Alcohol and drug treatment in secure settings 2022 to 2023: report
Published 25 January 2024
Applies to England
© Crown copyright 2024
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Main findings
Treatment numbers and substance use
There were 46,551 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2022 and 31 March 2023. Numbers in treatment have increased 3% year on year for the last 2 years, with 43,607 reported in 2020 to 2021 and 45,096 in 2021 to 2022.
Around three-quarters (35,809, 77%) of these people started treatment during this year, an increase of 6 percentage points since 2020 to 2021 (71%). Of the people starting treatment, 47% said they had a problem with opiate use, a similar proportion to last year.
The proportion of adults starting treatment for opiates, crack or both increased slightly this year with 56% reporting problems with these substances compared to 54% in 2021 to 2022.
Adults leaving treatment
A total of 28,065 people left treatment in secure settings in 2022 to 2023, compared to 27,520 in 2021 to 2022.
Over a third (36%) of those were discharged after completing their treatment free of dependence, the highest proportion recorded since reporting began. This is a rise from 32% in 2021 to 2022 and 31% in 2020 to 2021.
People transferring treatment, either to community treatment after release or to treatment in another secure setting, has fallen to the lowest proportion since reporting began (52%), compared to 66% in 2019 to 2020.
Continuity of care
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 43% in 2022 to 2023. This is a 5 percentage point increase from the proportion reported in 2021 to 2022 (37%) and is 12 percentage points higher than when this data was first reported in 2015 to 2016 (30%).
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 (62%), and London had the lowest (26%).
Deaths in treatment
There were 44 adults who died while they were in treatment in 2022 to 2023. This represents 0.09% of the total adults in treatment and is a similar proportion (0.08%) compared to the previous year when 34 people died.
Young people’s treatment
There were 550 young people receiving treatment for drug and alcohol problems in secure settings in 2022 to 2023, the lowest number since reporting began, but a small decrease from the number in 2021 to 2022 (553). This continues an overall downward trend since 2015 to 2016 (1,428).
Cannabis was the most common problem substance for young people in secure settings, with 93% saying they had a cannabis problem. This proportion has remained at similar levels since 2015 to 2016.
Of the 375 young people who left treatment in secure settings in 2022 to 2023, 41% completed their treatment successfully. This is the same proportion completing in 2020 to 2021, which was the highest rate since reporting began.
Adults in prison treatment: overview
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 2022 to 31 March 2023.
Many people experience difficulties with, and receive treatment for, both drugs and alcohol. 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
Numbers in treatment
Figure 2: adults in treatment by setting
There were 46,551 adults receiving treatment for drug and alcohol problems in secure settings between April 2022 and March 2023. Most adults received structured treatment in prison (98%), including local, training, high security and open prisons. The remaining people received treatment in young offender institutions (2%) and immigration removal centres (less than 1%).
You can find a definition of structured treatment in the NDTMS secure setting adult business definitions for core data set Q.
Figure 3: adults in treatment by substance group and setting
| Setting | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| Prisons | 46.6% | 20.4% | 20.7% | 12.3% | 100% |
| Immigration removal centres | 74.0% | 9.3% | 6.7% | 10.0% | 100% |
| Young offender institutions | 14.7% | 50.4% | 29.2% | 5.7% | 100% |
| Setting | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only |
|---|---|---|---|---|
| Prisons | 21,198 | 9,277 | 9,405 | 5,619 |
| Immigration removal centres | 111 | 14 | 10 | 15 |
| Young offender institutions | 133 | 455 | 263 | 51 |
In prisons and immigration removal centres, the biggest drug category was the opiate group (47% and 74% respectively). Most people in young offender institutions were treated for non-opiates only (50%) or non-opiates and alcohol (29%), with 15% reporting opiate use.
Forty-one per cent of people in treatment in prisons and 16% 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 (6%) than in the rest of the secure estate (between 10% and 12%).
Sex
Figure 4: breakdown of adults in treatment by sex and substance group
| Substance group | Women | Men | Total |
|---|---|---|---|
| Opiate | 2,630 | 18,812 | 21,442 (46%) |
| Non-opiate only | 453 | 9,293 | 9,746 (21%) |
| Non-opiate and alcohol | 502 | 9,176 | 9,678 (21%) |
| Alcohol only | 504 | 5,181 | 5,685 (12%) |
| Total | 4,089 | 42,462 | 46,551 (100%) |
Ninety-one per cent (42,462) of the people in treatment in adult secure settings were men and 9% (4,089) 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 12% 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 | 64.3% | 11.1% | 12.3% | 12.3% | 100% |
| Men | 44.3% | 21.9% | 21.6% | 12.2% | 100% |
The substance groups showed big differences by sex. Figure 5 shows the difference between the proportions of men and women in the different substance groups.
