Pathways between probation and addiction treatment in England: report
Published 30 March 2023
Applies to England
© Crown copyright 2023
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Summary
This report is a joint experimental statistics publication by the Ministry of Justice (MOJ) and the Office for Health Improvement and Disparities (OHID), which is part of the Department of Health and Social Care (DHSC).
The work is based on a data-sharing agreement that was secured as part of the Better Outcomes through Linked Data (BOLD) programme.
Background
This report focuses on offenders sentenced to a community order or suspended sentence order in England with an alcohol treatment requirement (ATR) or a drug rehabilitation requirement (DRR), as defined by the Criminal Justice Act 2003.
The aim was to assess whether the pathways between probation and treatment services are operating effectively and to describe treatment outcomes. This work is motivated by the commitments made in the government’s drug strategy and the outcomes of the joint thematic inspection of community-based treatment and recovery work with people on probation.
Methodology
DHSC received around 40,000 records from MOJ’s probation case management system, nDelius. These were records of offenders sentenced to an ATR or DRR between August 2018 and March 2022. Our aim was to link these records with the National Drug Treatment Monitoring System (NDTMS) to estimate how many of these sentences resulted in people accessing treatment and to describe how these groups progress through treatment.
We linked the records using both deterministic and probabilistic methods to test and improve the matching of the 2 data sets. You can find out more about these data linking methods in section ‘2.8 Pathways between probation and specialist addiction treatment’ of the methodology report.
The deterministic linkage method showed that almost 10,000 (26%) of the people sentenced between August 2018 and March 2022 had at least one treatment record during the same period. The probabilistic linkage method found a higher proportion having at least one treatment record in this period (41%).
We developed statistical models to determine whether any known characteristics of these groups of offenders were associated with either accessing treatment or completing treatment successfully.
The statistics in this report are experimental statistics. They are undergoing continual evaluation and development, and may be modified and improved following user and stakeholder feedback.
Main findings
Overall, 38.9% of offenders with ATRs or DRRs were engaged with treatment services on the dates they were sentenced or after being sentenced.
Offenders with an ATR appeared to engage more (45.9%) than those with a DRR (33.1%).
Looking at 3 weeks after the sentence date, 26% of offenders with an ATR were identified in treatment, compared with 20% of offenders with a DRR.
For offenders with an ATR who were identified as being in treatment:
- 68% reported alcohol as their only problem substance
- 24% reported non-opiates and alcohol as their problem substances
- 6% reported opiates (with or without concurrent alcohol problems) as their problem substance
- 1% reported only non-opiates as their problem substance
You can find more information about the drug and alcohol treatment substance groups in section ‘3.5 Profile of offenders accessing treatment’ below.
For offenders with a DRR who were identified as being in treatment:
- 68% reported opiates as their main problem substance
- 21% reported non-opiates as their problem substance
- 10% reported non-opiates and alcohol as their problem substances
- 1% reported alcohol only as their problem substance
Of the 15,121 offenders who engaged in treatment:
- 37% dropped out of treatment
- 35% successfully completed this treatment journey (by recovering from their substance misuse)
- 27% were still on the same initial treatment journey until the end of the observation period (March 2022)
- 1.4% died
For offenders accessing treatment, we saw substantial reductions in their main substance of use and in the frequency they reported using these substances.
Limitations
These results suggest that only just over a third of people sentenced to an ATR or DRR engaged with treatment. But there may be more people in treatment who we were unable to link between both data sets.
This experimental statistics publication is the first time DHSC and MOJ have collaborated by linking data to better understand how the pathway between probation and treatment services works. Our analysis shows that there are potential issues in this pathway that need to be resolved.
The BOLD substance misuse demonstrator pilot needs to do future work to:
- further evaluate the probabilistic linkage method used to join the probation and treatment systems together
- expand the variables available for analysis
- estimate whether people who engage in treatment (particularly those who complete treatment) achieve better reoffending outcomes
1. Introduction
1.1 The Better Outcomes through Linked Data (BOLD) programme
BOLD is a 3-year cross-government programme led by the Ministry of Justice (MOJ). It was created to show how people with complex needs can be better supported by linking and improving the government data held on them in a safe and secure way.
There are 4 main BOLD demonstrator pilots. These are focused on:
- reducing homelessness (led by the Department for Levelling Up, Housing and Communities)
- supporting victims of crime (led by MOJ)
- reducing reoffending (led by MOJ)
- substance misuse (led in England by OHID and in Wales by Public Health Wales)
A discovery phase between October and December 2021 identified more than 50 knowledge gaps. Between January and March 2022, the programme entered a prioritisation and mobilisation phase to identify which knowledge gaps should be prioritised and to recruit a team to start the work.
You can find more information on the BOLD programme at Ministry of Justice: Better Outcomes through Linked Data (BOLD).
This report is the first report from the substance misuse demonstrator pilot in England.
1.2 Community sentence treatment requirements
The Criminal Justice Act 2003 introduced community sentence treatment requirements (CSTRs), including:
- mental health treatment requirements
- alcohol treatment requirements
- drug rehabilitation requirements
Under the legislation, the court can impose either a community order or a suspended sentence order with CSTRs. The court can also impose other requirements (such as unpaid work) alongside these.
The purpose of CTSRs is to reduce drug, alcohol and mental health needs that are related to offending behaviour and so reduce reoffending.
