Young people's substance misuse treatment statistics 2022 to 2023: report
Published 25 January 2024
Applies to England
© Crown copyright 2024
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This publication is available at https://www.gov.uk/government/statistics/substance-misuse-treatment-for-young-people-2022-to-2023/young-peoples-substance-misuse-treatment-statistics-2022-to-2023-report
Main findings
Trends in young people’s treatment numbers
There were 12,418 young people (under the age of 18) in contact with alcohol and drug services between April 2022 and March 2023. This is a 10% increase from the previous year (11,326) but a 13% reduction in the number in treatment since 2019 to 2020 (14,291).
Trends in young people’s substance use
Cannabis remains the most common substance (87%) that young people come to treatment for.
Around half of young people in treatment (44%) said they had problems with alcohol, 7% had problems with ecstasy and 9% reported powder cocaine problems.
The proportion of young people seeking help for codeine has fallen over the last 2 years by 0.4 percentage points (1.2% in 2020 to 2021 compared to 0.8% this year).
This year also saw a continuing decrease in young people reporting a problem with benzodiazepines, with 2% having problems with this drug compared to 3.7% in 2020 to 2021.
The number of young people in treatment for solvent misuse increased markedly this year, from 329 (2.9%) people reporting a problem in 2021 to 2022, to 629 (5.1%) in 2022 to 2023. There was also a rise in the number of people reporting problems with ketamine, from 512 (4.5%) in 2021 to 2022 to 719 (5.8%) this year.
Vulnerabilities among young people in treatment
The most common vulnerability reported by young people starting treatment was early onset of substance use (79%), which means the young person started using substances before the age of 15. This was followed by young people using multiple substances (polydrug use, affecting 56% of young people).
Proportionally, girls tended to report more vulnerabilities than boys, particularly self-harming behaviour (51% compared with 17%) and sexual exploitation (11% compared with 1.5%).
Mental health treatment need
Nearly half (48%) of young people starting treatment this year said they had a mental health treatment need. This has risen each year since 2018 to 2019, when 32% had a mental health treatment need. A higher proportion of girls reported a mental health treatment need than boys (65% compared to 39%).
Most young people (71%) who had a mental health treatment need received some form of treatment, usually from a community mental health team.
Treatment exits
Of the young people who left treatment, 83% left because they successfully completed their treatment programme, which is slightly higher than the previous year’s proportion (82%). The next most common reason for leaving treatment (12%) was dropping out before they completed treatment, which is the same proportion as the previous year.
Age and sex of young people in treatment
There were 12,418 young people in structured treatment with drug and alcohol services between 1 April 2022 and 31 March 2023. Almost two-thirds were male (62%), a similar proportion to the previous year. The median age was nearly 16 years old for girls and for boys.
The number of younger children (under 14) in treatment remained relatively low (1,188, 10%).
Figure 1: age and sex of young people in treatment
| Age group | Girls | Boys |
|---|---|---|
| Under 12 | 10 | 28 |
| 12 years old | 106 | 136 |
| 13 years old | 396 | 512 |
| 14 years old | 912 | 1,321 |
| 15 years old | 1,279 | 2,088 |
| 16 years old | 1,017 | 1,816 |
| 17 years old | 994 | 1,803 |
Substances used by young people
When young people enter treatment, they can record up to 3 substances that they have a problem with. Numbers in this section are based on all substances recorded during their treatment.
Figure 2 shows the substance that young people in treatment report having problems with, and the numbers of each. The vast majority of young people in treatment (87% of all in treatment) said they have a cannabis problem. Nearly half (44%) said they had a problem with alcohol.
The section on trends over time in this report shows the numbers of young people in treatment broken down by substance since 2005 to 2006.
Figure 2: problem substances reported by young people
| Substance | Number of young people |
|---|---|
| Cannabis | 10,837 |
| Alcohol | 5,409 |
| Nicotine | 1,737 |
| Cocaine | 1,112 |
| Ecstasy | 895 |
| Ketamine | 719 |
| Other drugs | 386 |
| Benzodiazepines | 247 |
| Solvents | 629 |
| Codeine | 105 |
| Amphetamines | 77 |
| Psychoactive substances | 89 |
| Other opiates | 73 |
| Crack | 53 |
| Heroin | 47 |
Notes on the table:
Solvents include inhalants such as pressurised gases and aerosols.
Psychoactive substances are mainly synthetic cannabinoids, previously recorded as ‘new psychoactive substances’.
Other drugs include prescription drugs (such as barbiturates, tranquilisers and anti-depressants), hallucinogens other than ketamine, and caffeine.
Referral routes into treatment
The most common route for young people to get into specialist treatment services was a referral from education services, with 31% of young people entering this way.
This is very similar to the proportion of education referrals in 2021 to 2022 (32%), but much higher than the proportion in 2020 to 2021 (18%). Education service referrals fell much more during the first year of the COVID-19 pandemic than referrals from other sources. They decreased by 60%, compared to 16% for the other sources combined. They have nearly returned to pre-pandemic levels, with 2,796 education referrals in 2022 to 2023 compared to 3,196 in 2019 to 2020.
The second most common route for young people to get into specialist treatment services was a referral from social care, making up 23% of all referrals. This was the same proportion in 2021 to 2022.
Figure 3: referral routes into treatment
| Referral route | Number of young people |
|---|---|
| Education | 2,796 |
| Social care | 2,058 |
| Youth justice | 1,556 |
| Health | 1,088 |
| Self, family and friends | 1,027 |
| Other | 204 |
| Substance misuse service | 188 |
Note on the table: ‘other’ referral routes include non-substance misuse outreach services, helplines, housing services and domestic abuse services.
Vulnerabilities of young people in treatment
Young people often enter specialist substance misuse services with a range of problems or vulnerabilities related to (or in addition to) their substance use. Vulnerabilities are reported here only for young people who entered drug and alcohol treatment services during 2022 to 2023.
The most common vulnerability was early onset of substance use (79%), which means the young person started using substances before the age of 15. Girls reported this more than boys (81% and 78% respectively). This was followed by young people reporting polydrug use (56%). Again, girls tended to report this more than boys (64% and 51% respectively).
Proportionally, girls tend to report more vulnerabilities than boys, particularly for self-harming behaviours (51% compared with 17%) and sexual exploitation (11% compared with 1.5%). Boys reported more antisocial behaviour (37% compared with 17%), criminal exploitation (12% compared with 5%) and gang involvement (9% compared with 2%).
Other vulnerabilities that were reported by young people included:
- being affected by others’ substance use (23%)
- unsafe sex (19%)
- being affected by domestic abuse (17%)
- high risk alcohol use (4%)
- being at risk of homelessness (2%)
- opiate or crack use (2%)
- being pregnant or a parent (2%)
- housing problems (1%)
- injecting (less than 1%)
Being involved with social services as a looked after child (11%), a child in need (12%) or having a child protection plan (8%) were also recorded as vulnerabilities.
Figure 4: vulnerabilities among young people starting treatment
| Vulnerability | Girls | Boys |
|---|---|---|
| Early onset of substance misuse | 2,696 | 4,394 |
| Polydrug user | 2,133 | 2,881 |
| Mental health treatment need | 2,165 | 2,160 |
| Antisocial behaviour | 583 | 2,072 |
| Affected by others’ substance misuse | 999 | 1,086 |
| Affected by domestic abuse | 783 | 759 |
| Self-harm | 1,706 | 948 |
| Not in education, employment or training | 364 | 875 |
| Looked after child | 396 | 591 |
| Child in need | 448 | 631 |
| Child Protection Plan | 313 | 389 |
| Sexual exploitation | 371 | 84 |
| High risk alcohol user | 240 | 150 |
| Opiate and/or crack use | 68 | 133 |
| Pregnant and/or parent | 103 | 89 |
| Housing problem | 26 | 31 |
| Injecting | 26 | 38 |
| Criminal exploitation | 175 | 671 |
| Involved in gangs | 75 | 505 |
| Unsafe sex | 758 | 961 |
| Risk of homelessness | 76 | 127 |
Sexual exploitation
The Department for Education has published guidance that defines child sexual exploitation (CSE).
Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and, or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.
Overall, 5% (455) of young people who entered treatment in 2022 to 2023 reported CSE. Broken down by age, the proportion was:
- 6% of 17 year olds
- 5% of 16 year olds and 15 year olds
- 4% of 14 year olds and children under 14
Among the young people who started treatment in 2022 to 2023, girls reported CSE much more than boys, with 371 girls (11% of all girls) and 84 boys (2% of all boys) reporting it.
Among girls, 13% of those aged 15 or older reported CSE compared to 8% of those aged 14 or younger. For boys, the proportion reporting CSE was under 2% for both these age groups.
Figure 5: sexual exploitation of young people starting treatment
| Age | Girls | Boys |
|---|---|---|
| Under 14 years old | 28 | 6 |
| 14 years old | 62 | 12 |
| 15 years old | 100 | 21 |
| 16 years old | 81 | 19 |
| 17 years old | 100 | 26 |
Mental health needs
Nearly half (48%, 4,325) of young people who started treatment in 2022 to 2023 said they needed mental health treatment. A higher proportion of girls reported needing mental health treatment than boys (65% compared to 39%).
Of those reporting a mental health treatment need, 71% were receiving some form of mental health treatment. A slightly higher proportion of girls who said they needed mental health treatment were receiving a form of mental health treatment when they started substance misuse treatment, compared to boys (74% compared to 69%).
The majority of young people who reported needing mental health treatment (59%) were already engaged with community or other mental health services at the start of treatment. Figure 6 shows that 1,358 girls and 1,207 boys were already engaging with community or other mental health services when starting treatment in 2022 to 2023.
Smaller numbers received mental health treatment from a GP (237 girls and 266 boys) or within drug or alcohol services (98 girls and 98 boys).
Some young people also had an identified space in a health-based place of safety (62 girls and 47 boys) or were engaged with NHS talking therapies for anxiety and depression (41 girls and 33 boys).
However, 569 girls and 679 boys (29% overall) had a mental health treatment need identified but either were not receiving treatment or refused treatment.
Figure 6: mental health treatment received by young people in alcohol and drug treatment
| Mental health treatment received | Girls | Boys |
|---|---|---|
| Community or other mental health services | 1,358 | 2,160 |
| No treatment received | 569 | 679 |
| Mental health treatment from GP | 237 | 266 |
| Other mental health treatment | 103 | 80 |
| Treatment within drug or alcohol services | 98 | 98 |
Treatment types
Most young people in treatment received a psychosocial intervention (12,336 of 12,418, 99%). Psychosocial interventions (talking therapies) use psychological, psychotherapeutic and counselling skills to encourage behaviour change.
Structured harm reduction interventions are a type of psychosocial intervention. They involve support to manage risky behaviours associated with substance misuse. This might include behaviours that can cause overdose or accidental injury, for example injecting and polydrug use. In 2022 to 2023, 8,661 young people (70% of those receiving an intervention) received a harm reduction intervention.
Only 34 young people in treatment (less than 1%) received a pharmacological intervention during treatment. These interventions involve medication prescribed by a clinician and can include detoxification, stabilisation, relapse prevention and substitute prescribing for opiates.
Almost all interventions were delivered in a community setting (98%). A small number of young people received interventions in other settings, such as at home, in residential rehab, or in an inpatient unit.
Figure 7: treatment types and settings received by young people
| Treatment type | Community | Other |
|---|---|---|
| Psychosocial | 12,092 | 297 |
| Harm reduction | 8,417 | 248 |
| Pharmacological | 32 | 5 |
Note: figures less than 5 have been rounded up to 5 to prevent possible identification.