Age
Figure 6: age of adults in treatment
| Age group | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| 18 to 20 | 0.6% | 5.5% | 3.2% | 1.2% | 2.3% |
| 21 to 24 | 3.0% | 15.5% | 10.6% | 4.8% | 7.4% |
| 25 to 29 | 8.8% | 23.2% | 21.1% | 12.1% | 14.8% |
| 30 to 39 | 40.0% | 37.2% | 42.5% | 35.7% | 39.4% |
| 40 to 49 | 36.3% | 13.7% | 16.3% | 25.4% | 26.1% |
| 50 to 59 | 10.4% | 4.3% | 5.5% | 15.5% | 8.7% |
| 60 and over | 0.9% | 0.7% | 0.8% | 5.3% | 1.4% |
| Age group | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| 18 to 20 | 137 | 539 | 311 | 70 | 1,057 |
| 21 to 24 | 644 | 1,510 | 1,022 | 274 | 3,450 |
| 25 to 29 | 1,880 | 2,259 | 2,045 | 688 | 6,872 |
| 30 to 39 | 8,568 | 3,623 | 4,116 | 2,028 | 18,335 |
| 40 to 49 | 7,787 | 1,332 | 1,575 | 1,442 | 12,136 |
| 50 to 59 | 2,236 | 418 | 529 | 883 | 4,066 |
| 60 and over | 190 | 65 | 80 | 300 | 635 |
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 two-thirds (65%) of the total adults in treatment.
The largest drug group in both 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 44 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 33 years and 31 years respectively. The median ages were 35 years and 32 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.
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 | 14,616 |
| Opiates (not crack cocaine) | 6,826 |
| Cannabis | 3,312 |
| Cocaine | 2,227 |
| Benzodiazepines | 2,032 |
| Amphetamines | 363 |
| Alcohol | 4,842 |
Non-opiate only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 2,057 |
| Cannabis | 6,385 |
| Cocaine | 3,999 |
| Benzodiazepines | 594 |
| Amphetamines | 490 |
| Other drugs | 532 |
Non-opiate and alcohol substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,821 |
| Cannabis | 4,984 |
| Cocaine | 5,188 |
| Benzodiazepines | 430 |
| Amphetamines | 327 |
| Other drugs | 305 |
| Alcohol | 9,678 |
Alcohol only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Alcohol | 5,685 |
Figure 7 shows a breakdown of the substances reported by people in prison treatment in 2022 to 2023, 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 31% reporting both opiate and crack problems and 15% reporting problems with opiates but not crack. Eight per cent of people reported problems with crack but not opiates.
Over two-fifths (43%) of people said they had problems with alcohol, with around a quarter (28%) of these people using alcohol only. Just under a third (32%) of adults reported problems with cannabis and a quarter (25%) with cocaine.
Psychoactive substances (mainly synthetic cannabinoids, previously recorded as ‘new psychoactive substances’) were a problem for 5% of people in treatment in secure settings. However, this may not reflect overall psychoactive substance use in prisons, because data is collected when people enter treatment so does not include people who started using psychoactive substances while they were in prison. It’s also possible that some people who used psychoactive substances did not report it as one of the 3 main drugs they had problems with.
Adults starting prison treatment: pathways, age, substances
Pathways into treatment
Figure 8: pathway into treatment for adults starting treatment in 2022 to 2023
| Substance group | Taken directly into custody | Transferred from another secure setting | Total |
|---|---|---|---|
| Opiate | 58.9% | 41.1% | 100% |
| Non-opiate only | 38.1% | 61.9% | 100% |
| Non-opiate and alcohol | 45.4% | 54.6% | 100% |
| Alcohol only | 62.3% | 37.7% | 100% |
| Total | 52.4% | 47.6% | 100% |
Over half (52%) of the people starting treatment in an adult secure setting between 2022 and 2023 were taken directly into custody or detention from the community. The other 48% 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 (59% and 62% 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 at 62% and 55% respectively.
