Alcohol and drug treatment in secure settings 2023 to 2024: report
Published 30 January 2025
Applies to England
© Crown copyright 2025
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Main findings
Treatment numbers and substance use
There were 49,881 adults aged 18 and over in alcohol and drug treatment in prisons and secure settings between 1 April 2023 and 31 March 2024. This is a 7% rise compared to the previous year (46,551). The number of adults in treatment has increased year on year for the last 3 years, and the number in treatment this year is 14% higher than in 2020 to 2021, the lowest number of adults in treatment in the last 5 years.
Over three-quarters (77%, 38,351) of these people started treatment during this year, the same proportion as last year.
The proportion of adults starting treatment for opiates, crack or both increased slightly this year, with 58% reporting problems with these substances compared to 56% in 2022 to 2023. This rise was consistent among people with opiate problems and people with crack problems: both groups increasing by 2 percentage points from last year.
Adults leaving treatment
A total of 31,050 adults left treatment in secure settings in 2023 to 2024, compared to 28,065 in 2022 to 2023.
Nearly two-fifths (38%) of those were discharged after completing their treatment free of dependence, a 16 percentage point rise from 22% in 2015 to 2016, when reporting began.
Continuity of care
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 53% in 2023 to 2024. This is a 10 percentage point increase from the proportion reported in 2022 to 2023 (43%) and is 23 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 West had the highest rate of continuing treatment (66%) and London had the lowest (41%).
Deaths in treatment
There were 38 adults who died while they were in treatment in secure settings in 2023 to 2024. This represents 0.08% of the total adults in treatment and is a similar proportion (0.09%) to the previous year, when 44 people died.
Young people’s treatment
There were 566 young people receiving treatment for drug and alcohol problems in secure settings in 2023 to 2024, a small increase from the number in 2022 to 2023 (550).
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 370 young people who left treatment in secure settings in 2023 to 2024, 48% completed their treatment successfully. This is a 7 percentage point increase from 2022 to 2023 and is the highest rate since reporting began.
Adults in prison treatment: overview
Definitions
This report presents information on adults (aged 18 and over) and young people (aged 17 and under) who were receiving help in prisons and secure settings in England for problems with drugs and alcohol. It covers the year between 1 April 2023 to 31 March 2024.
Many people experience difficulties with, and receive treatment for, both drugs and alcohol. While these people 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.
Adults in treatment
There were 49,881 adults receiving treatment for drug and alcohol problems in secure settings between April 2023 and March 2024. 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 (over 1%) and immigration removal centres (less than 1%).
You can find a definition of structured treatment in the National Drug Treatment Monitoring System (NDTMS) secure settings adult business definitions, in the ‘Core dataset R documentation’ section on the NDTMS website.
Figure 1: adults in treatment by substance group and setting
| Setting | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| Prisons | 47.6% | 20.8% | 20.2% | 11.4% | 100% |
| Immigration removal centres | 75.8% | 7.1% | 8.7% | 8.4% | 100% |
| Young offender institutions | 14.5% | 51.7% | 29.3% | 4.4% | 100% |
| Setting | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only |
|---|---|---|---|---|
| Prisons | 23,246 | 10,151 | 9,879 | 5,572 |
| Immigration removal centres | 235 | 22 | 27 | 26 |
| Young offender institutions | 105 | 374 | 212 | 32 |
In prisons and immigration removal centres, the biggest category was the opiate group (48% and 76% respectively). Most people in young offender institutions were treated for non-opiates only (52%) 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 (4%) than in the rest of the secure estate (8% in immigration removal centres and 11% in prisons).
Sex
Figure 2: breakdown of adults in treatment by sex and substance group
| Substance group | Men | Women | Total |
|---|---|---|---|
| Opiate | 20,569 | 3,017 | 23,586 |
| Non-opiate only | 10,072 | 475 | 10,547 |
| Non-opiate and alcohol | 9,569 | 549 | 10,118 |
| Alcohol only | 5,223 | 407 | 5,630 |
| Total | 45,433 | 4,448 | 49,881 |
| Substance group | Total adults (%) |
|---|---|
| Opiate | 47% |
| Non-opiate only | 21% |
| Non-opiate and alcohol | 20% |
| Alcohol only | 11% |
Ninety-one per cent (45,433) of the people in treatment in adult secure settings were men. Nine per cent (4,448) were women, which is more than double the proportion of women in prison (4% at the end of March 2024), as reported in the HM Prison and Probation Service (HMPPS) offender equalities annual report 2023 to 2024.
