Young people's substance misuse treatment statistics 2021 to 2022: report
Published 2 February 2023
Applies to England
© Crown copyright 2023
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This publication is available at https://www.gov.uk/government/statistics/substance-misuse-treatment-for-young-people-statistics-2021-to-2022/young-peoples-substance-misuse-treatment-statistics-2021-to-2022-report
Main findings
Trends in young people’s treatment numbers
There were 11,326 young people (people under the age of 18) in contact with alcohol and drug services between April 2021 and March 2022. This is a 3% increase from the previous year (11,013) but a 54% reduction in the number in treatment since 2008 to 2009 (24,494).
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 (46%) said they had problems with alcohol, 8% had problems with ecstasy and 8% reported powder cocaine problems.
The proportion of young people seeking help for codeine is lower than last year, falling by 0.3% (1.2% compared to 0.9% this year). People seeking help for heroin was very similar to last year (0.35% compared to 0.33% this year).
This year also saw a small decrease in young people reporting a problem with benzodiazepines. However, the proportion (3%) was over 4 times the proportion in 2013 to 2014 (0.7%).
Vulnerabilities among young people in treatment
The most common vulnerability reported by young people starting treatment was early onset of substance use (80%), which means the young person started using substances before the age of 15. This was followed by polydrug use (55%).
Proportionally, girls tended to report more vulnerabilities than boys, particularly self-harming behaviour (46% compared with 17%) and sexual exploitation (10% compared with 1.5%).
Mental health treatment need
Nearly half (46%) of young people starting treatment this year said they had a mental health treatment need, which continues the rising trend of the last 3 years (43% in 2020 to 2021, 37% in 2019 to 2020 and 32% in 2018 to 2019). A higher proportion of girls reported a mental health treatment need than boys (60% compared to 38%).
Most young people (69%) 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, 82% left because they successfully completed their treatment programme, which is slightly higher than the previous year’s proportion (79%). The next most common reason for leaving treatment (12%) was dropping out before they completed treatment, which is slightly lower than the previous year (15%).
The effect of COVID-19
The coronavirus (COVID-19) pandemic has had a lingering effect on drug and alcohol treatment services, as it has other services. In 2020 to 2021, most services had to restrict face-to-face contact, which affected the types of interventions that service users received. This, and other changes to service provision during the pandemic, may have affected the data in last year’s report.
COVID-19 related restrictions were still in place in early April 2021, but these began to be gradually relaxed until almost all restrictions were lifted in July 2021. However, COVID-19 had a continued effect on services throughout 2021 to 2022. Effects included:
- service users testing positive for COVID-19 and not being able to access treatment
- staff testing positive and not being able to go to work
- service users and staff getting ill with COVID-19
- the above and other factors causing longer waits and reduced access to healthcare
So, like 2020 to 2021, the restrictions and COVID-19 itself might have affected the data in this report.
Age and sex of young people in treatment
There were 11,326 young people in structured treatment with drug and alcohol services between 1 April 2021 and 31 March 2022. Almost two-thirds were male (63%), a similar proportion to the previous 2 years. The median age was nearly 16 years old for girls and 16 years old for boys.
The number of younger children (under 14) in treatment remained relatively low (969, 9%).
Figure 1: age and sex of young people in treatment
| Age group | Girls | Boys |
|---|---|---|
| Under 12 | 8 | 31 |
| 12 years old | 81 | 119 |
| 13 years old | 299 | 431 |
| 14 years old | 751 | 1,089 |
| 15 years old | 1,152 | 1,856 |
| 16 years old | 934 | 1,721 |
| 17 years old | 964 | 1,890 |
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.
There were 9,845 young people who said they had a problem with cannabis (87% of all in treatment) and 5,179 (46%) said they had a problem with alcohol.
Eight per cent (937 young people) said they had a problem with powder cocaine and the same proportion (896) reported a problem with ecstasy. Twelve per cent (1,389) reported a problem with nicotine use (excluding vaping).
Other substances reported include ketamine, benzodiazepines, solvents, codeine, amphetamines, new psychoactive substances (NPS), crack, heroin and other opiates.
Figure 2: problem substances reported by young people
| Substance | Number of young people |
|---|---|
| Cannabis | 9,845 |
| Alcohol | 5,179 |
| Nicotine | 1,389 |
| Cocaine | 937 |
| Ecstasy | 896 |
| Ketamine | 512 |
| Other | 374 |
| Benzodiazepines | 340 |
| Solvents | 329 |
| Codeine | 103 |
| Amphetamines | 100 |
| NPS | 74 |
| Other opiates | 63 |
| Crack | 58 |
| Heroin | 37 |
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.
Referral routes into treatment
The most common route for young people to get into specialist treatment services was a referral from education services, with 32% of young people entering this way.
