

Less than 10% of people in treatment for opiates or alcohol only were under 30 (5% for opiates and 8% for alcohol only). Across all substance groups there were:

• 7.1% of people in the 25 to 29 age group
• 4.4% of people in the 20 to 24 age group
• 1.2% people aged 18 or 19

The median age of people in treatment in the 4 substance groups ranged from 46 for the alcohol only group to 32 for non-opiates only. People in treatment for opiates had a median age of 44. You can find a detailed breakdown of age statistics in the data tables that accompany this report.

A large proportion of opiate users in treatment will have started using heroin in the epidemics of the 1980s and 1990s and are now over 40 years old. In 2022 to 2023, 64% said they first used heroin before 2001 and only 15% first used heroin since 2011.

People starting treatment: substances, age and referral source

Substances reported by people starting treatment

Figure 5: substances by group for people starting treatment in 2022 to 2023 (count of problem substances reported)

Substance	Opiate	Non-opiate only	Non-opiate and alcohol	Alcohol only	Total
Opiates (not crack cocaine)	14,300	0	0	0	14,300
Both opiates and crack cocaine	20,158	0	0	0	20,158
Crack cocaine (not opiates)	0	2,921	2,523	0	5,444
Cannabis	5,167	11,858	11,820	0	28,845
Cocaine	2,071	8,184	13,274	0	23,529
Alcohol	5,277	0	24,229	57,802	87,308

In 2022 to 2023, 137,749 people started treatment for drug and alcohol problems. This is where a person started a new treatment journey, either for the first time or returning to treatment having had a break of over 21 days.

Of the people starting treatment:

• 63% said they had a problem with alcohol
• 25% said they had a problem with opiates
• 19% said they had a problem with crack cocaine
• 21% said they had a problem with cannabis
• 17% said they had a problem with (non-crack) cocaine

Of the people who said they had a problem with alcohol, two-thirds (66%, or 57,802) said it was their only problem substance.

Figure 5 shows the number of people starting treatment who reported problems with each substance, divided into the 4 substance groups. Most people with alcohol problems were in the alcohol only group. However, alcohol was the third most frequently reported substance in the opiate group.

In the non-opiate and alcohol group, cocaine was the second most frequently reported drug, followed closely by cannabis. Cannabis was the most frequently reported drug in the non-opiate substance group, followed by cocaine. Most people in the opiate group used both opiates and crack. Opiates without crack was the second most commonly reported substance in this group.

People starting treatment in 2022 to 2023 with powder cocaine problems increased by 10% (from 21,298 to 23,529). This surpasses the peak number of 21,396 in 2019 to 2020.

People starting treatment with cannabis problems increased again this year, with a 2% rise (from 28,263 in 2021 to 2022 to 28,845 this year).

New entrants with benzodiazepine problems fell for the second year, after increasing every year from 2018 to 2019 up until 2020 to 2021. Numbers fell 6% from 3,848 in 2021 to 2022 to 3,620 this year.

Although the numbers are relatively low, there was an increase in adults entering treatment in 2022 to 2023 with ketamine problems (from 1,551 in 2021 to 2022 to 2,211 this year). There was also a small rise in methamphetamine treatment numbers this year (from 558 last year to 615), which has been increasing gradually since reporting began in 2005 to 2006.

You can find more information on the breakdown of club drugs by substance group in the data tables that accompany this report.

Age of people starting treatment

Figure 6: people starting treatment by age

Age group	Opiate	Non-opiate only	Non-opiate and alcohol	Alcohol only	Total
18 to 19	143	1,214	757	365	2,479
20 to 24	974	3,588	2,593	1,613	8,768
25 to 29	2,443	4,103	3,611	3,229	13,386
30 to 34	5,037	4,180	4,864	5,613	19,694
35 to 39	6,969	3,196	4,378	7,558	22,101
40 to 44	7,504	2,112	3,200	8,160	20,976
45 to 49	5,219	1,289	2,051	8,008	16,567
50 to 54	3,484	834	1,478	8,203	13,999
55 to 59	1,676	433	841	6,802	9,752
60 to 64	690	170	345	4,429	5,634
65+	319	141	111	3,822	4,393

Figure 6 shows the number of people starting treatment in each age group, categorised into the 4 substance groups.

The most common age group was 35 to 39, with 22,101 people starting treatment. This was followed by the 40 to 44 age group, with 20,976 people, then the 30 to 34 age group with 19,694 people. Within these 3 groups, the alcohol only substance group was the largest, the same as last year. Over half of people starting treatment (52%) were 40 years old and over. Of those aged 55 years and over, 76% said they had problems with alcohol only. This is a decrease of 2% compared to the previous year.

