Alcohol and drug treatment in secure settings 2021 to 2022: report
Published 16 March 2023
Applies to England
© Crown copyright 2023
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1. Main findings
1.1 Treatment numbers and substance use
There were 45,096 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2021 and 31 March 2022. Numbers in treatment had been decreasing year on year until this year, which saw a 3% increase from the 43,607 reported in 2020 to 2021.
Around three-quarters (33,275, 74%) of these people started treatment during this year, a similar proportion to 2020 to 2021 (71%). Of the people starting treatment, 46% said they had a problem with opiate use, the lowest proportion seen since reporting began.
The proportion of people starting treatment for opiates, crack or both has been decreasing steadily from an all-time high recorded in 2017 to 2018 (60%). Fifty-four per cent reported problems with these substances in 2021 to 2022.
1.2 Adults leaving treatment
A total of 27,520 people left treatment in secure settings in 2021 to 2022, compared to 32,984 in 2020 to 2021.
A third (32%) of those were discharged after completing their treatment free of dependence, the highest proportion recorded since reporting began. This is a small rise from 31% in 2020 to 2021 and 26% in 2019 to 2020. The proportions of people completing their treatment by substance group were very similar to 2020 to 2021, with small rises in all groups except the opiate group, which had a slight fall within a percentage point.
1.3 Continuity of care
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 37.4% in 2021 to 2022. This is a slight decrease from the proportion reported in 2020 to 2021 (38.1%) but is still 7.1% higher than when this data was first reported in 2015 to 2016 (30.3%).
Rates of successfully transferring from prison to community treatment varied around the regions of England. The North East had the highest rate of continuing treatment (57%) and London had the lowest (21%).
1.4 Deaths in treatment
There were 34 people who died while they were in treatment in 2021 to 2022. This is a 43% decrease compared to the previous year when 60 people died.
1.5 Young people’s treatment
There were 553 young people receiving treatment for drug and alcohol problems in secure settings in 2021 to 2022, the lowest number since reporting began. This is a 17% decrease compared to the previous year (669 in 2020 to 2021), continuing an overall downward trend since 2015 to 2016 (1,428).
Cannabis was the most common problem substance for young people in secure settings, with 92% saying they had a cannabis problem. This proportion has remained at similar levels since 2015 to 2016.
Of the 402 young people who left treatment in secure settings in 2021 to 2022, 33% completed their treatment successfully. This is a significant decrease from 41% in 2020 to 2021, which was the highest rate since reporting began.
2. Adults in prison treatment: overview
2.1 Definitions
This report presents statistics from the National Drug Treatment Monitoring System (NDTMS) on adults (aged 18 and over) and young people (aged 17 or younger) who were receiving help in prisons and secure settings in England for problems with drugs and alcohol. It covers the period 1 April 2021 to 31 March 2022.
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 adults in treatment into 4 substance groups:
-
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.
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. All other people entering treatment are categorised as either ‘non-opiate only’, ‘non-opiate and alcohol’, or ‘alcohol only’.
Person enters treatment.
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 problems 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
2.2 Numbers in treatment
Figure 2: adults in treatment by setting
There were 45,096 adults receiving treatment for drug and alcohol problems in secure settings between April 2021 and March 2022. Most adults received structured treatment in prison (97%), including local, training, high security and open prisons. The remaining people received treatment in young offender institutions (3%) and immigration removal centres (less than 1%).
You can find a definition of structured treatment in our NDTMS secure setting alcohol and drug treatment business definitions guidance.
Figure 3: adults in treatment by substance group and setting
| Setting | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| Prisons | 46.3% | 21.1% | 20.0% | 12.6% | 100% |
| Immigration removal centres | 61.8% | 12.2% | 11.4% | 14.6% | 100% |
| Young offender institutions | 20.5% | 42.8% | 29.5% | 7.2% | 100% |
| Setting | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only |
|---|---|---|---|---|
| Prisons | 20,168 | 9,212 | 8,709 | 5,480 |
| Immigration removal centres | 76 | 15 | 14 | 18 |
| Young offender institutions | 288 | 601 | 414 | 101 |
In prisons and immigration removal centres, the biggest drug category was the opiate group (46% and 62% respectively). Most people in young offender institutions were treated for non-opiates only (43%) or non-opiates and alcohol (29%), with 21% reporting opiate use.
Forty-one per cent of people in treatment in prisons and 24% of people in immigration removal centres were in the non-opiate only and non-opiate and alcohol groups. A lower proportion of people in young offender institutions were treated for alcohol only (7%) than in the rest of the secure estate (between 13% and 15%).
