Substance misuse

National and local strategies

The 2010 Drug Strategy

The 2010 Drug Strategy shifts the focus for substance misuse services towards recovery, and not just harm-reduction, as was previously the case. It encourages a holistic person-centred approach, which is integrated and provides continuity of case management and support. 

The two overarching aims of the strategy are to:

NICE guidelines

When designing and commissioning services in line with the new model for treatment services, it remains essential to ensure that these are in line with national guidelines.  A number of relevant NICE guidelines exist, as follows:

NICE Clinical Guidelines

NICE Public Health Guidance

Cochrane Systematic Evidence Reviews

Motivational interviewing for substance abuse

Motivational interviewing is a client-centred semi-directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.  Compared with no treatment, but not other ‘usual’ treatments or assessment and feedback, motivational interviewing can reduce the extent of substance abuse. 

Smedslund G et al (2011) Motivational interviewing for substance abuse. The Cochrane Collaboration

Case management for persons with substance use disorders

Case management is a strategy for linking patients with alcohol and drug use disorders with relevant services for additional social, physical and mental health treatment needs.  A single case manager is responsible for the individual, linking them with multiple relevant services.  Evidence supports the fact that case management can enhance linkage with other services; however evidence that the approach reduces drug use or produces other beneficial outcomes was not found to be conclusive.

Hesse M et al (2009) Case management for persons with substance use disorders. The Cochrane Collaboration

Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence

Methadone was found to be effective maintenance therapy for treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments not utilising opioid replacement therapy.  No statistically significant effect was shown on criminal activity or mortality.

Mattick RP et al (2009) Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane Collaboration

Cost effectiveness

Drug addiction leads to significant economic and social costs.  Evidence-based drug treatment leads to savings, particularly in crime costs, but also through health improvements, including reductions in drug-related deaths and blood-borne disease transmission rates.  A recent report by the National Audit Office notes that the Drug Treatment Outcomes Research Study found a benefit-cost ratio for drug treatment of 2.5 to 1.

Medications in Recovery report 2012

A New Guide to Best Practice in reviewing treatment for drug users has been published by Public Health England, based on supplementary advice provided by the Recovery Orientated Drug Treatment Expert Group.

The Expert Group chaired by Professor John Strang, which produced the Medications in Recovery report last year, recently provided advice to the Chief Medical Officer on the frequency and context of treatment reviews to support recovery. In 2012 the Recovery Orientated Drug Treatment Expert Group published its report: Medications in Recovery :re-orientating drug dependence treatment. The report supports a radical ambition to place prescribing within a fully recovery orientated system of care, with changes at system, service and individual levels. The report makes it clear that this involves treatment services continuing to re-orient their delivery of care to provide active and visible support for recovery from the point of entry to treatment, during treatment and after exit and that successful recovery also relies on support from others, including mutual aid employment and housing services.   

The group's advice makes clear that:

  • Care planning, with its ongoing and planned reviews of specific goals and actions, should be part of a phased and layered treatment programme
  • A strategic review of the client's recovery pathway will normally be necessary within three months (and no later than six months) of treatment entry, and will then usually be repeated at six-monthly intervals
  • Strategic review should always revisit recovery goals and pathways (to support clients to move towards a drug-free lifestyle)
  • Drug treatment should be reviewed based on an assessment of improvement (or preservation of benefit) across the core domains of successful recovery.

Employment and recovery

Employment in Recovery - A Good Practice Guide has been published to update the NTA's 'Joint-working protocol between Jobcentre Plus and treatment providers' (December 2010).

It reflects the significant changes to the provision of employment support since this date, most notably the introduction of the Work Programme and changes to the way that Jobcentre Plus provide support to drug and alcohol users.

The updated document encourages drug and alcohol treatment providers to work more closely with Jobcentre Plus and Work Programme providers in order to better support the employment outcomes of people in treatment, and highlights key principles and best practice case studies that demonstrate joint-working arrangements.

Alcohol treatment in England 2012/13

In 2010/11 there were 198,900 admissions where the primary diagnosis was attributable to the consumption of alcohol (the narrow measure). This is a 2.1 per cent increase since 2009/10 when there were 194,800 admissions of this type and a 40 per cent increase since 2002/03 when there were around 142,000 such admissions.

In 2010/11, there were 1,168,300 alcohol related admissions to hospital based on the broad measure (primary and secondary diagnoses). This is an increase of 11 per cent on the 2009/10 figure (1,056,900) and more than twice as many as in 2002/03 (510,700). Comparisons over time in the broad measure are complicated by changes in recording practices over the period.

In order to estimate the trend once changes in recording practices are accounted for, a method to adjust the national figures has been devised which is presented in Appendix G of the report. Adjusted figures show a 49 per cent increase from an estimated 783,300 in 2002/03 but a 3 per cent decrease from 1,208,100 in 2009/10.

There has been a long-term downward trend in the proportion of adults who reported drinking in the week prior to interview. In 1998 75 per cent of men and 59 per cent of women drank in the week prior to interview compared to 68 per cent of men and 54 per cent of women in 2010.

13 per cent of secondary school pupils aged 11 to 15 reported drinking alcohol in the week prior to interview in 2010 compared with 18 per cent of pupils in 2009 and 26 per cent in 2001.

There has been a fall in recent years in the proportion of pupils who think that drinking is acceptable for someone of their age. In 2010 32 per cent thought it was okay for someone of their age to drink once a week compared to 46 per cent in 2003. Similarly 11 per cent of pupils thought that it was OK for someone of their age to get drunk once a week compared to 20 per cent who thought that in 2003.

In 2011, there were 167,764 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 4.7 per cent on the 2010 figure (160,181) and an increase of 63 per cent on the 2003 figure (102,741).

The Net Ingredient Cost (NIC) of these prescription items was £2.49 million in 2011. This is an increase of 3.3 per cent on the 2010 figure (£2.41 million) and an increase of 45 per cent on the 2003 figure (£1.72 million).

Last updated Wednesday, 25th July 2018