The non-opiate only and non-opiate and alcohol groups had the largest proportion of people under 30 years old starting treatment, at 42% and 29% respectively.

Referral sources

Figure 7: referral sources for people starting treatment in 2022 to 2023

Substance group	Self, family and friends	Health and social care	Criminal justice	Substance misuse service	Other	Total
Opiate	55%	9%	25%	6%	5%	100%
Non-opiate only	60%	19%	12%	3%	6%	100%
Non-opiate and alcohol	59%	21%	12%	3%	5%	100%
Alcohol only	61%	24%	7%	3%	5%	100%

Of the people starting treatment in 2022 to 2023, 59% self-referred (which may be following advice from a healthcare professional) or were referred by family and friends. This was the most common referral source in all 4 substance groups.

Referral from health and social care was the second most common referral source and made up 19% overall. This includes referrals from GPs, which accounted for 6% of all referrals, but was higher in the alcohol only group at 8%. Hospitals made up 5% of all referrals while only 3% of referrals came from social services. Referrals from healthcare varied between the individual substance groups. Only 9% of opiate referrals came from healthcare compared to 24% of alcohol only referrals.

Collectively, referrals from the criminal justice system made up 13%. But there was a big difference between substance groups, with 25% of opiate referrals coming from the criminal justice system compared to just 7% for those with only alcohol problems. Prison referrals accounted for 5% of all referrals.

You can find a further breakdown of these referral groups in the data tables that accompany this report.

Housing

For the first time in 2022 to 2023, services could record more detailed information about the current housing situation of people in treatment. The new category ‘risk of homelessness within the next 8 weeks’ was also included.

Figure 8 shows the proportions of people starting treatment by the category of housing they are living in, separated into the 4 substance groups.

Around 1 in 6 people (20,872 or 16%) starting treatment said they owned their own home. The highest proportion of these were found in the alcohol only group with 28%, while all other substance groups were under 10%.

A further 45% were renting from a private or a social landlord. Only 38% of people with opiate problems rented from a private or social landlord, whereas the proportions in all other substance groups were close to half (47% to 48%).

A fifth (20%) had no home of their own, which included people who were:

• living with friends or family as a short-term guest (6%)
• in temporary supported accommodation (4%)
• ‘sofa surfing’ (3%)
• living on the streets (2%)

Thirty-seven per cent of people starting treatment with opiate problems had no home of their own, the highest proportion among the 4 substance groups.

A further 19% of people starting treatment were living in other categories, including long term supported accommodation or living with friends and family permanently.

Figure 8: housing categories of people starting treatment in 2022 to 2023

Substance group	Owns home	Rented home	No home of their own	Other	Total
Opiate	4.1%	38.3%	37%	20.6%	100%
Non-opiate only	8.1%	47.9%	17.5%	26.5%	100%
Non-opiate and alcohol	9.2%	48.3%	19.9%	22.7%	100%
Alcohol only	28%	47.3%	10.5%	14.2%	100%

Figure 9 shows the proportions of people starting treatment who had a risk of being made homeless in the next 8 weeks, separated into the 4 substance groups.

Over 1 in 12 people (9%) starting treatment said they had a risk of homelessness. For people with opiate problems, the proportion with this risk was 16% while for people with problems with alcohol only this proportion was 5%.

People in treatment with problems with psychoactive substances (mainly synthetic cannabinoids, formerly recorded as ‘new psychoactive substances’) had the highest proportion of risk, with 24% saying they could be made homeless in the next 8 weeks when starting treatment.

Figure 9: risk of homelessness in the next 8 weeks for all substance groups and psychoactive substances, starting treatment in 2022 to 2023

Substance group	Risk of homelessness in the next 8 weeks
Opiate	16.2%
Non-opiate only	6.9%
Non-opiate and alcohol	8.3%
Alcohol only	4.7%
Psychoactive substances	24.4%
All	8.5%

Mental health

Figure 10: mental health need and treatment received for people starting treatment in 2022 to 2023

Over two-thirds of people starting treatment said they had a mental health need (71%). When looking at the 4 substance groups, the proportions of people reporting a mental health need were:

• 67% of people in the opiate group
• 71% of people in the non-opiate only group
• 77% of people in the non-opiate and alcohol group
• 71% of people in the alcohol only group