The proportion of women in each substance group ranged from 13% in the opiate group to 5% in both non-opiate groups.
Figure 3: proportion of substance groups by sex
| Sex | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| Women | 67.8% | 10.7% | 12.3% | 9.2% | 100% |
| Men | 45.3% | 22.2% | 21.1% | 11.5% | 100% |
The substance groups showed big differences by sex, with a significantly higher proportion of women in the opiate group than men. Figure 3 shows the difference between the proportions of men and women in the different substance groups.
Age
Figure 4: age of adults in treatment
| Age group | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| 18 to 20 | 0.6% | 5.2% | 2.7% | 1.0% | 2.1% |
| 21 to 24 | 2.7% | 14.7% | 9.6% | 4.1% | 6.8% |
| 25 to 29 | 8.4% | 22.1% | 19.4% | 10.8% | 13.8% |
| 30 to 39 | 38.8% | 38.1% | 44.2% | 36.5% | 39.5% |
| 40 to 49 | 37.1% | 14.6% | 18.2% | 27.0% | 27.4% |
| 50 to 59 | 11.3% | 4.3% | 5.0% | 15.6% | 9.0% |
| 60 and over | 1.0% | 1.0% | 0.9% | 5.0% | 1.5% |
| Age group | Opiate | Non-opiate only | Non-opiate and alcohol | Alcohol only | Total |
|---|---|---|---|---|---|
| 18 to 20 | 147 | 546 | 274 | 59 | 1,026 |
| 21 to 24 | 630 | 1,547 | 967 | 229 | 3,373 |
| 25 to 29 | 1,984 | 2,331 | 1,961 | 608 | 6,884 |
| 30 to 39 | 9,157 | 4,018 | 4,471 | 2,054 | 19,700 |
| 40 to 49 | 8,761 | 1,545 | 1,841 | 1,521 | 13,668 |
| 50 to 59 | 2,662 | 455 | 508 | 879 | 4,504 |
| 60 and over | 245 | 105 | 96 | 280 | 726 |
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 (67%) of the total adults in treatment.
The largest substance group in both age groups was opiates. Opiates was also the largest group in the next oldest category, 50 to 59 year olds. The largest group for adults aged 18 to 29 was non-opiates, and the largest group for those aged 60 and over was alcohol only.
The median age of adults in treatment in secure settings for alcohol only and for opiate use was 39 years old. This compares with 47 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 36 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 5: substances by group for adults in treatment
Opiate substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Both opiates and crack cocaine | 16,233 |
| Opiates (not crack cocaine) | 7,353 |
| Cannabis | 3,598 |
| Cocaine | 2,573 |
| Benzodiazepines | 2,147 |
| Amphetamines | 357 |
| Alcohol | 5,271 |
Non-opiate only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 2,419 |
| Cannabis | 6,773 |
| Cocaine | 4,304 |
| Benzodiazepines | 583 |
| Amphetamines | 471 |
| Other drugs | 619 |
Non-opiate and alcohol substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 2,082 |
| Cannabis | 4,965 |
| Cocaine | 5,513 |
| Benzodiazepines | 462 |
| Amphetamines | 283 |
| Other drugs | 313 |
| Alcohol | 10,118 |
Alcohol only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Alcohol | 5,630 |
Figure 5 shows a breakdown of the substances reported by people in prison treatment in 2023 to 2024, 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 has problems with cocaine, cannabis and alcohol use would be counted in the non-opiate and alcohol group for these 3 substances.
Opiates were the most reported drug by adults in treatment (47%) with 33% 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 (42%) of people said they had problems with alcohol, with just over a quarter (27%) of these people using alcohol only. Under a third (31%) of adults reported problems with cannabis and a quarter (25%) with powder cocaine.
Psychoactive substances (mainly synthetic cannabinoids, previously recorded as ‘new psychoactive substances’) were a problem for 6% of people in treatment in secure settings. However, this may not reflect overall psychoactive substance use in prisons. This is 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 6: pathway into treatment for adults starting treatment in 2023 to 2024
| Substance group | Taken directly into custody | Transferred from another secure setting | Total |
|---|---|---|---|
| Opiate | 58.6% | 41.4% | 100% |
| Non-opiate only | 37.2% | 62.8% | 100% |
| Non-opiate and alcohol | 49.5% | 50.5% | 100% |
| Alcohol only | 66.1% | 33.9% | 100% |
| Total | 53.4% | 46.6% | 100% |
Over half (53%) of the people starting treatment in an adult secure setting between 2023 and 2024 were taken directly into custody or detention from the community. The other 47% 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 66% 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 (63% and 51% respectively).
Most of the adults who were taken directly into custody from the community started treatment within 3 weeks of arriving into a secure setting (87%). Of the people transferring from another secure setting, 36% took over 3 weeks to start treatment.
Substances reported by adults starting treatment in secure settings
Figure 7: substances by group for adults starting treatment in 2023 to 2024
Opiate substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Both opiates and crack cocaine | 13,342 |
| Opiates (not crack cocaine) | 5,432 |
| Cannabis | 2,749 |
| Cocaine | 1,960 |
| Benzodiazepines | 1,742 |
| Amphetamines | 233 |
| Other drugs | 701 |
| Alcohol | 4,258 |
Non-opiate only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,887 |
| Cannabis | 4,828 |
| Cocaine | 3,119 |
| Benzodiazepines | 445 |
| Amphetamines | 322 |
| Other drugs | 474 |
Non-opiate and alcohol substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Crack cocaine (not opiates) | 1,648 |
| Cannabis | 3,512 |
| Cocaine | 4,073 |
| Benzodiazepines | 362 |
| Amphetamines | 176 |
| Other drugs | 233 |
| Alcohol | 7,459 |
Alcohol only substance group
| Substances reported | Count of problem substances reported |
|---|---|
| Alcohol | 4,408 |
There were 38,351 people who started treatment for drug and alcohol problems in a secure setting in 2023 to 2024. This is where a person started a new treatment episode, which might also include returning to treatment.
Of the people starting treatment:
- 18,774 (49%) said they had a problem with opiate use
- 16,125 (42%) said they had a problem with alcohol, either alone or alongside other substances
- 4,408 (11%) said they had a problem with alcohol alone
- 11,089 (29%) said they had a problem with cannabis
- 9,152 (24%) said they had a problem with cocaine
Over half (8,340, 55%) of people in the non-opiate substance groups reported having problems with cannabis.
Mental health
Over a quarter (28%) 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 (30%) and the lowest (25%) 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 8: injecting status of adults starting treatment in 2023 to 2024
| Substance group | Currently injecting | Previously injected | Never injected | Declined to answer | Total |
|---|---|---|---|---|---|
| Opiate | 13.6% | 33.5% | 48.5% | 4.3% | 100% |
| Non-opiate only | 1.2% | 8.8% | 87.9% | 2.1% | 100% |
| Non-opiate and alcohol | 0.8% | 9.8% | 87.3% | 2.1% | 100% |
| Alcohol only | 0.5% | 4.6% | 90.2% | 4.7% | 100% |
| Total | 7.1% | 20.6% | 68.7% | 3.5% | 100% |
Most people starting treatment in 2023 to 2024 had never injected drugs (69%). This ranged from 49% of people in the opiate group to between 87% and 90% in the other substance groups. People in the opiate group were most likely to be currently injecting (14% compared to 1% or less for the other substance groups).
Parental status and safeguarding children
Parental status
Figure 9: parental status of adults starting treatment in 2023 to 2024
| Parental status | Adults in treatment |
|---|---|
| Not parent and not in contact with children | 73.0% |
| Parent not living with children | 17.6% |
| Parent living with children | 7.8% |
| Other contact living with children | 1.6% |
Nine per cent of people starting treatment in 2023 to 2024 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-three per cent (34,186) reported that they were not parents and a further 18% (8,265) said they were parents but did not currently live with their children.
Safeguarding and early help
Figure 10: children receiving early help or in contact with children’s social care
| Help received | Children of adults starting treatment |
|---|---|
| Child in need | 9.7% |
| Early help | 26.0% |
| Child protection plan | 21.8% |
| Looked after child | 27.7% |
| Other support service | 18.2% |
Sixteen per cent of children of parents starting treatment were receiving early help. Figure 10 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. Twenty-eight per cent of people starting treatment who were in contact with children’s social care had a looked after child, though this proportion was higher in the opiate group, at 38%.