2.3 Sex
Figure 4: breakdown of adults in treatment by sex and substance group
| Substance group | Women | Men | Total |
|---|---|---|---|
| Opiate | 2,588 | 17,944 | 20,531 (46%) |
| Non-opiate only | 479 | 9,349 | 9,828 (22%) |
| Non-opiate and alcohol | 509 | 8,628 | 9,137 (20%) |
| Alcohol only | 566 | 5,033 | 5,600 (12%) |
| Total | 4,142 | 40,954 | 45,096 (100%) |
Ninety-one per cent (40,954) of the people in treatment in adult secure settings were men and 9% (4,142) were women. This is more than double the proportion of women in prison, which was 4% at the end of March 2022, as reported in the HM Prison and Probation Service (HMPPS) offender equalities annual report 2021 to 2022).
The proportion of women in each substance group ranged from 13% in the opiate group to 5% in the non-opiate only group.
Figure 5: proportion of substance groups by sex
| Sex | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| Women | 62.5% | 11.6% | 12.3% | 13.7% | 100% |
| Men | 43.8% | 22.8% | 21.1% | 12.3% | 100% |
The substance groups showed big differences by sex. Nearly two-thirds of women (62%) in treatment had problems with opiate use compared with 44% of men. The other 38% of women were split almost evenly across the other treatment groups with 12% in both the non-opiate groups, and 14% in the alcohol only group. Non-opiate drug problems were the second most common among men, with 44% in this category (22% in non-opiate and 21% in non-opiate and alcohol groups). Twelve per cent of men were in the alcohol only group.
2.4 Age
Figure 6: age of adults in treatment
| Age group | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| 18 to 20 | 0.8% | 6.6% | 4.1% | 1.3% | 2.8% |
| 21 to 24 | 3.0% | 16.9% | 11.5% | 5.4% | 8.1% |
| 25 to 29 | 9.2% | 23.6% | 22.0% | 12.6% | 15.4% |
| 30 to 39 | 41.3% | 34.8% | 41.2% | 35.2% | 39.1% |
| 40 to 49 | 35.1% | 13.6% | 15.2% | 24.9% | 25.1% |
| 50 to 59 | 9.7% | 3.9% | 5.1% | 15.8% | 8.3% |
| 60 and over | 0.8% | 0.6% | 0.8% | 4.8% | 1.3% |
| Age group | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| 18 to 20 | 163 | 648 | 377 | 73 | 1,261 |
| 21 to 24 | 614 | 1,664 | 1,053 | 304 | 3,635 |
| 25 to 29 | 1,899 | 2,318 | 2,014 | 707 | 6,938 |
| 30 to 39 | 8,480 | 3,420 | 3,766 | 1,970 | 17,636 |
| 40 to 49 | 7,212 | 1,335 | 1,387 | 1,392 | 11,326 |
| 50 to 59 | 1,994 | 385 | 467 | 886 | 3,732 |
| 60 and over | 170 | 58 | 73 | 267 | 568 |
The most common age range for adults in treatment in a secure setting was 30 to 39 years old, followed by 40 to 49 years old. These groups together made up around two-thirds (64%) of the total adults in treatment.
The largest drug group in both of these age groups was opiates. Opiates was also the largest drug group in the next oldest category, 50 to 59 year olds. The largest substance group for adults aged 18 to 29 was non-opiates, and the largest substance group for those aged 60 or older was alcohol only.
The median age of adults in treatment in secure settings for alcohol alone and for opiate use was 38 and 39 years respectively. This compares with 46 years and 43 years respectively for people in treatment in the community.
Adults in the non-opiate and alcohol and non-opiate only groups had median ages of 32 years and 30 years respectively. The median ages were 35 years and 31 years in community treatment.
Adults in alcohol and drug treatment in secure settings tended to be younger than those in community-based treatment. Although, like community treatment, adults being treated for alcohol problems only or opiates tended to be older than those treated for other substances.
2.5 Problem substances for adults in prison treatment
Figure 7: substances by group for adults in treatment
Opiate substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Both opiates and crack cocaine | 13,441 |
| Opiates (not crack cocaine) | 7,091 |
| Cannabis | 2,969 |
| Cocaine | 1,928 |
| Benzodiazepines | 2,171 |
| Amphetamines | 455 |
| Other drugs | 540 |
| Alcohol | 4,661 |
Non-opiate only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,949 |
| Cannabis | 6,380 |
| Cocaine | 3,783 |
| Benzodiazepines | 653 |
| Amphetamines | 528 |
| Other drugs | 547 |
Non-opiate and alcohol substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,677 |
| Cannabis | 4,847 |
| Cocaine | 4,573 |
| Benzodiazepines | 484 |
| Amphetamines | 320 |
| Other drugs | 265 |
| Alcohol | 9,137 |
Alcohol only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Alcohol | 5,599 |
Figure 7 shows a breakdown of the substances reported by people in prison treatment in 2021 to 2022, 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 within their substance group. For example, somebody who uses cocaine, cannabis and alcohol would be counted in the non-opiate and alcohol group for these 3 substances.
Opiates were the most reported drug by adults in treatment (46%) with 30% reporting both opiate and crack problems and 16% reporting problems with opiates but not crack. Eight per cent of people reported problems with crack only.
Over two-fifths (43%) of people said they had problems with alcohol, with around a third (29%) of these people using alcohol only. Just under a third (31%) of adults reported problems with cannabis and nearly a quarter (23%) with cocaine.
New psychoactive substances (NPS) were a problem for 7% of people in treatment in secure settings. However, this may not reflect overall NPS use in prisons, because data is collected when people enter treatment so does not include people who started using NPS while they were in prison. It’s also possible that some people who used NPS did not report it as one of the 3 main drugs they had problems with.
3. Adults starting prison treatment: pathways, age, substances
3.1 Pathways into treatment
Figure 8: pathway into treatment for adults starting treatment in 2021 to 2022
| Substance group | Taken directly into custody | Transferred from another secure setting | Total |
|---|---|---|---|
| Opiate | 60.2% | 39.8% | 100% |
| Non-opiate only | 38.5% | 61.5% | 100% |
| Non-opiate and alcohol | 48.5% | 51.5% | 100% |
| Alcohol only | 64.1% | 35.9% | 100% |
| Total | 53.8% | 46.2% | 100% |
Over half (54%) of the people starting treatment in an adult secure setting between 2021 and 2022 were taken directly into custody or detention from the community. The other 46% started treatment after being transferred from another secure setting.
Most people starting treatment for opiate use or alcohol use only came directly into custody from the community (60% and 64% respectively). In the non-opiate only and non-opiate and alcohol groups, the majority of people coming into treatment were transferred from another secure setting were 61.5% and 51.5% respectively.
Most of the adults starting treatment who were taken directly into custody from the community (62%) started treatment immediately on arrival in secure settings, 88% started within 3 weeks of arrival. Of the people transferring from another secure setting, 38% took over 3 weeks to start treatment. These will often be people who have developed drug problems in custody or decide they want to access treatment before their release, rather than being just people who have a break in their treatment when they transfer from one prison to another.
3.2 Substances reported by adults starting treatment in secure settings
Figure 9: substances by group for adults starting treatment in 2021 to 2022
Opiate substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Both opiates and crack cocaine | 10,318 |
| Opiates (not crack cocaine) | 4,966 |
| Cannabis | 2,137 |
| Cocaine | 1,330 |
| Benzodiazepines | 1,572 |
| Amphetamines | 265 |
| Other drugs | 416 |
| Alcohol | 3,617 |
Non-opiate only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,430 |
| Cannabis | 4,427 |
| Cocaine | 2,704 |
| Benzodiazepines | 462 |
| Amphetamines | 357 |
| Other drugs | 414 |
Non-opiate and alcohol substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,333 |
| Cannabis | 3,461 |
| Cocaine | 3,372 |
| Benzodiazepines | 372 |
| Amphetamines | 216 |
| Other drugs | 204 |
| Alcohol | 6,705 |
Alcohol only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Alcohol | 14,694 |
There were 33,275 people who started treatment for drug and alcohol problems in a secure setting in 2021 to 2022. This is where a person started a new treatment episode, which might also include returning to treatment.
Of the people starting treatment:
- 15,283 (46%) said they had a problem with opiate use
- 14,694 (47%) said they had a problem with alcohol
- 4,373 (13%) said they had a problem with alcohol alone
- 10,025 (30%) said they had a problem with cannabis
- 7,405 (22%) said they had a problem with cocaine
Of the people with opiate problems:
- 10,318 (68%) said they had a problem with crack
- 3,616 (29%) said they had a problem with alcohol
- 2,137 (14%) said they had a problem with cannabis
- 1,572 (10%) said they had a problem with benzodiazepines
Nearly 3 in 5 (7,888, 58%) people in the non-opiate substance groups reported having problems with cannabis. This included 4,427 (64%) people in the non-opiate only group and 3,461 (52%) people in the non-opiate and alcohol group.
Cannabis was the most common problem substance in the non-opiate group and the most common after alcohol in the non-opiate and alcohol group. Over a third (2,704, 39%) of the non-opiate only group reported problems with cocaine powder at the start of treatment, compared to half (3,372, 50%) of the non-opiate and alcohol group.
4. Mental health
Nearly a third (32%) of people starting treatment were identified as having a mental health need. This proportion was consistent across the 4 substance groups, with the highest proportion in the non-opiate and alcohol group (34%) and the lowest (29%) in the non-opiate only group.
The mental health needs recorded in NDTMS should reflect the needs identified by prison healthcare staff or identified in the community before the person was in the secure setting.
5. Injecting drugs
Figure 10: injecting status of people adults starting treatment in 2021 to 2022
| Substance group | Currently injecting | Previously injected | Never injected | Declined to answer | Total |
|---|---|---|---|---|---|
| Opiate | 16.8% | 33.9% | 45.0% | 4.3% | 100% |
| Non-opiate only | 1.3% | 8.4% | 86.5% | 3.9% | 100% |
| Non-opiate and alcohol | 0.9% | 10.6% | 85.2% | 3.3% | 100% |
| Alcohol only | 0.2% | 6.2% | 88.2% | 5.4% | 100% |
| Total | 8.2% | 20.3% | 67.3% | 4.2% | 100% |
Most people starting treatment in 2021 to 2022 had never injected drugs (67%). This ranged from 45% of people in the opiate group to between 85% and 88% in the other substance groups. People in the opiate group were most likely to be currently injecting (17% compared to 1% or less for the other substance groups). Over a third (34%) of people in the opiate group reported previously injecting, compared to 8% in the non-opiate only group, 11% in the non-opiate and alcohol group, and 6% in the alcohol only group.
6. Parental status and safeguarding children
6.1 Parental status
Figure 11: parental status of people starting treatment in 2021 to 2022
| Parental status | Adults in treatment |
|---|---|
| Not parent and not in contact with children | 67.1% |
| Parent not living with children | 22.2% |
| Parent living with children | 8.4% |
| Other contact living with children | 2.4% |
Eleven per cent of people starting treatment in 2021 to 2022 were living with children, either their own or someone else’s, before coming into the secure setting.
Most people starting treatment were not in contact with children. Sixty-seven per cent (27,743) reported that they were not parents and a further 22% (9,163) said they were parents but did not currently live with their children.
6.2 Safeguarding and early help
Figure 12: children receiving early help or in contact with children’s social care
| Help received | Children of adults starting treatment |
|---|---|
| Child in need | 1.6% |
| Early help | 3.9% |
| Child protection plan | 4.8% |
| Looked after child | 9.7% |
| No early help | 79.8% |
The children of 80% of adults starting treatment had no contact with children’s services. Ten per cent of people starting treatment had a looked after child, though this figure was higher in the opiate group at 13%.
Of the people starting treatment:
- 5% had a child with a child protection plan
- 4% had a child receiving early help
- 2% were in contact with social services because they had a child in need
- less than 1% were in contact with other relevant child or family support services
Early help describes any service that supports children and families as soon as problems emerge. Examples include parenting support and emotional health and wellbeing support.
7. Smoking
Figure 13: smoking prevalence at start of treatment
| Substance group | Women | Men |
|---|---|---|
| Opiate | 65.6% | 50.0% |
| Non-opiate only | 54.9% | 39.0% |
| Non-opiate and alcohol | 63.6% | 45.2% |
| Alcohol only | 46.9% | 41.2% |
| Total treatment population | 61.7% | 46.8% |
| General population | 12.1% | 15.8% |
Nearly 5,000 people said they had smoked tobacco in the 28 days before entering prison. This is based on information collected at the start of treatment as part of the treatment outcomes profile monitoring form.
Across all substance groups, the level of smoking was substantially higher than the smoking rates of the general adult population in England. The latest Office for National Statistics report on smoking habits in the UK says these rates are 15.8% for men and 12.1% for women. The smoking rates for the total treatment population in secure settings were 47% for men and 62% for women.
Across all substance groups, women consistently reported smoking at higher levels than men, which is different to the general population. The substance group with the lowest level of smoking for both men and women was the alcohol only group.