Over one-fifth (21%) of people who had a mental health need were not receiving any treatment to meet this need. Of those receiving mental health treatment:

• 64% received it in a primary care setting, such as a GP surgery
• 21% were engaged with the local community mental health services
• 2% were engaged with improving access to psychological therapies programmes (now known as NHS talking therapies for anxiety and depression)
• 2% received National Institute for Health and Care Excellence recommended psychosocial interventions provided for the treatment of a mental health problem in drug or alcohol services
• 1% had an identified space in a health-based place of safety for mental health crises

Injecting status

Figure 11: injecting status of people starting treatment in 2022 to 2023

Substance group	Currently injecting	Previously injected	Not currently injecting, unknown previous	Never injected	Total
Opiate	20%	32%	0.6%	48%	100%
Non-opiate only	2%	6%	0.7%	91%	100%
Non-opiate and alcohol	1%	6%	0.7%	92%	100%
Alcohol only	0.6%	2%	1.1%	96%	100%

Seventeen per cent of all people starting treatment were currently injecting or had previously injected drugs. This is much higher for people with opiate problems, with 20% currently injecting and 32% having previously injected. In the other substance groups, over 90% of people had never injected drugs. In the non-opiate only and non-opiate and alcohol groups, 6% said they had previously injected.

Only very small numbers outside of the opiate substance group were currently injecting with just 2% of people in the non-opiate only group, and 1% of the non-opiate and alcohol group. Only 2% of people with alcohol only problems had previously injected drugs.

Parental status and safeguarding children

Figure 12: parental status of people starting treatment in 2022 to 2023

Parental status	Percentage of people starting treatment
Not a parent and not in contact with children	66%
Parent not with children	14%
Other contact living with children	2%
Parent living with children	18%

In 2022 to 2023, 20% (26,924) of people starting treatment were living with children, either their own or someone else’s. A further 14% were parents who were not living with their children. This was highest among men in treatment for non-opiates and alcohol, where 18% were parents who were not living with their children.

Twenty-seven per cent of women reported either living with a child or being a parent when they started treatment, compared to 16% of men.

The average number of children per household where people in treatment live with a child was 1.9.

The total number of children living with people starting treatment was 50,053. This includes children who live with parents who are in treatment, and those who are living with someone in treatment who is not their parent.

Figure 13: children receiving early help or in contact with children’s social care

Help received or contact with children’s social care	Children receiving early help or in contact with children’s social care
Early help	21%
Child in need	24%
Child protection plan	40%
Looked after child	20%
Other support service	14%

Thirty-five per cent of children of people starting treatment were receiving early help. Figure 13 shows the types of early help that these children were receiving. The children of people starting treatment can receive more than one type of early help. Early help services provide support to children and their families as soon as problems emerge. Fourteen per cent of the children of all people starting treatment had a child protection plan and this figure was highest in the non-opiate group, at 23%.

Smoking

Figure 14: smoking rates at the start of treatment

Substance group	Women	Men
Opiate	60%	62%
Non-opiate only	55%	54%
Non-opiate and alcohol	59%	58%
Alcohol only	37%	39%
General population	10.9%	14.5 %

Over 40,000 people (49%) said they had smoked tobacco in the 28 days before starting treatment. This is based on information collected at the start of treatment and a 6-month review using the treatment outcomes profile (TOP), which is part of a set of outcome monitoring forms. You can find TOP forms in the ‘Core dataset Q (from 1 April 2022) combined review and outcome forms’ section on the NDTMS website.

Across all substance groups, men and women reported smoking at similar levels. In all cases, the level of smoking was much higher than the general adult smoking rate in England. The rate for men is 14.5% and for women is 10.9%, as outlined in the Office for National Statistics (ONS) dataset Smoking habits in the UK and its constituent countries.

Despite the high levels of smoking, only 4% of people were recorded as having been offered referrals for smoking cessation interventions, the same proportion recorded in 2021 to 2022.

Treatment interventions

Figure 15: breakdown of settings where people’s treatment took place

Setting	Prescribing	Psychosocial
Community	94%	98%
Primary care	10%	3%
Inpatient unit	7%	3%
Residential	1%	2%

We have excluded settings with proportions of less than 1% from figure 15, but the information is available in the data tables that accompany this report.

Almost all (more than 99%) people in treatment received some form of structured treatment. You can find a definition of structured treatment in the NDTMS Adult drug and alcohol treatment business definitions, in the ‘Core dataset Q documentation section’ on the NDTMS website.

Of the people that did receive structured treatment:

• 98% received community-based treatment
• 6% received treatment in a primary care setting
• 4% received treatment in an inpatient setting
• 2% received treatment in a residential setting

The number of people receiving treatment in inpatient settings has increased from 9,550 people in 2021 to 2022 to 11,400 this year. The number in residential rehabilitation has also increased from 4,555 in 2021 to 2022 to 5,066 this year.

Figure 16: breakdown of type of treatment that people received

Substance group	Prescribing	Psychosocial
Opiate	94%	99%
Non-opiate only	7%	100%
Non-opiate and alcohol	14%	100%
Alcohol only	18%	100%

Figure 16 shows the breakdown of the main type of intervention received, either prescribing or psychosocial interventions, by people in treatment for the 4 main substance groups.

Ninety-nine per cent of people received a psychosocial intervention while 53% received at least one prescribing intervention.

Over 99% of people in the non-opiate only, non-opiate and alcohol, and alcohol only groups received a psychosocial intervention. People with problems with opiates were the lowest proportion of people receiving a psychosocial intervention, with just below 99%.

Of the number of people receiving prescribing interventions:

• 85% were in the opiate group
• 10% were in the alcohol only group
• 3% were in the non-opiate and alcohol group
• 1% were in the non-opiate only group

Of the people starting treatment, 98% did so within 3 weeks of being referred to treatment.

This year, for the first time, we are reporting on the numbers of people receiving individual placement and support (IPS). IPS is a specialist intervention to help people find and stay in work. At the end of 2022 to 2023, IPS was available in 63 local authorities. You can find more information on the numbers of people receiving IPS in the data tables that accompany this report.

Treatment outcomes

Treatment exits

Figure 17: breakdown of latest treatment exits in 2022 to 2023

A total of 127,385 people left drug and alcohol treatment in 2022 to 2023.

Of the people who left treatment, 46% completed their treatment successfully and were discharged as ‘treatment completed’. The alcohol only group had the highest rate of treatment completed at 58%. This was followed by the non-opiate group (51%) and the non-opiate and alcohol group (49%). The opiate only group had a completion rate of 23%.

Over a third (37%) of people dropped out or left treatment without completing it. The remaining 16% of exits included:

• 10% who left due to unsuccessful transfers between services or to treatment in prison
• 2% who declined treatment
• 3% who died while in treatment

Time taken to successfully complete treatment

On average (mean), people who completed treatment successfully did so within a year of starting treatment (323 days).

The average time in treatment for people with opiate problems who completed treatment successfully was 3.3 years (1,209 days) and around 6 months for the other substance groups (172 days for non-opiate only, 205 days for non-opiate and alcohol and 206 days for alcohol only).

Deaths in treatment

Every year, people die while they are in an alcohol and drug treatment programme, but these deaths might not be alcohol or drug related.

There were 4,166 recorded deaths in treatment in 2022 to 2023, which was 1.4% of all people in treatment. Compared to 2021 to 2022, this is an 11% increase in the number of deaths (from 3,742) and is an increase in the proportion of people in treatment dying (from 1.3%). This is a higher proportion than the previous peak in 2020 to 2021 (1.35%).

People with opiate problems accounted for nearly two-thirds (64%) of these deaths, and the alcohol only group had a further 28% of deaths.

Drug use is a significant cause of premature death in England, as the ONS drug poisoning data has shown. In England, the number of deaths from drug misuse registered in 2021 was 2,846, which is the highest level since records began.

Data from ONS on deaths related to drug poisoning by date of occurrence in England and Wales shows that rates of drug misuse deaths continue to be higher among people born in the 1970s, with the highest rate in those aged 45 to 49. Among men, there were 110.3 drug poisoning deaths which occurred per million in 2020 (3,123 registered deaths), compared with 50.2 deaths per million among women (1,463 deaths).

Alcohol use is a significant cause of premature death in England, as the ONS alcohol-specific deaths data shows. In England, the number of alcohol-specific deaths registered in 2021 was 9,641, a rise of 27.4% since 2019.

Self-reported outcomes: substance use

Figure 18: change in self-reported number of days use between start of treatment and 6-month review

Substance	Baseline	Review
Opiate use (opiate only clients)	23.7 days	7.1 days
Opiate use (opiate and crack cocaine clients)	22.4 days	11.2 days
Crack cocaine use (all drug clients)	18.3 days	10.9 days
Alcohol use (alcohol only clients)	21.4 days	12.1 days

The Office for Health Improvement and Disparities (OHID) collects information about the outcomes for people who use drug and alcohol treatment services. This includes the TOP monitoring form, which measures change and progress in important areas of their lives.