Treatment exits
There were 7,974 young people who left treatment in 2022 to 2023. Of those who left, 6,600 (83%) successfully completed their treatment and 928 (12%) dropped out. A further 3% left during a transfer to another provider for treatment and 2% declined the treatment offered.
Figure 8: treatment exit reasons
| Treatment exit reason | Percentage of young people |
|---|---|
| Completed | 82.8% |
| Dropped out or moved away | 11.6% |
| Transferred on to another substance misuse service | 3.1% |
| Treatment declined | 2.1% |
| Other | 0.3% |
| Retained in secure estate | 0.2% |
Trends over time
Trends in age and numbers in treatment
There were 12,418 young people in contact with alcohol and drug services between April 2022 and March 2023. This is a 10% increase from the previous year (11,326) but a 13% reduction in the number in treatment since 2019 to 2020 (14,291), and 50% lower than a peak of 24,494 in 2008 to 2009.
Data from the Smoking, drinking and drug use among young people in England survey showed a long-term decreasing trend in the proportion of school pupils reporting lifetime drug use until 2014. Since 2016, when the survey started to include psychoactive substances, the trend has been falling again.
Figure 9 shows the trends in the numbers and ages of young people in treatment since 2005 to 2006, split into 3 age groups:
- under 14 years old
- 14 to 15 years old
- 16 to 17 years old
The total number of young people coming to treatment increased from 17,105 in 2005 to 2006 to a high of 24,494 in 2008 to 2009. Since then, the numbers in treatment have steadily fallen until 2020 to 2021, which saw a steep fall to 11,013 young people in treatment. Over the last 2 years, there was a slight rise to 12,418 young people in treatment.
The 3 age groups shown have largely followed these trends since 2005 to 2006 with the largest proportion being 16 to 17 year olds, followed by 14 to 15 year olds. The under 14 years old group makes up the smallest proportion year on year.
Figure 9: trends in age and numbers in treatment
| Year | Under 14 | 14 to 15 years old | 16 to 17 years old | Total |
|---|---|---|---|---|
| 2005 to 2006 | 1,504 | 6,386 | 9,215 | 17,105 |
| 2006 to 2007 | 1,770 | 7,858 | 11,579 | 21,207 |
| 2007 to 2008 | 2,060 | 9,238 | 12,982 | 24,280 |
| 2008 to 2009 | 2,069 | 9,187 | 13,238 | 24,494 |
| 2009 to 2010 | 1,890 | 9,206 | 13,069 | 24,165 |
| 2010 to 2011 | 1,643 | 8,651 | 12,261 | 22,555 |
| 2011 to 2012 | 1,533 | 8,219 | 11,497 | 21,249 |
| 2012 to 2013 | 1,487 | 8,151 | 10,963 | 20,601 |
| 2013 to 2014 | 1,275 | 7,801 | 10,606 | 19,682 |
| 2014 to 2015 | 1,211 | 7,628 | 10,026 | 18,865 |
| 2015 to 2016 | 1,157 | 7,205 | 9,161 | 17,523 |
| 2016 to 2017 | 1,337 | 7,076 | 8,436 | 16,849 |
| 2017 to 2018 | 1,402 | 6,899 | 7,601 | 15,902 |
| 2018 to 2019 | 1,289 | 6,529 | 6,959 | 14,777 |
| 2019 to 2020 | 1,204 | 6,446 | 6,641 | 14,291 |
| 2020 to 2021 | 740 | 4,280 | 5,993 | 11,013 |
| 2021 to 2022 | 969 | 4,848 | 5,509 | 11,326 |
| 2022 to 2023 | 1,188 | 5,600 | 5,630 | 12,418 |
Trends in recorded substance misuse
The proportion of young people in treatment who said that they had problems with cannabis has been between 85% and 90% since 2013 to 2014. The proportion who reported having alcohol problems had fallen steadily from a peak of 68% in 2008 to 2009 to 40% in 2020 to 2021. It rose to 46% in 2021 to 2022 before falling again this year to 44%.