8. Treatment types
Figure 14: breakdown of adults in treatment types by substance group
| Substance group | No structured intervention started or recorded | Prescribing and psychosocial | Pharmacological only | Psychosocial only | Total |
|---|---|---|---|---|---|
| Opiate | 0.6% | 69.6% | 6.8% | 23.0% | 100% |
| Non-opiate only | 1.0% | 6.1% | 0.7% | 92.1% | 100% |
| Non-opiate and alcohol | 1.4% | 12.3% | 1.6% | 84.7% | 100% |
| Alcohol only | 1.8% | 22.1% | 7.7% | 68.4% | 100% |
| Total | 1.0% | 38.3% | 4.5% | 56.2% | 100% |
Almost all adults in treatment in secure settings (95%) received psychosocial interventions. Five per cent received only pharmacological interventions and 1% either did not start an intervention or an intervention was not recorded.
Psychosocial intervention only was the most common treatment type in the non-opiate only (92%), non-opiate and alcohol (85%) and alcohol only (68%) groups. Only 23% of people using opiates received a psychosocial intervention only.
Close to half (43%) of adults in treatment received pharmacological interventions. Seventy-six per cent of the opiate group received these, compared to 30% of the alcohol only group and 7% of the non-opiate only group.
Pharmacological interventions are generally provided alongside psychosocial interventions to support a person’s recovery, as recommended by the UK clinical guidelines for drug misuse and dependence. Forty-four per cent of people in treatment received both pharmacological and psychosocial interventions. Of the people receiving both treatment types:
- 70% were in the opiate group
- 22% were in the alcohol only group
- 12% were in the non-opiate and alcohol group
- 6% were in the non-opiate only group
9. Treatment outcomes
9.1 Treatment exits and successful completion
Figure 15: breakdown of adult treatment exits in 2021 to 2022
A total of 27,520 people left treatment in secure settings between 1 April 2021 and 31 March 2022. A third (32%) of those were discharged after completing their treatment free of dependence.
The non-opiate only group (46%), non-opiate and alcohol group (45%) and the alcohol only group (45%) had the highest rates of successfully completing their treatment. The opiate group had the lowest rate of successfully completing treatment (15%).
Over half (56%) of adults leaving treatment were transferred for further treatment, either in the community (39%) or in another secure setting (18%).
Continuity of care between treatment services in prisons and the community is monitored by the Public Health Outcomes Framework (PHOF) indicator C20. This indicator measures the numbers of adults with substance misuse need who successfully engage in community-based structured treatment within 3 weeks of being released from prison. The proportion of adults successfully starting community treatment within 3 weeks of release was 37.4% in 2021 to 2022.
The remaining 7% of adults left treatment without completing it, mainly by dropping out of treatment (3%) or being discharged due to being released from court (2%).
Recommissioning transfers made up just over 4% of people leaving treatment. A recommissioning transfer indicates that a person has been transferred to another treatment provider, but this does not necessarily mean that the person has been physically transferred.
9.2 Deaths in treatment
There were 34 people who died while they were in treatment in 2021 to 2022, which represented 0.1% of all people leaving treatment. People with opiate problems accounted for 56% of these deaths.
The UK clinical guidelines for drug misuse and dependence emphasises the importance of take-home naloxone for previously heroin-dependent prisoners when they leave prison, to help reverse any overdose. Of all the people who were treated for opiate problems in prison, 46% were provided with take-home naloxone when they were released in 2021 to 2022.
10. Young people in treatment in secure settings
10.1 Young people’s treatment: overview
Figure 16: young people in treatment by setting
There were 553 young people receiving treatment for drug and alcohol problems in secure settings in 2021 to 2022. Most (64%) of these were in young offender institutions, with a further:
- 25% in secure children’s homes
- 6% in welfare-only homes
- 5% in secure training centres
10.2 Young people: age and sex
Figure 17: breakdown of young people by age and sex
| Age group | Girls | Boys |
|---|---|---|
| Under 14 | 9.1% | 1.0% |
| 14 years old | 12.1% | 6.2% |
| 15 years old | 27.3% | 15.6% |
| 16 years old | 27.3% | 25.1% |
| 17 and over | 24.2% | 52.2% |
Most (88%) of the young people in treatment in secure settings were male. HMPPS youth custody data on children and young people in secure settings show that 97% of the total youth custody population was male in March 2022 (excluding welfare only places but including settings in Wales).
Boys in treatment tended to be older, with the proportion of boys in each age group increasing with age. One per cent of boys in treatment were under 14 years old and over half (52%) were aged 17 or older. This was different to girls as only 24% of girls in treatment were aged 17 or older. Most of the girls in treatment were aged 15 or 16 (55%).
The median age of boys was 17 and the median age of girls was 16.