This is very similar to the proportion of education referrals in 2019 to 2020 (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 not returned to pre-pandemic levels, with 2,569 education referrals in 2021 to 2022 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 most common route in 2020 to 2021, when it made up 28% of referrals, but it was only the third most common route in 2019 to 2020 at 19%, after education (32%) and criminal justice (22%). Over this period, the number of social care referrals has been fairly stable, decreasing to 1,849 in 2021 to 2022 from 1,937 in 2019 to 2020.
Figure 3: referral routes into treatment
| Referral route | Number of young people |
|---|---|
| Education | 2,569 |
| Social care | 1,849 |
| Youth criminal justice | 1,435 |
| Health | 1,091 |
| Self, family and friends | 847 |
| Other | 179 |
| Substance misuse service | 138 |
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. These include:
- using multiple substances (polydrug use)
- having a mental health treatment need
- being a looked after child
- not being in education, employment or training (NEET)
- self-harming behaviour
- sexual exploitation
- offending
- domestic abuse
Vulnerabilities are reported here only for young people who entered drug and alcohol treatment services during 2021 to 2022.
The most common vulnerability was early onset of substance use (80%), which means the young person started using substances before the age of 15. Girls reported this more than boys (82% and 79% respectively). This was followed by young people reporting polydrug use (55%). Again, girls tended to report this more than boys (61% and 51% respectively).
Proportionally, girls tend to report more vulnerabilities than boys, particularly for self-harming behaviours (46% compared with 17%) and sexual exploitation (10% compared with 2%).
Other vulnerabilities that were commonly reported by young people include:
- antisocial behaviour (28%), which was more common for boys than girls (36% compared with 16%)
- being affected by domestic abuse (20%)
- being affected by others’ substance use (23%)
Less commonly reported vulnerabilities include:
- opiate or crack use (2%)
- being pregnant or a parent (5%)
- 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 (7%) were also recorded as vulnerabilities.
Figure 4: vulnerabilities among young people starting treatment
| Vulnerability | Girls | Boys |
|---|---|---|
| Early onset of substance misuse | 2,482 | 4,046 |
| Polydrug user | 1,861 | 2,610 |
| Mental health treatment need | 1,711 | 1,772 |
| Antisocial behaviour | 481 | 1,821 |
| Affected by others’ substance misuse | 888 | 995 |
| Affected by domestic abuse | 733 | 909 |
| Self-harm | 1,388 | 851 |
| Not in education, employment or training | 292 | 691 |
| Looked after child | 351 | 561 |
| Child in need | 420 | 565 |
| Child protection plan | 252 | 351 |
| Sexual exploitation | 298 | 76 |
| High risk alcohol user | 245 | 185 |
| Opiate and/or crack use | 62 | 126 |
| Pregnant or parent | 184 | 234 |
| Housing problem | 20 | 41 |
| Injecting | 24 | 24 |
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% (374) of young people who entered treatment in 2021 to 2022 reported CSE. Broken down by age, the proportion was:
- 6% of 17 year olds (107)
- 5% of 15 year olds (101) and 16 year olds (83)
- 4% of 14 year olds (54) and children under 14 (29)
Among the young people who started treatment in 2021 to 2022, girls reported CSE much more than boys, with 298 girls (10% of all girls) and 76 boys (1% of all boys) reporting CSE.
Among girls, 11% of those aged 15 or older reported CSE compared to 7% of those aged 14 or younger. For boys, the proportion reporting CSE was under 2% for both these age groups.
Most girls who reported CSE were aged 15 (83, 28%), 16 (64, 22%) or 17 (89, 30%). Sixty-two girls (21%) who reported CSE were aged 14 or younger. Most boys who reported CSE were 16 years old (19, 25%). Nearly a quarter of boys who reported CSE (18, 24%) were 17 years old, another 18 boys were 15 years old and the remaining 21 boys were aged 14 or younger.
Figure 5: sexual exploitation of young people starting treatment
| Age | Girls | Boys |
|---|---|---|
| Under 14 years old | 20 | 9 |
| 14 years old | 42 | 12 |
| 15 years old | 83 | 18 |
| 16 years old | 64 | 19 |
| 17 years old | 89 | 18 |
Mental health needs
Over two-fifths (46%, 3,739) of young people who started treatment in 2021 to 2022 said they needed mental health treatment.
A higher proportion of girls reported needing mental health treatment than boys (60% compared to 38%). Of those reporting a mental health treatment need, 69% were receiving some form of mental health treatment.
Overall, a slightly higher proportion of girls who needed mental health treatment were receiving a form of mental health treatment when they started substance misuse treatment compared to boys (72% compared to 66%).
The majority of young people (58%) were already engaged with community or other mental health services at the start of treatment. Figure 6 shows that 1,109 girls and 1,059 boys were already engaging with community or other mental health services while in treatment in 2021 to 2022.
Smaller numbers received mental health treatment from a GP (165 girls and 186 boys) or within drug or alcohol services (59 girls and 64 boys).
Some young people also received other mental health treatment, either within a health-based place of safety (28 girls and 27 boys) or by engaging with improving access to psychological therapies (38 girls and 25 boys).