Treatment types
Figure 11: 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 | 0.3% | 73.5% | 4.8% | 21.5% | 100% |
| Non-opiate only | 0.4% | 5.3% | 0.4% | 94.0% | 100% |
| Non-opiate and alcohol | 0.3% | 11.4% | 0.7% | 87.5% | 100% |
| Alcohol only | 0.7% | 24.3% | 4.1% | 70.9% | 100% |
| Total | 0.4% | 40.9% | 2.9% | 55.8% | 100% |
Almost all adults in treatment in secure settings (97%) 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 (94%), non-opiate and alcohol (88%) and alcohol only (71%) groups. Over one fifth (22%) 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:
- 78% of the opiate group
- 28% 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-one per cent of people in treatment received both pharmacological and psychosocial interventions.
Treatment outcomes
Treatment exits and successful completion
A total of 31,050 people left treatment in secure settings between 1 April 2023 and 31 March 2024. Over a third (38%) of those were discharged after completing their treatment free of dependence.
The alcohol only group (57%), non-opiate and alcohol group (53%) and the non-opiate only group (52%) had the highest rates of successfully completing their treatment. The opiate group had the lowest rate of successfully completing treatment (18%).
Nearly half (49%) of adults leaving treatment were transferred for further treatment, either to community treatment (31%) or to treatment in another secure setting (18%).
Four per cent of people were transferred to another provider as part of a recommissioning process, so will be likely to still be in treatment. This happens when a new provider takes over treatment in the same secure establishment.
The remaining 9% of adults left treatment without completing it, mainly by dropping out of treatment (4%) or being discharged due to being released from court (3%).
Continuity of care
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 53% in 2023 to 2024. This is a 10 percentage point increase from the proportion reported in 2022 to 2023 (43%) and is 23 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 regions in England. The North West had the highest rate of continuing treatment (66%) and London had the lowest (41%).
Deaths in treatment
There were 38 adults who died while they were in treatment in 2023 to 2024, which represented 0.08% of all people in treatment. People with opiate problems accounted for 61% of these deaths.
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, 54% were provided with take-home naloxone when they were released in 2023 to 2024.
Young people in treatment in secure settings
Young people’s treatment: overview
There were 566 young people receiving treatment for drug and alcohol problems in secure settings in 2023 to 2024.
Figure 12: young people in treatment by setting
| Setting | Proportion of young people |
|---|---|
| Young offender institutions | 70% |
| Secure children’s homes | 23% |
| Welfare only homes | 6% |
| Secure training centres | 2% |
Young people: age and sex
Figure 13: breakdown of young people by age and sex
| Age group | Girls | Boys |
|---|---|---|
| 13 and under | 14.6% | 2.5% |
| 14 years old | 14.6% | 5.3% |
| 15 years old | 29.3% | 11.2% |
| 16 years old | 24.4% | 27.8% |
| 17 and over | 17.1% | 53.1% |
Most (93%) of the young people in treatment in secure settings were boys. HMPPS youth custody data shows that 98% of the total youth custody population were boys in March 2024 (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 aged 13 and under and over half (53%) were aged 17 and over. This was different from girls, as only 17% of girls in treatment were aged 17 and over. Most of the girls in treatment were aged 15 or 16 (54%).
The median age of boys was 17 and the median age of girls was 15.
Young people: substance use
Figure 14: substances used by young people
| Substance | Young people in treatment |
|---|---|
| Cannabis | 91.9% |
| Alcohol | 24.9% |
| Cocaine | 13.8% |
| Solvents | 16.4% |
| Nicotine | 12.4% |
| Opiates | 6.5% |
| Benzodiazepines | 3.5% |
| Ecstasy | 2.7% |
| Other | 7.4% |
| Amphetamines | 0.5% |
| Crack | 1.8% |
Figure 14 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 15: vulnerabilities of young people starting treatment
| Vulnerability | Young people starting treatment |
|---|---|
| Polydrug use | 48.3% |
| Pregnant or parent | 27.2% |
| Opiate and/or crack use | 7.8% |
| Injecting (currently or previously) | 1.0% |
| Vulnerability | Young people starting treatment |
|---|---|
| Polydrug use | 199 |
| Pregnant or parent | 112 |
| Opiate and/or crack use | 32 |
| Injecting (currently or previously) | 4 |
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 (48% of young people starting treatment). A further 27% reported being a parent or pregnant. Eight per cent of young people said they used opiates and/or crack.