10.3 Young people: substance use
Figure 18: substances used by young people
| Substance | Young people in treatment |
|---|---|
| Cannabis | 91.7% |
| Alcohol | 38.3% |
| Cocaine | 18.1% |
| Nicotine | 17.0% |
| Solvents | 7.4% |
| Opiates | 6.1% |
| Benzodiazepines | 4.7% |
| Ecstasy | 2.9% |
| Other | 3.8% |
| Amphetamines | 1.1% |
| Crack | 1.1% |
| NPS | 0.5% |
Of all the young people in treatment in secure settings in 2021 to 2022:
- 92% said they had a problem with cannabis
- 38% said they had a problem with alcohol
- 18% said they had a problem with cocaine powder
- 17% said they had a problem with nicotine
- 7% said they had a problem with solvents
- 6% said they had a problem with opiates
- 5% said they had a problem with benzodiazepines
10.4 Vulnerabilities of young people starting treatment
Figure 19: vulnerabilities of young people starting treatment
| Vulnerability | Young people starting treatment |
|---|---|
| Poly-substance use | 60.7% |
| Pregnant or parent | 28.0% |
| Opiate and/or crack use | 7.3% |
| Injecting (currently or previously) | 1.0% |
| Vulnerability | Young people starting treatment |
|---|---|
| Poly-substance use | 241 |
| Pregnant or parent | 111 |
| Opiate and/or crack use | 29 |
| Injecting (currently or previously) | 4 |
Young people often enter specialist substance misuse services with a range of problems or ‘vulnerabilities’ which are related to (or in addition to) their substance use. These include using multiple substances (poly-substance use) and being a parent or pregnant.
The most common vulnerability by far was poly-substance use (61% of young people starting treatment). A further 28% reported being a parent or pregnant. Seven per cent of young people said they used opiates or crack. and nobody reported being a high-risk alcohol user.
10.5 Young people: treatment type
Figure 20: intervention types for young people
| Intervention | Young people receiving an intervention |
|---|---|
| Harm reduction | 71.1% |
| Psychosocial – motivational interviewing | 59.7% |
| Psychosocial – relapse prevention | 25.5% |
| Psychosocial – cognitive behavioural therapy | 15.0% |
| No valid intervention recorded | 13.6% |
| Psychosocial – counselling | 13.7% |
| Pharmacological | 1.1% |
| Psychosocial – family work | 0.0% |
Over two-thirds of young people in treatment (71%) in 2021 to 2022 received a harm reduction intervention. These interventions include support to manage risky behaviour associated with substance use, such as behaviour that can lead to overdose or accidental injury.
Of the other interventions that young people received:
- 60% received motivational interviewing
- 25% received relapse prevention psychosocial interventions
- 15% received cognitive behavioural therapy
- 14% received counselling
- 1% received a pharmacological intervention (medication prescribed by a clinician)
10.6 Young people: treatment exits
Figure 21: breakdown of young people’s latest treatment exits in 2021 to 2022
There were 402 young people who left treatment in secure settings in 2021 to 2022. Of these, 33% completed their treatment successfully.
Of the 67% who did not complete their treatment successfully:
- 17% declined treatment after being referred
- 14% were released from custody and transferred to another treatment service in the community
- 12% were transferred to another treatment service in custody
- 14% left treatment after being released from court
- 10% dropped out or had their treatment withdrawn by the provider (usually due to the person breaking their treatment contract)
11. Trends over time
11.1 Trends: adults in treatment
Figure 22: trends in the number of adults in treatment by substance group
Figure 22 shows the proportion of adults in treatment split by the 4 substance groups.
There were 45,096 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2021 and 31 March 2022. Numbers in treatment had been decreasing year on year until this year. And this year’s total is a 3% increase from the 43,607 reported in 2020 to 2021. This ends a downward trend in numbers in treatment, but is still 25% lower than the first year these statistics were reported (59,963 in 2015 to 2016).
This slight increase might just reflect the rise in prison population numbers in 2021 to 2022, rather than be a change in the overall treatment trend.
Compared to the previous year, there were increases in the number of people in treatment for all substance groups except the opiate group, which fell by 4%. The other 3 groups all increased between 10% and 11%.
11.2 Trends: adults starting treatment
Figure 23: trends in substance use by adults starting treatment
Figure 23 shows the proportion of adults starting treatment each year between 2015 to 2016 and 2021 to 2022 split by the 4 substance groups.
Around three-quarters (33,275, 74%) of the total adults in treatment started treatment during this year, a similar proportion to 2020 to 2021 (71%). Of the people starting treatment, 46% said they had a problem with opiate use, the lowest proportion seen since reporting began.
The number of adults starting treatment in secure settings in 2021 to 2022 was 8% higher than the previous year (33,275 compared to 30,776 in 2020 to 2021). This ends a year-on-year decrease since 2016 to 2017, but is still 29% lower than the first year of reporting (46,784 in 2015 to 2016).
This increase was present in all substance groups except the opiate group, which fell 2%.
11.3 Trends: opiate and crack use among adults starting treatment
Figure 24: trends in adults starting treatment reporting opiate or crack problems
The proportion of people starting treatment for opiates, crack or both has been decreasing steadily from an all-time high recorded in 2017 to 2018 (60%). This year, 54% reported problems with these substances.
Thirty-one per cent of people starting treatment in 2021 to 2022 reported problems with both crack and opiate use. This continued a recent decreasing trend from 37% in 2019 to 2020 and 33% in 2020 to 2021. But this year’s proportion is still higher than the lowest proportion since reporting began, which was 24% in 2015 to 2016.
The proportion of people starting treatment with opiate problems (but not crack problems) has also decreased from 25% in 2015 to 2016 to 15% in 2021 to 2022. In contrast, the proportion starting treatment with crack problems (but not opiate problems) has been increasing steadily from 5% in 2015 to 2016 to 8% in 2021 to 2022.
Figure 25: trends in adults starting treatment reporting problems with other substances
The proportion of people starting treatment who reported alcohol problems was very similar to previous years, with 44% of people in 2021 to 2022 compared to 45% in 2015 to 2016. But this proportion is part of rising trend from 39% reported in 2018 to 2019 and 2019 to 2020. The proportion of people in treatment for cannabis also remained fairly consistent between 2015 to 2016 (29%) and this year (30%).
Over time, proportions of people in treatment for benzodiazepines and amphetamines have decreased since these statistics were first reported (decreases of 4% for both substances since 2015 to 2016). The proportion of people in treatment for cocaine and other drugs have increased over the same period (increases of 3% and 2% for these groups since 2015 to 2016, respectively).
11.4 Trends: adults leaving treatment
Figure 26: trends in adults completing treatment since 2015 to 2016
A total of 27,520 people left treatment in secure settings in 2021 to 2022, compared to 32,984 in 2020 to 2021.
A third (32%) of people were discharged after completing their treatment free of dependence, the highest proportion recorded since reporting began. This represents a small rise from 31% in 2020 to 2021 and 26% in 2019 to 2020. The proportions of people completing their treatment by substance group were very similar to 2020 to 2021, with small rises in all groups except the opiate group, which had a small fall within a percentage point.
Transfers outside of custody (normally following a release from prison) decreased in 2021 to 2022 compared to the previous year, falling from 43% to 39%.
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 37.4% in 2021 to 2022. This is a slight decrease from the proportion reported in 2020 to 2021 (38.1%) but is still 7.1% higher than when this was first reported in 2015 to 2016 (30.3%). Proportions varied around the regions of England, with the North East having the highest rate of continuing treatment (57%) and London having the lowest (21%).
11.5 Trends: deaths of adults in treatment
Figure 27: trends in deaths of adults in treatment
The number of adults who died in 2021 to 2022 while they were in contact with treatment services was 34. This is a decrease of 43% from 60 deaths in the previous year.
As in previous years, people with opiate problems continue to be the most at risk, with 56% of all deaths occurring in this group. The other substance groups accounted for less than 21% of deaths.
11.6 Trends: young people in treatment
Figure 28: trends in numbers of young people in treatment from 2015 to 2016
There were 553 young people receiving treatment for drug and alcohol problems in secure settings in 2021 to 2022, the lowest number since reporting began. This is a 17% decrease compared to the previous year (669 in 2020 to 2021), continuing an overall downward trend since 2015 to 2016 (1,428). This is similar to the 15% decrease in the youth custody population (which includes 18 year olds) for England and Wales between March 2021 and March 2022. You can find statistics on this from HMPPS and the Youth Custody Service in their youth custody data on children and young people in secure settings.
11.7 Trends: substance use by young people in treatment
Figure 29: trends in young people in treatment by most commonly reported problematic substances
Cannabis was the most common problem substance for young people in secure settings with 92% saying they had a cannabis problem. This proportion has remained at similar levels since 2015 to 2016.
The proportion of young people reporting problems with cocaine (18%) is also at a similar level reported in 2015 to 2016, but the proportion with nicotine problems (17%) has decreased substantially from last year, from 26% in 2020 to 2021.