However, 499 girls and 650 boys (31% overall) had a mental health treatment need identified but either did not receive 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 | 1,109 | 1,059 |
| No treatment received | 499 | 650 |
| Mental health treatment from GP | 165 | 186 |
| Other mental health treatment | 66 | 52 |
| Treatment within drug or alcohol services | 59 | 64 |
Treatment types
Most young people in treatment received a psychosocial intervention (11,188 of 11,326, 99%). The small number who did not receive an intervention probably entered treatment at the end of the time period covered by this report, and so had not started their intervention yet. Psychosocial interventions (also known as 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 polysubstance use. In 2021 to 2022, 7,599 young people (68% of those receiving an intervention) received a harm reduction intervention.
Only 29 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 (97%). 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 received by young people
| Treatment type | Community | Other |
|---|---|---|
| Psychosocial | 10,906 | 335 |
| Harm reduction | 7,330 | 275 |
| Pharmacological | 28 | 5 |
Note: figures less than 5 have been rounded up to protect possible identification.
Treatment exits
There were 7,314 young people who left treatment in 2021 to 2022. Of those who left, 5,969 (82%) successfully completed their treatment and 888 (12%) dropped out. A further 3% were referred to another provider for treatment and 2% declined the treatment offered.
Figure 8: treatment exit reasons
| Treatment exit reason | Percentage of young people |
|---|---|
| Completed | 81.6% |
| Dropped out or moved away | 12.1% |
| Transferred on to another substance misuse service | 3.4% |
| Treatment declined | 2.4% |
| Other | 0.3% |
| Prison | 0.1% |
Trends over time
Trends in age and numbers in treatment
The number of young people attending specialist substance misuse services has increased this year after year-on-year falls since a peak of 24,494 in 2008 to 2009. The number of young people attending treatment services during 2021 to 2022 is 54% lower than this peak, although it is 3% higher than the number in treatment in the previous year.
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.There was a significant increase in this proportion in 2016 and it has been falling again since.
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. This year, we saw a slight rise to 11,326 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 |
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 41% in 2020 to 2021, to a slight rise this year (46%). The proportion of young people in treatment whose main problem substance was something other than cannabis or alcohol has consistently been around 10% for the past 10 years of reporting.
Figure 10: trends in primary 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 2021 to 2022, the proportion decreased to 8%.
The proportion of young people in treatment for amphetamine use decreased slightly between 2005 and 2010 before increasing quickly 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 (0.9% 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 (8.3% this year). The number of young people reporting NPS 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%) between 2005 and 2018. It has since increased from under 1% in 2015 to 2016 to 5% in 2020 to 2021, which it has remained at this year.
The proportion of young people who reported benzodiazepines as a problematic substance was also consistently low (under 1%) between 2005 and 2017. Since 2018 to 2019, it has consistently been over 3%, which is the proportion in 2021 to 2022. This was more than 4 times the proportion in 2013 to 2014 (less than 1%).
The proportion of young people seeking help for heroin has remained stable since 2017 to 2018. However, there have been recent increases in young people getting help for codeine (another opiate), at 0.9% this year, up from a low of 0.1% in 2014 to 2015. This is still a decrease from 1.2% in 2020 to 2021.
The number of young people reporting solvent use has remained stable compared to the previous year (from 2.8% to 2.9%).
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 substance that the young person reported problems with when they entered treatment.
Figure 11: trends in amphetamine, cocaine and ecstasy misuse
Figure 12: trends in benzodiazepines, ketamine and new psychoactive substances 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 services for young people are normally separate from adult treatment services because young people’s alcohol and drug problems tend to be different from adults’ and need a different response. This includes:
- being child-centred
- considering the age and maturity of young people
- acting on safeguarding concerns
- making sure the young people do not mix with adults who use drugs
These services support young people, help them to reduce the harm their alcohol or drug use causes them and try to prevent it from becoming a bigger problem as they get older. Services should be part of a wider network of local prevention services that support young people with a range of issues and help them to build their resilience.
Young people’s alcohol and drug treatment in England is commissioned by local authorities using the public health grant. They are responsible for assessing local need for treatment and commissioning a range of services and interventions to meet that need.
The public health grant conditions for 2022 to 2023 make it clear that:
A local authority must, in using the grant: have regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services based on an assessment of local need and a plan which has been developed with local health and criminal justice partners.
The Office for Health Improvement and Disparities works with local authorities and provides them with bespoke data, guidance, tools and other support to help them commission services more effectively.
Guidance for alcohol and drug treatment is available in the Alcohol and drug misuse prevention and treatment guidance collection.
A wide range of NDTMS data is available on the NDTMS website including some data reports that are only available to local authority commissioners (via login).
The government’s strategy for drug treatment and prevention includes actions and funding for young people’s treatment.
Young people’s substance misuse services need to ensure that they are responding appropriately to child sexual exploitation and county lines exploitation. There is guidance that can help with this, including: