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Alcohol specialist treatment services

Trends

In England, there has been a 141% increase in clients accessing alcohol treatment services over the last decade, from 35,221 in 2005/06 to 85,035 in 2015/16. Figure 3 shows how the number has risen for clients accessing alcohol only treatment services, reaching a peak of 91,651 in 2013/14.[1]

 

 

 

In Wales, the five-year trend figures from Welsh National Database for Substance Misuse show a 21% rise between 2011/12 and 2015/16 in clients starting alcohol only treatment services, matching an overall increase in that period.[2]

 

 

 

The Census of Drug and Alcohol Treatment Services in Northern Ireland provides a snapshot of those in treatment. Its latest release shows that between 2007 and 2017 the number of people accessing treatment services for alcohol only fell by a quarter (from 3,476 to 2,577) compared with a 7% rise in overall numbers (from 5,583 to 5,969) in that time.[3]

Age

In England, clients accessing alcohol only treatment services were most likely to be in their forties. Furthermore, the proportion of clients using alcohol only treatment services is markedly higher in old age; 81% of 70+ year-olds were doing so in 2015/16.

 

 

 

The figures for those accessing alcohol only treatment services in Wales tell a similar story. Those accessing alcohol only treatment services were most likely to be in their forties, and the highest proportion of substance treatment clients accessing alcohol only treatment services were in the oldest age bracket (60+ years of age).

 

 

The latest Northern Ireland census figures are simply split into two categories: children and adults. Of the 2,577 clients accessing alcohol treatment services only on 1 March 2017, 95 were under 18 years of age, meaning 2,482 adults were reported to be in treatment for alcohol only.

Gender

Figure 5 shows that the ratio of men to women in treatment for alcohol only services in England, Wales and Northern Ireland was in the range 61–63 : 37–39.

 

 

 

New presentations to treatment

Figure 6 shows that the likelihood of new clients accessing substance misuse treatment centres doing so for alcohol increases with age. In England, from the mid-twenties, the highest proportion of new presentations to treatment among adults is for alcohol. By the time people reach their sixties, as many as nine out of every ten new presentations are for alcohol. Figure 6a shows that overall, nearly two-thirds of new presentations to treatment in 2015/16 were for alcohol treatment services.

 

 

Wales tells a similar story, with alcohol becoming the most common substance that clients sought treatment for over the lifecourse. Figure 6b shows that overall, almost half of new presentations to treatment in 2015/16 were for alcohol treatment services. The (median) average age for such presentations was 42 years of age, five years older than the average for all substances.

 

 

New presentations: Source of referral into treatment

In England, the majority (52%) of new referrals to alcohol only treatment services in 2015/16 were from the client themselves, their family and friends (29,728 of 57,723 referrals, see figure 7). Substance misuse services and the criminal justice system were amongst the least popular.

Figure 7 also shows that in Wales, most new referrals (45%) to alcohol treatment services in 2015/16 were from the client themselves.

 

 

In Scotland, the Information Services Division publishes two sets of data on the subject of treatment for substance misuse – National Drug & Alcohol Treatment Waiting Times and Alcohol Brief Intervention (ABI).[4],[5]

The most recent data (2016/17) of completed waits for drug and alcohol treatment indicate that 27,972 clients started their first treatment for alcohol use in that 12-month period.[6]

There were 86,560 ABIs delivered in Scotland over the same period. Almost two-thirds (64%) were delivered in “priority settings” (primary care, A&E, antenatal). This has declined 15 percentage points in the last five years.

Figure 8 shows where the other 30,610 ABIs were delivered. The most common sources for ABI in wider settings were the criminal justice system and the NHS.

 

 

Engagement

Figure 9 shows clients retained in treatment for at least 12 weeks or completing treatment earlier in England. 91% of all clients in contact with treatment services for alcohol only were retained in treatment for at least 12 weeks or completed treatment earlier.

 

 

Exits

In England, the majority of the 53,803 exits from alcohol (only) treatment centres in 2015/16 were free of dependence. Just over a third of exits (19,349) were free of drugs and alcohol altogether. However, a sizeable proportion of exits – roughly one in every four – were also drop outs or occurred without any reason.

 

 

In Wales, seven out of every ten exits from alcohol treatment centres in 2015/16 were described as “planned” (6,734 from a total of 9,407, see figure 10b). Of those, 45% (3,015) completed treatment free of dependence, and another 29% became substance free altogether.

 

 

NICE guidelines

The National Institute for Health & Care Excellence (NICE) has a guide for commissioners of alcohol services, outlining the different treatment options available.