Young people: treatment type
Figure 16: intervention types for young people
| Intervention | Young people receiving an intervention |
|---|---|
| Harm reduction | 68.6% |
| Psychosocial – motivational interviewing | 68.7% |
| Psychosocial – relapse prevention | 33.0% |
| Psychosocial – cognitive behavioural therapy | 15.0% |
| Psychosocial – counselling | 10.2% |
| Pharmacological | 0.0% |
| Psychosocial – family work | 0.7% |
Over two-thirds of young people in treatment (69%) in 2023 to 2024 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
There were 370 young people who left treatment in secure settings in 2023 to 2024. Of these, 48% completed their treatment successfully.
The 52% who did not complete their treatment successfully included:
- 16% who declined treatment after being referred
- 13% who left treatment after being released from court
- 9% who were released from custody and transferred to another treatment service in the community
- 8% who were transferred to another treatment service in custody
- 6% who dropped out or had their treatment withdrawn by the provider
Trends over time
Trends: adults in treatment
Figure 17: trends in the proportion of adults in treatment by substance group
Figure 17 shows the proportion of adults in treatment split by the 4 substance groups.
There were 49,881 adults aged 18 and over in alcohol and drug treatment in prisons and secure settings between 1 April 2023 and 31 March 2024. The number of adults in treatment has increased year on year for the last 3 years, and the number in treatment this year is 14% higher than in 2020 to 2021, the lowest total in treatment in the last 5 years. Despite this upward trend in numbers in treatment, this total is still 17% lower than the first year these statistics were reported (59,963 in 2015 to 2016).
This change in the trend of numbers in treatment may reflect the rise in prison population numbers in the last few years.
Trends: adults starting treatment
Figure 18: trends in substance use by adults starting treatment
Figure 18 shows the proportion of adults starting treatment each year between 2015 to 2016 and 2023 to 2024 split by the 4 substance groups.
Over three-quarters (77%, 38,351) of the total adults in treatment started treatment during this year, the same proportion as last year. Of the people starting treatment, 49% said they had a problem with opiate use, a 2 percentage point increase from last year.
Despite this rise in the number of adults with opiate problems, the total number of adults starting treatment in 2023 to 2024 is still 19% lower than the highest total reported (47,549 in 2016 to 2017).
Trends: opiate and crack use among adults starting treatment
Figure 19: trends in adults starting treatment reporting opiate or crack problems
The proportion of people starting treatment for opiates, crack or both has increased steadily from a low of 54% in 2021 to 2022 to 58% this year.
Thirty-five per cent of people starting treatment in 2023 to 2024 reported problems with both crack and opiate use. This was a slight rise, after the proportion fell to 31% in 2021 to 2022. This year’s proportion is below the peak of 37% in 2019 to 2020.
The proportion of people starting treatment with opiate problems (but not crack problems) decreased from 25% in 2015 to 2016 to 14% in 2022 to 2023, where it remains this year. 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 2023 to 2024.
Figure 20: 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 42% of people in 2023 to 2024 compared to 43% in 2022 to 2023. The proportion of people in treatment for cannabis has remained consistent between 2015 to 2016 (29%) and this year (also 29%).
Over time, proportions of people in treatment for benzodiazepines and amphetamines have decreased since these statistics were first reported (decreases of 5 and 4 percentage points respectively since 2015 to 2016). The proportion of people in treatment for powder cocaine and other drugs have increased over the same period (increases of 5 and 2 percentage points respectively since 2015 to 2016).
Trends: adults leaving treatment
Figure 21: trends in adults completing treatment
A total of 31,050 people left treatment in secure settings in 2023 to 2024, compared to 28,065 in 2022 to 2023.
Nearly two-fifths (38%) of people were discharged after completing their treatment free of dependence, the highest proportion recorded since reporting began. This is a 16 percentage point rise from 22% in 2015 to 2016.