Most of the adults starting treatment who were taken directly into custody from the community (56%) and started treatment when they arrived in secure settings - 86% started within 3 weeks of arrival. Of the people transferring from another secure setting, 41% 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.
Substances reported by adults starting treatment in secure settings
Figure 9: substances by group for adults starting treatment in 2022 to 2023
Opiate substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Both opiates and crack cocaine | 11,894 |
| Opiates (not crack cocaine) | 4,990 |
| Cannabis | 2,598 |
| Cocaine | 1,738 |
| Benzodiazepines | 1,553 |
| Amphetamines | 250 |
| Other drugs | 631 |
| Alcohol | 3,827 |
Non-opiate only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,611 |
| Cannabis | 4,704 |
| Cocaine | 2,960 |
| Benzodiazepines | 451 |
| Amphetamines | 349 |
| Other drugs | 394 |
Non-opiate and alcohol substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,446 |
| Cannabis | 3,643 |
| Cocaine | 3,918 |
| Benzodiazepines | 329 |
| Amphetamines | 234 |
| Other drugs | 231 |
| Alcohol | 7,237 |
Alcohol only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Alcohol | 4,483 |
There were 35,809 people who started treatment for drug and alcohol problems in a secure setting in 2022 to 2023. This is where a person started a new treatment episode, which might also include returning to treatment.
Of the people starting treatment:
- 16,884 (47%) said they had a problem with opiate use
- 15,547 (43%) said they had a problem with alcohol
- 4,483 (13%) said they had a problem with alcohol alone
- 10,945 (31%) said they had a problem with cannabis
- 8,616 (24%) said they had a problem with cocaine
Nearly 3 in 5 (8,347, 58%) people in the non-opiate substance groups reported having problems with cannabis.
Mental health
Nearly a third (30%) 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 (32%) and the lowest (26%) in the alcohol 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.
Injecting drugs
Figure 10: injecting status of people adults starting treatment in 2022 to 2023
| Substance group | Currently injecting | Previously injected | Never injected | Declined to answer | Total |
|---|---|---|---|---|---|
| Opiate | 15.9% | 32.8% | 47.7% | 3.6% | 100% |
| Non-opiate only | 1.0% | 8.8% | 87.6% | 2.6% | 100% |
| Non-opiate and alcohol | 0.8% | 9.7% | 87.1% | 2.4% | 100% |
| Alcohol only | 0.3% | 5.3% | 90.6% | 3.9% | 100% |
| Total | 7.9% | 19.9% | 69.0% | 3.2% | 100% |
Most people starting treatment in 2022 to 2023 had never injected drugs (69%). This ranged from 48% of people in the opiate group to between 87% and 91% in the other substance groups. People in the opiate group were most likely to be currently injecting (16% compared to 1% or less for the other substance groups).
Parental status and safeguarding children
Parental status
Figure 11: parental status of people starting treatment in 2022 to 2023
| Parental status | Adults in treatment |
|---|---|
| Not parent and not in contact with children | 70.1% |
| Parent not living with children | 19.2% |
| Parent living with children | 8.8% |
| Other contact living with children | 1.9% |
Eleven per cent of people starting treatment in 2022 to 2023 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. Seventy per cent (30,276) reported that they were not parents and a further 19% (8,313) said they were parents but did not currently live with their children.
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 | 9.3% |
| Early help | 24.4% |
| Child protection plan | 20.3% |
| Looked after child | 38.1% |
| Other support service | 11.6% |
Twenty-two per cent of children of parents starting treatment were receiving early help. Figure 12 shows the types of early help that these children were receiving. The children of people starting treatment can receive more than one type of early help. Early help services provide support to children and their families as soon as problems emerge. Of the people starting treatment who were in contact with children’s social care 38% had a looked after child, though this figure was higher in the opiate group at 50%.
Of the parents starting treatment who were in contact with children’s social care:
- 20% had a child with a child protection plan
- 24% had a child receiving early help
- 9% were in contact with social services because they had a child in need
- 12% were in contact with other relevant child or family support services
Smoking
Figure 13: smoking prevalence at start of treatment
| Substance group | Women | Men |
|---|---|---|
| Opiate | 54.3% | 47.7% |
| Non-opiate only | 61.2% | 34.7% |
| Non-opiate and alcohol | 53.8% | 44.9% |
| Alcohol only | 42.0% | 38.5% |
| Total treatment population | 53.7% | 44.6% |
| General population | 10.9% | 14.5% |
Over 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 14.5% for men and 10.9% for women. The smoking rates for the total treatment population in secure settings were 45% for men and 54% 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 overall was the non-opiate only group, with both the non-opiate only group and the alcohol only group having 39% smoking tobacco.