Fewer young people in treatment said they had problems with alcohol use in 2021 to 2022 (38%) than in 2015 to 2016 (50%). This continues the downward trend in young people with alcohol problems since the start of reporting secure setting treatment data in 2015 to 2016.
Figure 30: trends in young people in treatment by other problematic substances
The proportion of young people in treatment for opiate use has decreased to 6% in 2021 to 2022, from 7% the previous year. Solvent use has also increased to 7%, the highest level since these statistics were first reported in 2015 to 2016 (1%).
The proportion of young people in treatment reporting problems with other drugs (including benzodiazepines) was 8% this year. This is a small decrease from 2020 to 2021, where this proportion was 9%, but is a large increase from the lowest recorded proportion (4%) in 2015 to 2016.
The proportion of young people reporting problems with NPS and amphetamine use has fallen from 7% and 8% respectively in 2015 to 2016, to 1% this year.
Reported ecstasy problems have also fallen from a peak of 7% in 2015 to 2016 to 3% this year.
11.8 Trends: young people’s treatment exits
Figure 31: trends in young people leaving treatment
Of the 402 young people who left treatment in secure settings in 2021 to 2022, 33% completed their treatment successfully. This is a significant decrease from 41% in 2020 to 2021, the highest since reporting began. The previous highest proportion was 34.2% in 2016 to 2017 and the lowest proportion recorded was 25% in 2017 to 2018.
The proportion of young people in treatment who were transferred either to other treatment services in the community or within the secure estate fell from 15% and 14% in 2020 to 2021 to 14% and 12 % in 2021 to 2022 respectively.
These decreases may be partly explained by the NDTMS dataset introducing a new discharge reason to the dataset from April 2018. This discharge reason includes the young people who were released from court and discharged before a transfer to community services could be arranged. In 2021 to 2022, the proportion of young people in treatment who left it because they were released from court was 14%, the highest reported.
The proportion of young people who dropped out, had their treatment withdrawn by the provider or left treatment for another unplanned reason has historically been consistently low (4% in the last 3 years). In 2021 to 2022 this proportion increased to 10%, the highest proportion recorded.
After an initial decrease from 7% in 2015 to 2016 to 4% in 2016 to 2017, the proportion of young people who were referred for treatment but declined it has steadily increased. In 2021 to 2022 the proportion was 17%, the highest proportion since reporting began.
12. Background and policy context
12.1 Background
Statistics in this publication
This report presents statistics on the availability and effectiveness of alcohol and drug treatment in prisons and secure settings in England, and the profile of people accessing this treatment.
The statistics in this publication come from analysis of the NDTMS, which collects data from services providing structured substance misuse interventions to adults and young people in about 140 prisons and secure settings across England. This includes adult settings (prisons and immigration removal centres) and the children and young people’s secure estate.
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.
Change in methodology
This year we have improved the way people are counted in the report. Previously a person was identified by their local prison identifier. Now a person is identified by the combination of their initials, date of birth and sex at birth, together with the secure setting they received treatment at and the date they started this treatment.
This helps to bring the methodology closer to the way we calculate alcohol and drug misuse and treatment statistics in the community. We expect the number of people in treatment to be slightly higher as a result of this change, but within 1% of figures for previous years. To ensure we can make comparisons with previous years, we have provided data back to 2015 to 2016 in the report. Trend data includes trends in:
- adults and young people in treatment
- substance use
- treatment exits
You can find more details on the methodology used in the report in the NDTMS annual statistics quality and methodology information paper.
12.2 Policy context
Alcohol and drug treatment services in prisons and secure settings for adults and young people are commissioned by NHS England.
NHS England commissions specialist treatment services in secure settings which are equivalent to community-based treatment and informed by evidence-based clinical guidance. Treatment includes interventions to reduce harm and to help people recover from alcohol and drug dependence.
You can read more about how NHS England commissions healthcare for young people and adults across secure settings at the health and justice page on the NHS England website.
The Royal College of Paediatrics and Child Health has published healthcare standards for children and young people in secure settings.
Keeping prisoners engaged in treatment after release is a priority of the treatment and recovery part of the government’s drug strategy. The Public Health Outcomes Framework supports this priority by monitoring the numbers of adults who engage in community substance misuse treatment within 3 weeks of leaving prison.
Under the Children Act 1989, local authorities can place children into secure children’s homes and welfare only homes. In these circumstances, children and young people are held there because of concerns about their welfare, rather than because they have offended.
12.3 Enquires or feedback
If you have any enquiries or feedback about these statistics, please email the Office for Health Improvement and Disparities at [email protected].