People in treatment for opiate problems reported a fall in the number of days they used opiates. When they started treatment, they reported an average of 22.9 days using opiates in the previous 28 days. At their 6-month treatment review, this number had fallen to 9.5 days.

The alcohol only group reported a fall in the number of days that they used alcohol. When they started treatment, they reported an average of 21.4 days drinking in the previous 28 days. At their 6-month review, this number had fallen to 12.1 days.

Self-reported outcomes: education, employment and injecting

Figure 19: change in self-reported injecting, employment and education between start of treatment and 6-month review

Category	Baseline	Review
Education (all)	11 days	10.3 days
Employment (all)	18.1 days	18.2 days
Injecting (opiate)	20.5 days	8.9 days

For people in education at the start of treatment and at their 6-month review, the average number of days that they reported being in education fell from 11 at the start to 10.3 at the review.

For people in employment at the start of treatment and at their 6-month review, the average number of days they were in employment in the last 28 days increased. This rose from 18.1 days at the start of treatment to 18.2 days at their review.

For people with opiate problems who were injecting at the start of treatment, the average number of days of injecting dropped from 20.5 days per month at the start of treatment to 8.9 days per month at the 6-month review.

Trends over time

Numbers in treatment

Figure 20: trends in numbers in treatment by substance group between 2005 to 2006 and 2022 to 2023

The overall number of people in treatment increased by 0.5% since last year, with 290,635 people in treatment, the highest amount since 2014 to 2015.

The non-opiate and alcohol group saw the highest proportional rise of all the substance groups, with a 4% increase (1,395). This continues an upward trend from 27,684 in 2017 to 2018. The non-opiate only group had the highest number of people (30,001) in treatment since reporting started, 4% higher than the previous peak in 2006 to 2007 (28,777). The opiate group has declined since 2020 to 2021, with a 1.4% decrease this year.

Numbers for people in treatment who said they had a problem with alcohol only are shown from 2009 to 2010 onwards when national alcohol treatment data collection started.

You can find these trends over time on the NDTMS website using the ViewIt tool. You can choose to display either England or local authority level data, as well as split the data by substance, sex and age groups.

People leaving treatment

Figure 21: trends in people successfully completing treatment as a proportion of exits in the year between 2005 to 2006 and 2022 to 2023

The percentage of people leaving treatment free of dependence fell slightly in 2022 to 2023 to 46.3%. This overall proportion is a slight decline from last year (48.5%) but is comparable with the proportions in the previous years since 2015 to 2016 (50.5%). There were decreases in each group’s successful completion rate, and the decreases were most pronounced in the non-opiate only group (3.3 percentage point decrease).

Trends in substance use

Figure 22: trends of people starting treatment with opiate and/or crack problems between 2005 to 2006 and 2022 to 2023

The number of people entering treatment for problems with opiates but not crack continued on a downward trend. It is now less than half the number of people that started in 2010 to 2011.

After decreasing over the last few years, the number of people entering treatment for both crack and opiates increased by 7% this year, and it is now at 20,158, which is still lower than the number in 2020 to 2021.

The total number of people entering treatment for crack without opiates (5,444) is 16% higher than the previous year and the highest since 2008 to 2009.

The number of people starting treatment for psychoactive substances (664 this year) declined by 41% after remaining relatively stable since 2017 to 2018 (1,223).

There was a continued rise in ketamine numbers, with 2,211 people starting treatment, compared to 1,551 in 2021 to 2022 and 426 in 2014 to 2015. The number of people with methamphetamine problems also rose, reaching 615 compared to 131 in 2011 to 2012.

You can find more detailed data on the drugs people had problems with in the data tables that accompany this report.

Deaths in treatment

Figure 23: trends in deaths of people in treatment between 2005 to 2006 and 2022 to 2023

In 2022 to 2023, deaths as a proportion of all in treatment increased compared to last year (from 1.3% to 1.4%). Last year’s decrease from 1.35% to 1.3% remains the only decrease on record. The increase in 2020 to 2021 from 1.1% to 1.4% was the largest rise in the proportion of people dying in treatment since NDTMS data has been collected.