Conversely, 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 (49%), compared to 74% in 2015 to 2016.
Trends: continuity of care
Figure 22: trends in continuity of care
Improving continuity of care between custody and community-based treatment for people leaving prison contributes to reducing re-offending, improved health outcomes and reducing drug related deaths. The Ministry of Justice and Department of Health and Social Care have been working with HMPPS and NHS England, along with local authority substance misuse commissioners, to improve criminal justice pathways into treatment for prison leavers.
The proportion of adults released from prison and successfully starting community treatment within 3 weeks of release was 53% in 2023 to 2024. This is a 10 percentage point increase from the proportion reported in 2022 to 2023 (43%) and is 23 percentage points higher than when this data was first reported in 2015 to 2016 (30%).
Most adults released from prison with a continuing treatment need are in the opiate group (86%), although this proportion was as low as 68% in 2015 to 2016. This group are the most likely to successfully begin treatment in the community, with 56% doing so.
The other 3 substance groups make up less than 10% of the total proportion released with a treatment need. The proportion of these groups who successfully start treatment in the community ranges from 32% in the non-opiate and alcohol and alcohol only groups, to 39% in the non-opiate group.
Trends: deaths of adults in treatment
Figure 23: trends in deaths of adults in treatment
There were 38 adults who died in 2023 to 2024 while they were in contact with treatment services. This represents 0.08% of the total people in treatment and is a similar proportion (0.09%) compared to the previous year when 44 people died.
As in previous years, people with opiate problems were most at risk, with 61% of all deaths occurring in this group.
Trends: young people in treatment
Figure 24: trends in numbers of young people in treatment
There were 566 young people receiving treatment for drug and alcohol problems in secure settings in 2023 to 2024, a small increase from 2022 to 2023 (550).
In contrast, there was a 5% decrease in the youth custody population for England and Wales between March 2023 and March 2024. You can find statistics on this from HMPPS in the latest youth custody data report.
Trends: substance use by young people in treatment
Figure 25: 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 (14%) has decreased 4 percentage points from 2015 to 2016, and the proportion with nicotine problems (12%) has decreased substantially over the last 3 years, from the peak of 26% in 2020 to 2021.
The proportion of young people in treatment that said they had problems with alcohol use halved between 2023 to 2024 (25%) and 2015 to 2016 (50%). This is the lowest proportion recorded since the start of reporting secure setting treatment data in 2015 to 2016.
Figure 26: trends in young people in treatment by ecstasy, amphetamines and psychoactive substances
Figure 27: trends in young people in treatment by other problematic substances
The proportion of young people in treatment for opiate use was 7% in 2023 to 2024, a similar proportion to the previous year (6%). Solvent use has increased by 2 percentage points this year, from 14% in 2022 to 2023 to 16% 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 10% this year. This is also a 2 percentage point increase from last year.
The proportion of young people reporting problems with amphetamine use has fallen from 7% in 2015 to 2016, to less than 1% this year.
Trends: young people’s treatment exits
Figure 28: trends in young people leaving treatment by completing treatment or being transferred
Figure 29: trends in young people leaving treatment by other reasons
Of the 370 young people who left treatment in secure settings in 2023 to 2024, 48% completed their treatment successfully. This is a 7 percentage point increase from 2022 to 2023 and is the highest rate since reporting began. The previous highest proportion was 41% in 2020 to 2021 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 rose from 5% in 2022 to 2023 to 8% in 2023 to 2024. But the proportion transferring to treatment services in the community fell from 16% in 2022 to 2023 to 9% in 2023 to 2024.
In 2022 to 2023, 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 9%. This year it rose to 13%.
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 2023 to 2024 this proportion decreased from 7% to 6%.
In 2022 to 2023, 22% of young people declined treatment, the highest proportion since reporting began. This year it was 16%.
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.
You can find more details on the methodology used in the report in the Quality and methodology document in the ‘Annual publications for NDTMS’ section on the NDTMS website.
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.
Following the increased investment in community based substance misuse treatment announced as a part of 2021 Spending Review, there has been a focus on enhancing criminal justice pathways into treatment. This led to a steady increase in referrals from criminal justice settings, particularly from prisons. The Public Health Outcomes Framework supports this 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 evidenceapplicationteam@dhsc.gov.uk.