Figure 10: trends in reported substance
The proportion of people treated for ecstasy has fluctuated from around 10% between 2005 and 2008, decreasing to 4% between 2010 and 2012 before rising to a peak of 14% between 2017 and 2019. In 2022 to 2023, the proportion decreased to 7%.
The proportion of young people in treatment for amphetamine use decreased slightly between 2005 and 2010 before increasing sharply to a peak of 12% in 2012 to 2013. Since then, there has been a trend of decreasing proportions of young people in treatment for amphetamine use (0.6% this year).
Cocaine use among young people in treatment peaked in 2008 to 2009 (13%), falling to 7% in 2012 to 2013. Since this point, the number has remained similar year-on-year (9% this year). The number of young people reporting psychoactive substances has continued to fall. This was first reported on in 2013 to 2014 and rose to a peak of 6% in 2015 to 2016 before falling to under 1% in 2020 to 2021 which is still the case this year.
The number of young people in treatment for ketamine problems was consistently low (under 2.5%) between 2005 and 2018. It has since increased from under 1% in 2015 to 2016 to 5% in 2020 to 2021. This year it has increased to 6%.
The proportion of young people who reported benzodiazepines as a problematic substance was also consistently low (under 1.5%) between 2005 and 2017. From 2018 to 2019 to 2021 to 2022, it was consistently over 2.5%, but this year the proportion has decreased to 2%.
The proportion of young people seeking help for codeine has fallen over the last 2 years (1.2% in 2020 to 2021 compared to 0.8% this year), but is up from a low of 0.1% in 2014 to 2015. The proportion of young people seeking help for heroin has remained stable since 2017 to 2018 (0.43% compared to 0.38% this year).
The number of young people in treatment for solvent misuse increased markedly this year, from 329 (2.9%) people reporting a problem in 2021 to 2022, to 629 (5.1%) in 2022 to 2023.
The data tables for this year’s young people’s substance misuse treatment statistics also contain trends by the primary substance. This is the main problem substance that the young person reported when they entered treatment.
Figure 11: trends in amphetamine, cocaine and ecstasy misuse
Figure 12: trends in benzodiazepines, ketamine and psychoactive substances and solvent (including inhalant) misuse
Background and policy context
Background to the data
This report presents statistics on the availability and effectiveness of young people’s alcohol and drug treatment in England and the profile of those accessing treatment.
The statistics in this publication come from analysis of the National Drug Treatment Monitoring System (NDTMS). The NDTMS collects data from sites providing structured substance misuse interventions to young people in every local authority in England.
The data collected includes information on the demographics and personal circumstances of young 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 information paper.
Policy context
Specialist substance misuse support for young people is separate from adult treatment for many reasons. For example, young people typically use different substances, with most using cannabis and alcohol rather than heroin, which is far more common among adults. Also, for some young people, substance misuse may not be the main issue they need help with, particularly in cases of neglect and abuse and other child safeguarding concerns.
Whatever support services provide, it needs to take place in a safe environment, be centred on children and young people and be age-appropriate. Staff need to have a therapeutic relationship with parents and carers where appropriate. They also need to have arrangements in place to transition to transition young people to adult care at the right time.
Work is ongoing to improve the quality of young people’s treatment. This includes commissioning quality standards for alcohol and drug services to help local partnerships commission age-appropriate alcohol and drug services more effectively. The standards outline the expectation for commissioners to take into account the complex needs of young people in their commissioning plan, including safeguarding duties and developmental needs.
The government’s drug strategy includes £780 million to improve treatment and recovery, and includes an aim for 5,000 more young people to access alcohol and drug treatment by 2024 to 2025.
The effect of the COVID-19 pandemic
Previous reports have noted the effect of the COVID-19 pandemic on young people’s 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.
So, like in 2020 to 2021 and in 2021 to 2022, the COVID-19 pandemic and its effects might have affected the data in this report.
Enquiries or feedback
If you have any enquiries or feedback about these statistics, please email the Office for Health Improvement and Disparities at [email protected].