Treatment types
Figure 14: breakdown of adults in treatment types by substance group
| Substance group | No structured intervention started or recorded | Pharmacological and psychosocial | Pharmacological only | Psychosocial only | Total |
|---|---|---|---|---|---|
| Opiate | 0.2% | 73.3% | 5.2% | 21.3% | 100% |
| Non-opiate only | 0.3% | 6.0% | 0.6% | 93.2% | 100% |
| Non-opiate and alcohol | 0.1% | 12.1% | 1.0% | 86.8% | 100% |
| Alcohol only | 0.3% | 23.9% | 6.2% | 69.6% | 100% |
| Total | 0.2% | 40.4% | 3.5% | 55.9% | 100% |
Almost all adults in treatment in secure settings (96%) received psychosocial interventions. Three per cent received only pharmacological interventions and less than 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 (87%) and alcohol only (71%) groups. About one-fifth (21%) of people using opiates received a psychosocial intervention only.
Nearly half (44%) of adults in treatment received pharmacological interventions. Overall, by substance group, the percentage receiving pharmacological interventions was:
- 73% of the opiate group
- 24% of the alcohol only group
- 6% of the non-opiate only group
- 12% of the non-opiate and alcohol group
Pharmacological interventions are generally provided alongside psychosocial interventions to support a person’s recovery, as recommended by Drug misuse and dependence: UK guidelines on clinical management. Forty per cent of people in treatment received both pharmacological and psychosocial interventions.
Treatment outcomes
Treatment exits and successful completion
Figure 15: breakdown of adult treatment exits in 2022 to 2023
A total of 28,065 people left treatment in secure settings between 1 April 2022 and 31 March 2023. Over a third (36%) of those were discharged after completing their treatment free of dependence.
The non-opiate only group (52%), non-opiate and alcohol group (50%) and the alcohol only group (48%) had the highest rates of successfully completing their treatment. The opiate group had the lowest rate of successfully completing treatment (16%).
Over half (52%) of adults leaving treatment were transferred for further treatment, either to community treatment (34%) or to treatment in another secure setting (18%).
Continuity of care between treatment services in prisons and the community is monitored by the Public Health Outcomes Framework indicator C20. This indicator measures the numbers of adults with substance misuse problems 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 43% in 2022 to 2023.
The remaining 12% of adults left treatment without completing it, mainly by dropping out of treatment (5%) or being discharged due to being released from court (2%).
Deaths in treatment
There were 44 people who died while they were in treatment in 2022 to 2023, which represented 0.09% of all people in treatment. People with opiate problems accounted for 57% of these deaths.
The Drug misuse and dependence: UK guidelines on clinical management 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 2022 to 2023.
Young people in treatment in secure settings
Young people’s treatment: overview
Figure 16: young people in treatment by setting
There were 550 young people receiving treatment for drug and alcohol problems in secure settings in 2022 to 2023. Most (70%) of these were in young offender institutions, with a further:
- 21% in secure children’s homes
- 6% in welfare-only homes
- 2% in secure training centres
Young people: age and sex
Figure 17: breakdown of young people by age and sex
| Age group | Girls | Boys |
|---|---|---|
| Under 14 | 8.2% | 2.6% |
| 14 years old | 6.1% | 4.2% |
| 15 years old | 38.8% | 12.0% |
| 16 years old | 26.5% | 33.3% |
| 17 and over | 20.4% | 47.9% |
Most (91%) 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 98% of the total youth custody population was male in March 2023 (excluding welfare-only places but including secure settings in Wales).
Boys in treatment tended to be older, with the proportion of boys in each age group increasing with age. Three per cent of boys in treatment were under 14 years old and over half (48%) were aged 17 or older. This was different to girls, as only 20% of girls in treatment were aged 17 or older. Most of the girls in treatment were aged 15 or 16 (65%).
The median age of boys was 16 and the median age of girls was 15.