To be eligible for an alcohol treatment requirement (ATR), the court must be satisfied that the offender:
- is dependent on alcohol
- requires treatment for their alcohol dependence and it is likely to be effective
- can access and attend alcohol treatment
- is willing to comply with the requirement
To be eligible for a drug rehabilitation requirement (DRR), the court must be satisfied that the offender:
- is dependent on illegal drugs
- requires and would benefit from treatment
- can access and attend drug treatment
- is willing to comply with the requirement
The substance misuse demonstrator pilot’s focus on ATRs and DRRs is motivated by the government’s drug strategy and the joint thematic inspection of community-based treatment and recovery work with people on probation. The drug strategy emphasises improving the criminal justice response to illegal drug use. It also specifically identified the use of community sentences to reduce crime and reoffending. The thematic report found a sharp decline in DRRs and highlighted weaknesses in joint working between probation and treatment services.
The drug strategy reflects the recommendations set out in the second part of Dame Carol Black’s independent review of drugs. The review highlighted the need to maximise the use of community sentences as a way to divert drug users away from the criminal justice system and into treatment.
The 2019 process evaluation report of CSTRs highlighted the importance of multi-agency working, and factors that challenge and assist co-working between agencies. This data linking project will inform policy across DHSC and MOJ. The data share is intended to support specific policies and to help broaden the evidence base for people in contact with both the probation and treatment systems.
This report provides insight into how the probation and treatment systems respond to offenders sentenced to an ATR or DRR in line with section 177 of the Criminal Justice Act 2003. It focuses on the pathways into treatment in England. Partners in Public Health Wales and SAIL Databank will be focusing on pathways into treatment in Wales over the coming months.
1.3 Aims and objectives
The substance misuse demonstrator pilot includes a project where MOJ and DHSC are working together to explore the pathway into treatment when people receive ATRs and DRRs at court.
The report Substance misuse treatment for adults: statistics 2021 to 2022 showed 607 people starting treatment with an ATR and 1,118 people starting treatment with a DRR in England. However, the referral source is self-reported by people accessing treatment. This report uses statistics on alcohol and drug misuse treatment for adults from the NDTMS.
Offender management statistics from MOJ and HM Prison and Probation Service report that 5,501 DRRs and 5,361 ATRs started as part of community sentences in 2021 to 2022 in England and Wales. This suggests that NDTMS referral information may not be reliable, or a substantial proportion of people sentenced to DRRs and ATRs are not attending treatment.
The aim of this project is to improve the criminal justice and treatment systems’ response to substance misuse. It has 3 objectives to achieve this aim.
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To develop the evidence base on the pathways between probation and treatment, including assessing treatment outcomes for those offenders who engage with treatment services. This report is part of this objective.
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To engage with probation staff, treatment staff or people using services to understand barriers to treatment and suggest solutions. For more about this objective, see section ‘7.2 Qualitative research with service providers and users’ below.
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To seek the views of people who use treatment services to help improve and refine projects that we identified in our discovery phase. For more about this objective, see section ‘7.3 Engaging with stakeholders’ below.
2. Overview of the MOJ and DHSC data share
OHID manages the NDTMS, which collects data on all people accessing publicly funded drug and alcohol treatment in England. It captures sociodemographic information as well as data on the:
- substances people have problems with
- interventions people receive
- treatment outcomes
People accessing treatment are asked for consent to share their information. Part of this consent explicitly includes provisions for linking their information with other administrative data sets.
MOJ manages the probation data capture system nDelius. Alongside demographic data, nDelius captures information needed for probation supervision and includes court reports.
There is no unique identifier that enables NDTMS to perfectly link the same person with nDelius. However, the 2 systems share information about:
- a person’s forename and surname initials
- a person’s date of birth
- a person’s sex and gender
- where a person lives
We used this information to link these systems using deterministic and probabilistic approaches. More information on the approaches we took in this report is available in the methodology report.
The data linkage project between MOJ and DHSC addresses the following questions.
- Can we find people who are sentenced to an ATR or a DRR in the NDTMS data set detected?
- What is the time lag between an ATR or DRR sentencing date and the person starting treatment?
- What characteristics of people with an ATR or DRR make accessing treatment more or less likely?
- How many offenders with an ATR or DRR, who are identified as accessing treatment, go on to recover from drug or alcohol dependence?
3. Results
3.1 What the results cover
The results in this report cover 4 main areas.
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We present details on the records from nDelius and the overall rate of linkage (or detection) to the NDTMS data set.
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We describe how many of the offenders we could link in the NDTMS data set were in treatment, either on the date they were sentenced or at some point after sentencing and between August 2018 and March 2022. We also consider the rate of offenders who access treatment within 3 weeks of being sentenced.
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We describe the profile of offenders who access treatment services and provide an analysis of the outcomes they achieved. We do this by using the treatment outcomes profile (TOP) and the NDTMS record of how they left treatment. TOP measures the changes in a person’s drug and alcohol use when they are in treatment. See section ‘2.9 Treatment outcomes’ of the methodology for more information.
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We use statistical models to measure whether or not any of the people’s characteristics, such as their age or ethnicity, are associated with accessing or completing treatment.
3.2 Linking probation and treatment data sets
MOJ had a total of 40,353 records of people receiving ATRs and DRRs to DHSC, covering the period August 2018 to March 2022.
