Policy and context
Good-quality drug treatment is effective
National and international evidence consistently shows that good- quality drug treatment is highly effective in reducing illegal drug misuse, improving the health of drug misusers, reducing drug- related offending, reducing the risk of death due to overdose, reducing the risk of death due to infections (including blood-borne virus infections) and improving social functioning. Key references for the effectiveness of drug treatment include the Taskforce Review (Department of Health, 1996),6 the National Treatment Outcome Research Study (1995–2000)7 and Treating Drug Misuse Problems: Evidence of Effectiveness (NTA 2006).4
Significant improvement in access to and capacity in drug treatment since 2001
Funding for drug treatment has increased significantly since 2001 and has received substantial investment in the last five years. This investment has achieved a rapid expansion in drug treatment to achieve the Government’s PSA target to double the number of drug misusers in effective, well-managed drug treatment by 2008. The drug treatment workforce has also grown significantly, from just over 6,000 practitioners and managers in 2002 to over 10,000 in March 2005.
The Audit Commission report Drug Misuse 2004,8 recognised the impressive progress in the drug treatment system since 2002, including the increased capacity of local drug treatment services, better working partnerships between local agencies, and more
The wide variation in access to different types of treatment – as referred to in an earlier Audit Commission report, Changing Habits (2002)9 – has been largely tackled, with the implementation of Models of Care 2002 leading to a good range of drug treatment services now available in most areas in England.
In 2002, the Audit Commission reported drug treatment as being characterised by lengthy waiting times in most areas. In December 2001, the average national waiting time across all types of treatment was 9.1 weeks. This had been reduced to a national average of 2.3 weeks by June 2005. Furthermore, lower average waiting times were achieved for all clients in intensive Drug Interventions Programme (DIP) DAT areas (1.85 weeks in June 2005).10
Drug treatment population trends
Data analysis from the National Drug Treatment Monitoring System (NDTMS) for 2003/04 produced the following key findings on clients in contact with structured drug treatment services.
Models of care for treatment of adult drug misusers: Update 2006
In 2003/04, 125,545 individuals were reported to the NDTMS as receiving structured drug treatment. This figure has been revised from the figure published in September 2004 after resubmissions and corrections to the data received during 2004/05
Heroin was identified as the main problem drug for over two- thirds (67 per cent) of clients receiving drug treatment
Where heroin was a client’s main drug of misuse, 21 per cent reported crack or cocaine as the second drug of misuse
Of clients reporting crack or cocaine as their main drug of misuse, 13 per cent reported heroin as their second drug of misuse
Cannabis was reported as the main problem drug for clients under 18 (61 per cent), while the figure for adults was nine per cent. One-fifth (20 per cent) of individuals under 18 reported heroin as their main problem drug, five per cent reported crack or cocaine
There are notable regional differences in the proportions of individuals receiving drug treatment with crack or cocaine recorded as the main problem drug. This ranges from under two per cent of those treated in the NTA’s Yorkshire and Humber region, to 23 per cent in the London region
The most common referral route into treatment was self- referral, representing over two-fifths (43 per cent) of all reported referral sources
Approximately 17 per cent of clients were referred into treatment via criminal justice agencies
Over half of all recorded drug treatment (54 per cent) was reported as being through specialist prescribing programmes, provided primarily by mental health trusts
About half (52 per cent) of all clients discharged from treatment remained in contact for 12 weeks or more following a triage assessment
A little under three-quarters (72 per cent) of clients presenting were male
Over two-fifths (41 per cent) of closed Tier 4 treatment episodes resulted in a successful completion.
More information on the data analysis can be found in the report Statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2003 to 31 March 2004 (DH, NTA, 2005).11
Evidence also indicates that alcohol misuse among those in drug treatment is common and polydrug and alcohol use is common, if not the norm (Gossop, 2005).12 The National Treatment Outcome Research Study (NTORS, 2000) found that drug treatment services were having little or no impact on drug service users’ drinking behaviour, despite half having identified alcohol problems. NTORS (1996) also commented on the “heavy burden” of health problems carried by drug users attending treatment, which