Young people: substance use
Figure 18: substances used by young people
| Substance | Young people in treatment |
|---|---|
| Cannabis | 93.5% |
| Alcohol | 34.2% |
| Cocaine | 15.3% |
| Solvents | 14.4% |
| Nicotine | 12.0% |
| Opiates | 6.2% |
| Benzodiazepines | 3.6% |
| Ecstasy | 2.0% |
| Other | 4.7% |
| Amphetamines | 0.9% |
| Crack | 1.3% |
Figure 18 shows the different problem substances reported by young people in secure settings. Solvents includes inhalants such as pressurised gases and aerosols.
Vulnerabilities of young people starting treatment
Figure 19: vulnerabilities of young people starting treatment
| Vulnerability | Young people starting treatment |
|---|---|
| Polydrug use | 54.3% |
| Pregnant or parent | 28.6% |
| Opiate and/or crack use | 8.3% |
| Injecting (currently or previously) | 1.4% |
| Vulnerability | Young people starting treatment |
|---|---|
| Polydrug use | 235 |
| Pregnant or parent | 124 |
| Opiate and/or crack use | 36 |
| Injecting (currently or previously) | 6 |
Young people often enter specialist substance misuse services with a range of problems or vulnerabilities that are related (or in addition) to their substance use. These include using multiple substances (polydrug use) and being a parent or pregnant.
The most common vulnerability by far was polydrug use (54% of young people starting treatment). A further 29% reported being a parent or pregnant. Eight per cent of young people said they used opiates or crack.
Young people: treatment type
Figure 20: intervention types for young people
| Intervention | Young people receiving an intervention |
|---|---|
| Harm reduction | 69.6% |
| Psychosocial – motivational interviewing | 64.0% |
| Psychosocial – relapse prevention | 33.6% |
| Psychosocial – cognitive behavioural therapy | 19.8% |
| No valid intervention recorded | 16% |
| Psychosocial – counselling | 11.1% |
| Pharmacological | 0.5% |
| Psychosocial – family work | 0.5% |
Two-thirds of young people in treatment (70%) in 2022 to 2023 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.
Young people: treatment exits
Figure 21: breakdown of young people’s latest treatment exits in 2022 to 2023
There were 375 young people who left treatment in secure settings in 2022 to 2023. Of these, 41% completed their treatment successfully.
The 59% who did not complete their treatment successfully included:
- 22% who declined treatment after being referred
- 16% who were released from custody and transferred to another treatment service in the community
- 9% who left treatment after being released from court
- 7% who dropped out or had their treatment withdrawn by the provider
- 5% who were transferred to another treatment service in custody
Trends over time
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 46,551 adults in alcohol and drug treatment in prisons and secure settings between 1 April 2022 and 31 March 2023. Numbers in treatment have increased 3% year on year for the last 2 years, with 43,607 reported in 2020 to 2021 and 45,096 in 2021 to 2022. This is an upward trend in numbers in treatment but is still 22% 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 the last few years, 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 non-opiate only group, which fell by 1%. The other 3 groups all increased between 2% and 6%.
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 2022 to 2023 split by the 4 substance groups.
Around three-quarters (35,809, 77%) of the total adults in treatment started treatment during this year, an increase of 6 percentage points since 2020 to 2021 (71%). Of the people starting treatment, 47% said they had a problem with opiate use, a similar proportion to last year.
The number of adults starting treatment in secure settings in 2022 to 2023 was 8% higher than the previous year (35,809 compared to 33,275 in 2021 to 2022). This is the same proportional rise seen between 2020 to 2021 and 2021 to 2022 but is still 23% lower than the first year of reporting (46,784 in 2015 to 2016).
This increase was present in all substance groups with the opiate group rising 10% and all other groups seeing rises between 3% and 8%.
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 decreased steadily from an all-time high of 60% in 2017 to 2018 to 54% in 2021 to 2022. However, this year, 56% reported problems with these substances, which was a slight rise.
Thirty-three per cent of people starting treatment in 2022 to 2023 reported problems with both crack and opiate use. This was a slight rise from 31% in 2021 to 2022. This proportion is below the peak of 37% in 2019 to 2020.
The proportion of people starting treatment with opiate problems (but not crack problems) has decreased from 25% in 2015 to 2016 to 14% in 2022 to 2023. In contrast, the proportion starting treatment with crack problems (but not opiate problems) has been increasing steadily from 5% in 2015 to 2016 to 9% in 2022 to 2023.