The trend of people dying in treatment has increased from 711 deaths in 2005 to 2006 to 4,166 deaths this year, which is 2.5 times higher than in 2009 to 2010 (when NDTMS started collecting data on deaths in alcohol treatment). This is the largest number of deaths in treatment on record, as well as the highest proportion of people in treatment.

Deaths in treatment by substance

Figure 24: percentages of deaths in treatment between 2005 to 2006 and 2022 to 2023

Figure 24 shows deaths as a proportion of total numbers of people in treatment, broken down by substance group. Since 2006, people in treatment for opiates have consistently made up the majority of people who die while in treatment. People in treatment for alcohol only are consistently the second largest group, with the other groups having fewer people dying while in treatment.   

From 2005 to 2006 the rate of people dying while in treatment has risen from 0.33% to 1.43% this year.

An 18-year analysis

People in treatment

Figure 25: most recent status of all people in treatment between 2005 to 2006 and 2022 to 2023

Status	People in treatment between 2005 to 2006 and 2022 to 2023
Still in treatment 31 March 2023	13%
Left and not completed treatment	40%
Completed treatment and not returned	47%

In the 18 years of treatment data starting from 2005 to 2006, there has been a total of 1,153,514 people in contact with drug and alcohol treatment services. By 31 March 2023:

• 152,994 (13%) were still engaged in treatment
• 460,356 (40%) had left before they completed their treatment and had not returned
• 540,164 (47%) had completed their treatment and not returned

Treatment journeys

Figure 26: number of previous journeys for people still in treatment at the end of 2022 to 2023

Treatment journeys	People still in treatment at the end of 2022 to 2023
More than 4 journeys since first starting treatment	47,656
4 journeys since first starting treatment	16,560
3 journeys since first starting treatment	21,851
2 journeys since first starting treatment	28,743
Continuous journey	38,184

Of the people still in treatment at the end of March 2023:

• around a third (31%) have had 4 or more treatment journeys
• a quarter (25%) have been in treatment continuously since their treatment started and 54% of those started treatment in 2022 to 2023
• nearly 3 quarters (74%) have been in treatment for 5 years or more

You can find more information on the methodology of this analysis in the NDTMS annual statistics quality and methodology document.

Background and policy context

Background to the data

This report presents statistics on the availability and effectiveness of alcohol and drug treatment in England and the profile of people accessing this treatment.

The statistics in this publication come from analysis of the NDTMS.

The NDTMS collects data from about 600 sites providing structured substance misuse interventions, covering every local authority in England. Treatment centres returning data include:

• community-based drug and alcohol services
• specialist outpatient services
• GP surgeries
• residential rehabilitation centres
• inpatient units

The data collected includes information on the demographics and personal circumstances of people receiving treatment, as well as details of the interventions delivered and their outcomes.

You can find more details on the methodology used in the report in the NDTMS annual statistics quality and methodology document.

Alcohol and drug treatment statistics reports for previous years can be found in OHID’s Alcohol and drug misuse and treatment statistics collection.

OHID and the UK Health Security Agency have produced updated prevalence estimates of opiate and/or crack cocaine users in England for 2016 to 2017, 2018 to 2019 and 2019 to 2020 using a revised methodology. You can see the data tables for each year and read more about the revised methodology at Opiate and crack cocaine use: prevalence estimates.

We will also update the existing estimates of alcohol dependence prevalence in England this year, using the existing methodology.

The effect of the COVID-19 pandemic

Previous reports have noted the effect of the COVID-19 pandemic on drug and alcohol treatment services. In 2020 to 2021, most services had to restrict face to face contact, which affected the types of interventions that service users received. Many interventions continue to include remote components, which has benefits and disadvantages.

So, like 2020 to 2021 and 2021 to 2022, the COVID-19 pandemic and its effects might have affected the data in this report.

Policy context

Alcohol and drug treatment in England is commissioned by local authorities using the public health grant. They are responsible for assessing local need for treatment and commissioning a range of services and interventions to meet that need.

The public health grant conditions for 2023 to 2024 make it clear that:

A local authority must, in using the grant: have regard to the need to 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.

OHID works with local authorities and provides them with bespoke data, guidance, tools and other support to help them commission services more effectively.

Guidance for alcohol and drug treatment is available in the Alcohol and drug misuse prevention and treatment guidance collection.

A wide range of NDTMS data is available on the NDTMS website, including some data reports that are only available to local authority commissioners (via login).

Enquiries or feedback

If you have any enquiries or feedback about these statistics, please email the Office for Health Improvement and Disparities at evidenceapplicationteam@dhsc.gov.uk.