We performed data cleansing on the probation data set, which involved removing 606 records without enough data to allow them to be linked (such as initials, date of birth or where they live). This resulted in 39,747 records being used in the linkage process. To protect the confidentiality of the people involved in this report, we anonymised the data set after the linkage was completed and deleted the personal identifiable data following the Information Commissioner’s Office code of practice on anonymisation (PDF, 1.9MB). The final data set for analysis contained 38,895 records (representing 96.4% of the original data set).
The deterministic linkage process identified that 9,976 (25.7%) offenders sentenced between August 2018 and March 2022 had at least one treatment record during the same period. The probabilistic linkage approach improved this overall linkage rate.
The probabilistic linkage process linked 15,891 offenders (40.9%) with at least one treatment record during this same period. There was an error rate of around 1 in 1,000, which means we are 99.9% confident that the records from the 2 separate systems correctly aligned. The results in this report are based on this probabilistic linkage approach.
The main advantage of the probabilistic approach is its flexibility. In the deterministic approach, people in both data sets have to match exactly on initials, date of birth, sex, ethnicity and geography. But the probabilistic approach allows records to be linked if, for example, a person’s forename initial is recorded differently on different systems (such as when Anthony or ‘A’ is recorded on one system, but Tony or ‘T’ is recorded on the other).
It is important to note that there may be individuals who appear in both data sets, but we could not confidently identify their records when we linked the data sets. So, there could be more people in treatment that we could not find.
Given that nDelius and NDTMS do not currently share a common identifier to link people, we will continue to investigate the most effective way to link these data sets (see section ‘7.1 Data for the next phase of the project’ below). Health and justice systems should also consider whether a common identifier can be incorporated into their respective information systems (such as NHS number) to improve future connections between them.
A more detailed profile, broken down by offender characteristics, of people sentenced to an ATR or DRR and who had at least one treatment record is available in the data tables (tables 1 and 2).
3.3 Pathways between probation and treatment
Treatment status of people sentenced to an ATR or DRR
Figure 1 shows a breakdown of the pathways between probation and treatment services. Of the 15,891 people sentenced to an ATR or DRR who have been linked with NDTMS, 770 (4.8%) had only historic treatment journeys. This means they had been in treatment at some stage but did not start treatment again following their ATR or DRR sentence date.
There were 5,408 people (34% of those linked) already in treatment on their sentence date. On average (using the mean), offenders with an ATR within this group had spent 110 days in treatment by their sentence date, compared with 195 days for those sentenced to a DRR.
There were also 9,713 people (61.1% of those linked) who engaged in treatment after their sentence date. For people not already in treatment on their sentence date, on average (mean), it took offenders sentenced to an ATR 93 days to engage in treatment after their sentencing date. This compared with 160 days for offenders sentenced to a DRR.
More detail is available in the data tables (tables 3 and 4).
Figure 1: treatment status of offenders linked with NDTMS
| Treatment status | ATR | DRR | All |
|---|---|---|---|
| Already in treatment | 31.7% | 36.7% | 34% |
| Accessed treatment within 3 weeks | 22.5% | 19.2% | 21% |
| Accessed treatment within 3 to 6 weeks | 14.3% | 8.6% | 11.6% |
| Accessed treatment within 6 to 9 weeks | 7.7% | 4.9% | 6.4% |
| Accessed treatment within 9 to 12 weeks | 4.6% | 2.8% | 3.7% |
| Accessed treatment after 12 weeks | 14.8% | 22.5% | 18.4% |
| Only accessed treatment before they were sentenced | 4.3% | 5.4% | 4.8% |
So, in total, there were 15,121 offenders (38.9% of the available 38,895 records) who appeared to have either been in treatment on, or started treatment after, their sentence date.
This is broken down as 8,065 offenders (45.9%) with an ATR who appear to have engaged in treatment on or after their sentence date, compared with 7,056 offenders (33.1%) with a DRR. Further detail for people already in treatment on or after their sentence date is available for the ATR and DRR groups in the data tables (tables 5 and 6).
It’s possible that some of those who do not access treatment were prevented from doing so – for example, by receiving a prison sentence as a result of breaching their community sentence. We can explore this in more detail in future iterations of data-sharing between MOJ and DHSC (see section ‘7.1 Data for the next phase of the project’ below).
Characteristics associated with treatment engagement
We can assess whether any particular individual characteristic increases or decreases the likelihood of a person engaging with treatment by using a statistical model known as a multilevel logistic regression. You can find more detail about this statistical model in the methodology report.
The individual characteristics we included in the model include:
- sociodemographic characteristics (such as age, sex, ethnicity, accommodation and employment)
- criminogenic characteristics (such as offence type, risk of serious reoffending and offender group reconviction scale (OGRS), which is a predictor of reoffending based on age, sex and criminal history)
- sentencing-related variables (such as sentence type and year, court type, count of requirements ordered by the court and reason why the court order was terminated)
The model measures associations between these characteristics and the likelihood of being in treatment either on the date of sentencing or engaging in treatment after sentencing. The model produces adjusted odds ratios (AOR). These ratios show how one characteristic compares with another, while adjusting for all other characteristics in the model. For example, women were around 10% less likely to be in treatment either on or after their sentencing date compared with men (AOR 0.89 (95% confidence interval 0.79 to 0.99)). The confidence interval is important because it shows the range of values within which we are 95% confident the true value lies. So, we are 95% confident women engage in treatment 1% to 21% less often than men.
ATR characteristics associated with accessing treatment
Figure 2 presents the results from the multilevel logistic regression model for offenders sentenced to an ATR. The AOR for a given characteristic is represented by the black circle, while the confidence intervals are represented by the horizontal lines either side of the circle. Confidence intervals to the right of the red dashed line indicate that the characteristic is associated with an increased likelihood of accessing treatment. Confidence intervals to the left of the line indicate a decreased likelihood. The figure does not show characteristics that were not statistically significant.
The results indicate that several variables are associated with a decreased likelihood of accessing treatment, including:
- being female
- being an older offender
- being from an ethnic minority
- being sentenced later in the data period (August 2018 to March 2022)
- scoring higher on the OGRS
- having a sentence terminated early
In contrast, variables that were associated with an increased likelihood of accessing treatment include:
- being sentenced to an ATR with a main offence category of drink driving (compared with those with a main offence category of violence)
- having an accommodation status of either bail or probation accommodation, or were otherwise housed (compared with those in settled accommodation)
Full details of the outputs from this statistical model are available in the data tables (table 7).
Figure 2: significant associations between ATR offender characteristics and the likelihood of accessing treatment on or after sentencing date
These findings indicate that certain demographic groups are relatively disadvantaged. At this stage, the evidence does not provide the reasons for people not engaging in treatment.
DRR characteristics associated with accessing treatment
We applied the same kind of multilevel logistic regression to offenders sentenced to a DRR. The results are in figure 3.
Again, the characteristics associated with a decreased likelihood of accessing treatment have confidence intervals to the left of the red dashed line, while those associated with an increased likelihood of accessing treatment have confidence intervals to the right of this line.
Characteristics associated with decreased likelihood of accessing treatment include:
- being female
- being an older offender
- being sentenced later in the data period (August 2018 to March 2022)
- having a main offence of theft
- having a medium score on the risk of serious reoffending metric, and a medium score on the OGRS
- terminating the sentence and recording it as ‘successful completion’ or ‘other reason’
The variables associated with an increased likelihood of accessing treatment include having:
- a longer community sentence
- an accommodation status of rough sleeping or ‘other housed’
Full details of the outputs from this statistical model are available in the data tables (table 8).
Figure 3: significant associations between DRR offender characteristics and the likelihood of accessing treatment on or after sentencing date
3.4 Quick access to treatment from probation
The statistical models described in previous sections ‘3.2 Linking probation and treatment data sets’ and ‘3.3 Pathways between probation and treatment’ showed that people were less likely to access treatment if the year they received their treatment requirement was the most recent one (2021 to 2022). It is possible that this is simply due to people from earlier years having a longer time to access treatment. For example, people who were sentenced in March 2022 would have had a limited amount of time to access treatment compared with those who were sentenced in March 2019.
To adjust for this possibility, we put a time limit on people seeking access to treatment. This time limit focused on if a person was either in treatment at their sentence date or if they accessed treatment within 3 weeks of their sentence date.
This modified definition showed 26% of offenders sentenced to an ATR and 20% of offenders sentenced to a DRR had a successful and quick pathway from probation into specialist addiction treatment services.
For offenders sentenced to an ATR (as shown in figure 4 below), being sentenced in 2019 to 2020 or 2020 to 2021 was associated with being more likely to access treatment within 3 weeks, relative to those sentenced in 2018 to 2019. There was no statistical difference between 2018 to 2019 and 2021 to 2022. Only the significant associations are displayed. The data is available in the data tables (see table 9).
There are some other noteworthy differences between figure 2 and figure 4. Limiting the timeframe to only 3 weeks after the sentence date shows that women are now significantly more likely to engage in treatment. Offenders sentenced in a magistrates’ court are also more likely to engage in treatment.
Figure 4: significant associations between ATR offender characteristics and the likelihood of accessing treatment on or within 3 weeks of sentencing date
For offenders sentenced to a DRR (figure 5), being sentenced in any year after 2018 to 2019 was associated with an increased likelihood of accessing treatment within 3 weeks. Again, those sentenced in a magistrates’ court were more likely to access treatment. Offenders with 3 or more requirements as part of their sentence were less likely to access treatment within 3 weeks. The data is available in the data tables (see table 10).
Figure 5: significant associations between DRR offender characteristics and the likelihood of accessing treatment on or within 3 weeks of sentencing date
3.5 Profile of offenders accessing treatment
NDTMS can provide a clinical picture of offenders who access treatment. One of the main characteristics available from NDTMS is the substances for which people are being treated. The NDTMS standard reporting methodology categorises people into one of 4 groups, depending on which substances the person says they are having problems with when they enter treatment. These 4 substance groups are:
- Opiate: people who are dependent on or have problems with opiates, mainly heroin.
- Non-opiate: people who have problems with non-opiate drugs only, such as cannabis, crack and ecstasy.
- Non-opiate and alcohol: people who have problems with both non-opiate drugs and alcohol.
- Alcohol only: people who have problems with alcohol but do not have problems with any other substances.
As we show in figure 6, the problem substance profile indicates that around a third (32%) of offenders sentenced to an ATR have substantial drug-related problems. Also, most offenders sentenced to a DRR are in the opiate group (68%).
As you can see in figure 6, for offenders with an ATR who were identified as being in treatment:
- 68% reported alcohol as their only problem substance
- 24% reported non-opiates and alcohol as their problem substances
- 6% reported opiates (either with or without concurrent alcohol problems) as their problem substance
- 1% reported only non-opiates as their problem substance
In contrast, for offenders with a DRR who were identified as being in treatment:
- 68% reported opiates as their main problem substance
- 21% reported non-opiates as their problem substance
- 10% reported non-opiates and alcohol as their problem substances
- 1% reported alcohol only as their problem substance
Figure 6: NDTMS substance groups for offenders in treatment on, or after, sentencing date
| Treatment requirement | Alcohol only | Non-opiate and alcohol | Non-opiate | Opiate | Total |
|---|---|---|---|---|---|
| ATR | 68% | 24% | 1% | 6% | 100% |
| DRR | 1% | 10% | 21% | 68% | 100% |
Figure 7 shows the age, ethnicity, sex and self-referral data from NDTMS.
We found a higher proportion of offenders with a DRR who accessed treatment were in the ‘18 to 32 years’ age group than those with an ATR (37% vs 28%). And we saw a lower proportion of offenders with a DRR in the ‘42 years and over’ age group, compared with those with an ATR (26% vs 42%).
A higher proportion accessing treatment with a DRR were from ethnic minority groups than those accessing treatment with an ATR (12% vs 7%). For both types of treatment requirement, almost 80% who accessed treatment were men.
Almost 40% of people did not report being referred from the criminal justice system (ATR: 39%; DRR: 40%). This finding shows that the ‘referral source’ data in NDTMS may be less accurate than previously assumed.
More details are available in the data tables (tables 3, 4, 11 and 12).
Figure 7: selected NDTMS characteristics for offenders in treatment on, or after, sentencing date
Age
| Age group | ATR | DRR |
|---|---|---|
| 18 to 32 years | 28% | 37% |
| 33 to 41 years | 30% | 37% |
| 42 years and over | 42% | 26% |
Ethnicity
| Ethnicity | ATR | DRR |
|---|---|---|
| White | 86% | 83% |
| Minority ethnic groups | 7% | 12% |
| Missing | 6% | 5% |
Sex
| Sex | ATR | DRR |
|---|---|---|
| Men | 78% | 79% |
| Women | 22% | 21% |
Referral source
| Referral source | ATR | DRR |
|---|---|---|
| Criminal justice | 61% | 60% |
| Self, family and friends | 28% | 30% |
| Health and social care | 5% | 4% |
| Other | 4% | 3% |
| Substance misuse service | 1% | 2% |
| Missing | 0% | 1% |
3.6 Changes in substance use
The treatment outcomes profile and substance groups
The treatment outcomes profile (TOP) is an outcome monitoring form that provides information on the frequency of a person’s substance use in the 28 days before the assessment date.
We report the TOP completed at the start of treatment as well as the latest TOP completed in the offender’s treatment journey. This could be the person’s final TOP review, or the latest one for those who were still in treatment. For offenders sentenced to an ATR, there was an average of 228 days between these 2 assessments. For offenders sentenced to a DRR, this average was 363 days.
When offenders sentenced to an ATR or a DRR enter treatment, they are categorised into one of the 4 substance groups depending on what substances they are having problems with. For offenders with an ATR, we show the changes captured on the TOP as being in the ‘alcohol only’ substance group. For offenders sentenced to a DRR, we show the changes captured on the TOP as being on the ‘opiate’ substance group.
We report the data for each of the other NDTMS categories for both ATR and DRR offenders in the data tables 13 to 14.
Changes in substance use for offenders with an ATR
As shown in figure 8, almost 9 in 10 (89%) offenders with an ATR report using alcohol in the 28-day period before starting treatment. By the time of their latest TOP, 62% continued to report using alcohol.
Self-reported use of other substances was minimal. The next highest proportion reported was almost 4% for cannabis. This did not change by the latest TOP.
Figure 8: prevalence of substance use for offenders sentenced to an ATR and categorised as ‘alcohol only’
| Substance | Baseline | Review |
|---|---|---|
| Alcohol | 89% | 61.8% |
| Amphetamines | 0.2% | 0.2% |
| Cannabis | 3.6% | 3.6% |
| Cocaine | 1.5% | 0.8% |
| Crack cocaine | 0.3% | 0.5% |
| Injected drugs | 0.1% | 0.2% |
| Opiates | 0.2% | 0.4% |
| Other drugs | 0.6% | 0.4% |
The data reported in figure 9 shows the average number of days that people report using particular substances in the 28 days before the TOP assessment. People using alcohol reported an average (mean) of 19 days’ use in the 28 days before treatment (89%, as in figure 8 above). The 62% who reported alcohol use at their latest TOP assessment (see figure 8) reported an average use of almost 14 days a month.
This means that, for the people still using alcohol, there were reductions in both the proportion of people reporting alcohol use, and in the number of days in which they drank alcohol.
Figure 9: frequency of substance use for offenders sentenced to an ATR and categorised as ‘alcohol only’ in the 28 days preceding the TOP assessment
| Substance | Baseline (days) | Review (days) |
|---|---|---|
| Alcohol | 19.3 | 13.7 |
| Amphetamines | 2.2 | 6.1 |
| Cannabis | 13.3 | 15.6 |
| Cocaine | 4.0 | 4.8 |
| Crack cocaine | 7.0 | 8.0 |
| Injected drugs | 8.2 | 5.3 |
| Opiates | 13.3 | 13.6 |
| Other drugs | 15.1 | 20.2 |
Even though the proportion of people who reported using other substances was small (from figure 7), people in the later TOP review reported using other substances more often than at the start of treatment. These substances included:
- amphetamines
- cannabis
- cocaine powder
- crack cocaine
- opiates
- other drugs
This might indicate that some people use other substances more often even as they are reducing their alcohol consumption.
Changes in substance use for offenders with a DRR
In figures 10 and 11, we show data from the TOP for offenders sentenced to a DRR and who have been categorised as being in the ‘opiate’ substance group. The use of substances by these offenders is very different to the ‘alcohol only’ offenders sentenced to an ATR.
In the month before starting treatment, offenders who were sentenced to a DRR and were classified in the ‘opiate’ group reported higher levels of substance use than offenders sentenced to an ATR. This included:
- 76% reporting opiate use
- 64% reporting crack cocaine use
- 27% reporting alcohol use
- 22% reporting cannabis use
Smaller proportions reported cocaine powder (6%), amphetamines (2%) and other drugs (13%).
At these people’s latest TOP review, the greatest reductions in the use of substances were for opiates (22 percentage points) and crack cocaine (14 percentage points). Injecting frequency was reduced by 11 percentage points.
Figure 10: prevalence of substance use for offenders sentenced to a DRR and categorised as opiates
| Substance | Baseline | Review |
|---|---|---|
| Alcohol | 27.3% | 25.5% |
| Amphetamines | 1.9% | 1.5% |
| Cannabis | 22.3% | 21.4% |
| Cocaine powder | 5.5% | 6.1% |
| Crack cocaine | 64% | 50.2% |
| Injected drugs | 24.3% | 13.8% |
| Opiates | 75.7% | 53.5% |
| Other drugs | 12.8% | 10.1% |
As you can see in figure 11, the average (mean) number of days that people reported using substances in the previous 28 days reduced for most reported substances, including for:
- opiates, from 21 days to 16 days
- crack cocaine, from 17 days to 14 days
- cocaine powder, from 9 days to 8 days
In contrast, people reporting alcohol use in the TOP review reported a higher average number of days drinking (from 11 days to 14 days) compared with those at the baseline TOP. The frequency of cannabis use also increased from 14 days to 17 days. This might indicate that some people use other substances more often, even as they are reducing their opiate or cocaine use.
Figure 11: frequency of substance use for offenders sentenced to a DRR and categorised as opiates
| Substance | Baseline (days) | Review (days) |
|---|---|---|
| Alcohol | 11.4 | 13.7 |
| Amphetamines | 9.7 | 9.6 |
| Cannabis | 14.2 | 17.5 |
| Cocaine | 8.7 | 7.7 |
| Crack cocaine | 17.0 | 14.2 |
| Injected drugs | 20.4 | 17.0 |
| Opiates | 21.5 | 16.3 |
| Other drugs | 16.5 | 16.2 |
3.7 Treatment status at the end of the data period
Of the 15,121 offenders who were identified as accessing treatment, at the end of the observation period (March 2022):
- over a quarter were still in treatment (27%)
- almost 2 in 5 dropped out (37%)
- around 1 in 3 successfully completed this treatment journey (they had recovered from their substance misuse) (35%)
- 217 people died (1.4%)
There were differences in the treatment status between offenders sentenced to an ATR compared with those sentenced to a DRR.
A greater proportion of offenders with a DRR were still in treatment compared with those sentenced to an ATR (33.3% vs 22.4%). A higher proportion of offenders with DRRs also dropped out of treatment (45.8% vs 28.5%), while a lower proportion completed treatment (19.5% vs 47.7%). Similar proportions of people died. The data is available in the data tables (see table 15).
Figure 12: treatment discharge status for offenders accessing treatment on, or after, sentencing date
| Discharge status | ATR | DRR |
|---|---|---|
| Still in treatment | 22.4% | 33.3% |
| Dropped out | 28.5% | 45.8% |
| Completed | 47.7% | 19.5% |
| Died | 1.5% | 1.4% |
To put these results in context, it is useful to consider the latest national statistics on alcohol and drug misuse treatment for adults, which records the treatment exits of people who left treatment in that year. The 2021 to 2022 report showed that people completing treatment successfully accounted for 48.5% of all those who left.
In the combined group of people who left treatment after having an DRR or ATR, 47.6% completed their treatment successfully. This indicates that the combined group achieved slightly worse outcomes than the general treatment population.
The annual report also showed that successful completion rates among people discharged from treatment also varied by substance group. The proportions of people who completed their treatment successfully were:
- 23.9% of the opiate group
- 54.6% of the non-opiate only group
- 51.1% of the non-opiate and alcohol group
- 59.4% of the alcohol only group
Breaking the combined group down by treatment requirement, we found 29.2% of people with a DRR and 61.4% with an ATR completed their treatment successfully. These results indicate that offenders sentenced to an ATR or DRR who access treatment services are achieving slightly better outcomes than the general treatment population.
3.8 Characteristics associated with successfully completing treatment
Characteristics associated with completing treatment
Section ‘3.7 Treatment status at the end of the data period’ above reported that 61.4% of people with an ATR successfully completed their treatment, compared with 29.2% of those with a DRR. We used similar statistical models to those reported in sections ‘3.2 Linking probation and treatment data sets’ and ‘3.3 Pathways between probation and treatment’ (multilevel logistic regression) to measure the associations between individual-level characteristics and the likelihood of successfully completing treatment.
As well as the characteristics available from the probation data set, we also included NDTMS variables. These variables included information on:
- whether people were using the substances recorded on the TOP in the 28 days before starting treatment
- injecting behaviour
- work and employment status
- housing
- physical and psychological health
- quality of life
- the number of years between first starting to use drugs and the sentencing date
ATR characteristics associated with successfully completing treatment
As you can see in figure 13, characteristics associated with a decreased likelihood of successful completing treatment for people with an ATR include:
- being female
- reporting being referred to treatment from health and social care services, or by self, family and friends (compared with people who reported being referred from the criminal justice system)
- starting treatment on or after the day of being sentenced, rather than already being in treatment
- having a public order main offence category
- being sentenced in the year 2021 to 2022
- having a medium or high score on the OGRS
- having a court order terminated because a person was convicted of another offence, failed to comply with the order or for other reasons (compared with someone whose court order was not yet terminated)
- reporting alcohol use in the month before starting treatment
Compared with people in the NDTMS opiate group, all other substance categories had an increased likelihood of completing treatment successfully. People who reported working in the month before treatment were also more likely to successfully complete treatment. And there was a small but significant positive association for people with higher levels of self-assessed physical health at the start of treatment.
Full details of the outputs from this statistical model are available in the data tables (table 16).
Figure 13: significant associations between ATR offending and clinical characteristics and the likelihood of completing treatment
DRR characteristics associated with successfully completing treatment
For offenders with a DRR, those sentenced in 2019 to 2020 or 2020 to 2021 were more likely to successfully complete treatment (compared with people sentenced in 2018 to 2019) (see figure 14). People who were recorded as employed on the probation data set or who successfully completed their probation order were more likely to complete treatment successfully.
The characteristics associated with a decreased likelihood of successfully completing treatment included:
- being aged 33 to 41 years (compared with those aged 18 to 32 years)
- having a main offence category of burglary, public order, robbery or theft
- scoring medium or high on the OGRS
- being convicted of a further offence, failing to comply with the court order or having the order terminated for ‘other reasons’
- reporting use of either opiates or crack cocaine in the month before starting treatment
Full details of the outputs from this statistical model are available in the data tables (table 17).
Figure 14: significant associations between DRR offending and clinical characteristics and the likelihood of completing treatment
4. Implications
The analysis in this report is the start of the evidence we can gather by linking probation and specialist addiction treatment data sets. For the first time, we were able to show that it’s possible to link all ATRs and DRRs recorded on the probation information system (nDelius) with information from the NDTMS. However, we cannot fully outline the implications at this stage and further work is required (see section ‘5. Strengths and limitations’ below).
This report explored 3 main outcome areas:
- The rate of offenders accessing treatment.
- Changes in reported drug use while in treatment.
- The rate of completing treatment successfully.
Our findings provide a first insight to the engagement levels in treatment. We found that 45.9% of people sentenced to an ATR and 33.1% of people sentenced to a DRR engage in treatment. We found that most of this engagement happens early: 26% of people with an ATR access treatment within 3 weeks, compared with 20% of those with a DRR. These findings suggest more work is required to optimise the pathways between probation and specialist addiction treatment services.
For offenders accessing treatment, we saw substantial reductions in their main substance of use and in the frequency they reported using these substances. We need to better understand how changes in substance use relate to the likelihood of successfully exiting the treatment system and how these outcomes relate to reoffending behaviours.
5. Strengths and limitations
The main strength of this report is that it included all ATRs and DRRs recorded on the probation information system (nDelius). These sentencing orders were issued across England and Wales from August 2018 to March 2022. DHSC received data from courts in Wales because it was possible that some offenders were treated in England. For the first time, we were able to show that it is possible to link this information with information from the NDTMS.
The main limitation of this report is that we are currently unable to verify the linked information between nDelius and NDTMS. Since NDTMS does not capture individual names, we had to use a person’s initials only. For example, this means that, where a person is recorded as ‘Tony’ on one system and ‘Anthony’ on another system, it was more difficult to consider this a valid match.
National administrative data sets require people to input the data, and sometimes people make mistakes that can affect our ability to correctly align different systems, such as inputting a date of birth incorrectly. As a result, we may be missing an unknown quantity of valid linkages.
The probabilistic linkage methodology helps to mitigate this issue, but does not eliminate it entirely. For example, we do not have the information available to completely adjust the linkage methodology to account for people moving from one part of the country to another.
6. Suggested improvements
The work of this project so far indicates some areas that could be improved on, as follows.
6.1 Data reporting
MOJ and DHSC will consider different ways of reporting the information to courts and local treatment providers.
6.2 Common identifier
Taking a longer-term view, health and justice systems should consider using a common unique identifier for people across their databases, such as a person’s NHS number. This would help to link records more accurately in the future.
6.3 Economic evaluation
It is important that evidence on the cost-effectiveness of sentencing people to an ATR or DRR is developed. DHSC should work with MOJ to ensure the best possible data is made available to describe the costs and benefits from an ATR or DRR sentence compared with other sentencing options.
6.4 System improvements
Better co-ordination between local services
The low proportion of people with an ATR or DRR who accessed treatment within 3 weeks of their sentencing date seems to show that local working arrangements can be improved. This would require better co-ordination between courts, probation and treatment services. Local service level agreements setting out clear roles, responsibilities and accountability at all stages in the process may be useful.
More information in pre-sentencing reports
One of the main eligibility criteria for a court to issue an ATR or DRR is that the offender is willing to engage in treatment. The findings in this report suggest that many offenders do not access treatment. One explanation for this could be that the pre-sentencing reports (a requirement in the process for sentencing an offender to an ATR or DRR) do not accurately reflect the offender’s willingness to comply with the treatment requirement. The underlying reasons will need to be explored further.
7. Next steps
Building on the lessons learned from this data-sharing project, we have identified several elements to develop in the next phase of this project. These elements fall into 3 broad categories and require continued collaboration between MOJ and DHSC.
7.1 Data for the next phase of the project
DHSC and MOJ will work together to ensure that the following data elements are available in the next phase of this project. They will begin to regularly share data and refine their methodology for linking and analysing the information. They will also make sure they can evidence any progress being made in the pathways between probation and treatment services – for example, the proportion of people with an ATR or DRR engaging with treatment within a particular time.
Which courts sentence people to ATRs and DRRs
We will use data that helps us to identify the specific courts (and associated probation regions) that are sentencing offenders to an ATR or DRR. This will enable the project to see more clearly where the pathways between probation and treatment are working effectively or not.
This will help us to identify the courts and areas that do not have effective pathways into treatment and work out what support they need to improve the numbers of offenders accessing treatment.
Why people do not access treatment after sentence
We will create a process for MOJ to receive information on people who do not access treatment after sentencing. This would enable MOJ to find any information they hold that can explain why people do not access treatment or highlight areas that can be improved. It could also help to verify the linked information.
People who move to other systems
Since this project suggests that a significant proportion of offenders sentenced to an ATR or DRR do not access treatment, it is reasonable to try to find if they are in other systems, like the prison system. Our next data share should include data sets of people accessing drug and alcohol treatment in prisons.
How treatment affects reoffending
Understanding how many offenders access treatment after sentencing and the proportion who go on to complete treatment successfully is only the start of this work. It will be important to examine how accessing treatment and recovering from drug or alcohol dependence affects reoffending rates. So, DHSC and MOJ will attempt to incorporate data on reoffending in the next phase of this project.
Date of main offence
Given the sizeable minority of people who are already in treatment when they are sentenced, it would be helpful to know the date of their main offence. This will help analysts to determine more accurately when people start treatment, compared with the offence that triggered the sentence.
Other community sentence requirements
We will use data on the other community sentence requirements that a person receives alongside the ATR or DRR, such as mental health treatment requirements (rather than a simple count of requirements). This will help us to better understand how these extra requirements may help or hinder people to access treatment and recover from drug or alcohol dependence.
Length of requirement
It is also worth investigating whether the stipulated length of the ATR or DRR is associated with either accessing treatment or the discharge status for people who engage in treatment.
7.2 Qualitative research with service providers and users
By carrying out this project, we want to improve how services are provided to vulnerable adults. The analysis presented in this report focuses on whether the pathways between probation and treatment were operating as intended. While we need to do more work to verify the information between these national databases, we should attempt to discover why some pathways are not fully optimised. For this, we need to do qualitative research to build a richer understanding of the problem than we can gather from linked data alone. This would also help us to investigate any barriers to accessing treatment for people sentenced to ATRs or DRRs.
To do this qualitative research, the BOLD team commissioned Policy Lab to evaluate current service provision by speaking with probation staff and users of treatment services. Policy Lab will then co-design potential new solutions with our stakeholders. Policy Lab is a government team that works with other departments to bring people-centred design approaches to policy making.
Policy Lab will interview:
- probation practitioners
- staff at treatment services
- offenders sentenced to ATRs and DRRs
Policy Lab will attempt to validate the findings from the linked data. These findings will help us understand the problems faced by operational staff and offenders, as well as to identify potential barriers to accessing treatment. Policy Lab hopes to speak to people in different areas, and with different backgrounds and circumstances.
We will also examine ways to improve our data collection so that we can support future rounds of analysis.
7.3 Engaging with stakeholders
The BOLD team is working with the Centre for Data Ethics and Innovation (CDEI) on a data subject engagement project between May 2022 and March 2023.
BOLD and CDEI commissioned Britain Thinks to seek the views of people with lived experience of any of the BOLD pilots.
Engaging and consulting with the relevant audiences for the overall BOLD project will help improve and refine the individual pilot projects. This means we are seeking views on acceptable uses and forms of analysis of shared data.
The work will also inform communications about the aims of BOLD and help us to understand whether the relevant audiences are content with the steps we took to safeguard their data.
Britain Thinks has worked closely with the BOLD substance misuse pilot team to identify trusted organisations to work with and to design the research approach. Britain Thinks has held workshops with third-sector organisations to gain their support for the research, as well as their views, advice and guidance about approaching people with lived experience of substance misuse. The third-sector organisations included:
For more information, see the CDEI reports on public engagement for the BOLD programme.
8. Further information
8.1 Experimental statistics
This report is experimental statistics because it is the first time that probation and alcohol and drug treatment data sets have been linked.
Experimental statistics are statistics that are not yet fully developed and are in a testing phase. The teams involved in developing these experimental statistics invite all users to provide feedback. We are particularly interested in if users think these statistics:
- have public value
- are high quality
- are trustworthy
For more information about experimental statistics, see the Office for National Statistics’ Guide to experimental statistics.
8.2 Enquiries or feedback
These statistics could be useful to people who want to ensure that pathways between probation and treatment services are operating as intended.
If you have any enquiries or feedback about these statistics, email MOJ at [email protected].