Figure 25: trends in adults starting treatment reporting problems with other substances
The proportion of people starting treatment who reported alcohol problems was similar to previous years, with 43% of people in 2022 to 2023 compared to 44% in 2021 to 2022. The proportion of people in treatment for cannabis remained fairly consistent between 2015 to 2016 (29%) and this year (31%).
Over time, proportions of people in treatment for benzodiazepines and amphetamines have decreased since these statistics were first reported (decreases of 5% and 4% respectively since 2015 to 2016). The proportion of people in treatment for cocaine and other drugs have increased over the same period (increases of 5 percentage points and 2 percentage points respectively since 2015 to 2016).
Trends: adults leaving treatment
Figure 26: trends in adults completing treatment since 2015 to 2016
A total of 28,065 people left treatment in secure settings in 2022 to 2023, compared to 27,520 in 2021 to 2022.
Over a third (36%) of people were discharged after completing their treatment free of dependence, the highest proportion recorded since reporting began. This is a small rise from 32% in 2021 and 2022 and 31% in 2020 to 2021.
People transferring treatment, either to community treatment after release or to treatment in another secure setting has fallen to the lowest proportion since reporting began (52%), compared to 66% in 2019 to 2020.
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 43% in 2022 to 2023. This is a 5 percentage point increase from the proportion reported in 2021 to 2022 (37%) and is 12 percentage points higher than when this was first reported in 2015 to 2016 (30%). Proportions varied around the regions of England, with the North East having the highest rate of continuing treatment (62%) and London having the lowest (26%).
Trends: deaths of adults in treatment
Figure 27: trends in deaths of adults in treatment
There were 44 adults who died in 2022 to 2023 while they were in contact with treatment services. This represents 0.09% of the total people in treatment and is a similar proportion (0.08%) compared to the previous year when 34 people died.
As in previous years, people with opiate problems were most at risk, with 57% of all deaths occurring in this group.
Trends: young people in treatment
Figure 28: trends in numbers of young people in treatment from 2015 to 2016
There were 550 young people receiving treatment for drug and alcohol problems in secure settings in 2022 to 2023. This is lowest number since reporting began, and a small decrease from 2021 to 2022 (553). This continues an overall downward trend since 2015 to 2016 (1,428).
In contrast, there was a 7% increase in the youth custody population for England and Wales between March 2022 and March 2023. 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.
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 93% 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 (15%) is also at a similar level reported in 2015 to 2016, but the proportion with nicotine problems (12%) has decreased substantially over the last 2 years, from 26% in 2020 to 2021.
Fewer young people in treatment said they had problems with alcohol use in 2021 to 2022 (34%) than in 2015 to 2016 (50%). This is the lowest proportion recorded 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 was to 6% in 2022 to 2023, as it was the previous year. Solvent use has doubled this year, from 7% in 2021 to 2022 to 14% this year, 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 relatively similar proportion to those in the last 2 years.
The proportion of young people reporting problems with amphetamine use has fallen from 7% in 2015 to 2016, to 1% this year.
Reported ecstasy problems continued to fall from 7% in 2015 to 2016 to 2% this year.
No young person reported use of psychoactive substances this year.
Trends: young people’s treatment exits
Figure 31: trends in young people leaving treatment
Of the 375 young people who left treatment in secure settings in 2022 to 2023, 41% completed their treatment successfully. This is the same proportion as 2020 to 2021, the highest since reporting began. The previous highest proportion was 34% 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 within the secure estate fell from 12% in 2021 to 2022 to 5% in 2022 to 2023. But the proportion transferring to treatment services in the community rose slightly from 14% in 2021 to 2022 to 16% in 2022 to 2023.
In 2021 to 2022, the proportion of young people in treatment who left treatment because they were released from court and discharged before a transfer to community services could be arranged was 14%, the highest reported. This year it fell to 9%.
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 (5% or less until 2020 to 2021). In 2021 to 2022 this proportion increased to 10%, the highest proportion recorded, but this year it was 7%.
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 2022 to 2023 the proportion was 22%, the highest proportion since reporting began.
Background and policy context
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
Last year we improved the way people are counted in the report. Before this, 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 because 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.
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 in 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.
Enquiries or feedback
If you have any enquiries or feedback about these statistics, please email the Office for Health Improvement and Disparities at evidenceapplicationteam@dhsc.gov.uk.