 

 

NICE also recommends that all people screened who score more than 15 in an Alcohol Use Disorder Identification Test (AUDIT) should be referred to specialist alcohol services for comprehensive assessment covering the following areas:

 

 

For those delivering treatment, NICE general interventions emphasise the use of motivational techniques such as helping “encourage positive change”, and adopting a “persuasive and supportive” position.[7]

Commissioners of alcohol services are also advised to offer interventions that reduce a client’s (or service user) drinking or to promote abstinence, and to prevent relapse, preferably in community-based settings.

For people with alcohol dependence who are homeless, NICE suggests considering offering residential rehabilitation for a maximum of 3 months, coupled with efforts to “help the service user find stable accommodation before discharge.”[8]

The guidance also stresses the importance of interventions being delivered by “appropriately trained and competent staff” and that they should all be the subject of “routine outcome monitoring”, in the event that a service user requires the continuation of treatment.[9]

The NHS Choices website also provides a breakdown of intervention options – including medications and therapies – for treating alcohol misuse.[10]

Health and social care professionals have raised concerns that access to effective alcohol treatment services is limited in the UK. In its response to a House of Commons Health Select Committee inquiry on alcohol in 2012, the Alcohol Health Alliance UK (AHA) highlighted that cost-effective treatment interventions for alcohol dependence are currently available only to a small proportion of those who could benefit from them, and that only sustained investment in specialist alcohol services will be required to achieve parity for services for drug misusers.[11]

The AHA recommended that there should be a multidisciplinary ‘Alcohol Care Team’, a seven-day Alcohol Specialist Nurse Service and an ‘Assertive Outreach Alcohol Service’ in every District Hospital. A 2011 paper on Alcohol Care Teams, accredited by NHS Evidence, found that if each district general hospital established a seven-day Alcohol Specialist Nurse Service to care for patients admitted for less than one day and an Assertive Outreach Alcohol Service to care for frequent hospital attendees and long-stay patients, this could result in a 5% reduction in alcohol-related hospital admissions, with potential cost savings to its locality of £1.6 million per annum, which would equate to savings of £393 million per annum if rolled out nationally.[12]

Public health budgets have instead been devolved to cash-strapped local authorities, who, under pressure to tighten budgets, can no longer guarantee the ring fencing of drug and alcohol treatment services. According to Colin Drummond, professor of addictions psychiatry at Kings College London, “People with drug or alcohol dependence are stigmatised and so their services are often the first to be axed.

“Typically, addiction services in England have seen cuts of 30% but some areas are planning cuts of up to 50%. In Birmingham, for example, the addiction treatment budget was cut from £26m to £19m in 2015-16.

“Cuts at a local level make savings—but what is the real cost? Our previously well functioning treatment system has been downgraded by a short term strategy to save money… there must be no further cuts to addiction services by local authorities.”[13]

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[1] Public Health England (November 2016), ‘Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS)’ <http://www.nta.nhs.uk/statistics.aspx>

[2] Welsh National Database for Substance Misuse (October 2016), ‘Treatment Data – Substance Misuse in Wales 2015-16’ <http://gov.wales/docs/dhss/publications/161025datawalessubmisuseen.pdf>

[3] Department of Health Northern Ireland, Public Health Information & Research Branch (August 2017), ‘Census of Drug and Alcohol Treatment Services in Northern Ireland: 1 March 2017 (Tables)’

<https://www.health-ni.gov.uk/news/census-drug-and-alcohol-treatment-services-northern-ireland-1-march-2017>

[4] NHS National Services Scotland (June 2017), ‘National Drug and Alcohol Treatment Waiting Times Report’, Information Services Division Scotland <http://bit.ly/2uNcLBy>

[5] Information Services Division Scotland (June 2017), ‘Scotland Alcohol Brief Interventions 2016/17’

<http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/data-tables2017.asp?id=1940#1940>

[6] NHS National Services Scotland (June 2017), ‘National Drug and Alcohol Treatment Waiting Times Report’, Information Services Division Scotland, p. 8 <http://bit.ly/2uNcLBy>

[7] National Institute for Health Care and Clinical Excellence (NICE) (February 2011), ‘Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence’, updated April 2015 <https://www.nice.org.uk/guidance/cg115>

[8] NICE (February 2011), ‘Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence’, updated April 2015

[9] NICE, updated April 2015

[10] NHS Choices (November 2015), ‘Alcohol misuse – treatment’ <http://www.nhs.uk/Conditions/Alcohol-misuse/Pages/Treatment.aspx>

[11] House of Commons Health Committee (July 2012), Written evidence from Alcohol Health Alliance UK (GAS 27), in ‘Government’s Alcohol Strategy, Third Report of Session 2012–13’, Ev 100

<https://publications.parliament.uk/pa/cm201213/cmselect/cmhealth/132/132we06.htm>

[12] The British Society of Gastroenterology and the Royal Bolton Hospital NHS Foundation Trust, (2012), Quality and Productivity: Proven Case Study, ‘Alcohol Care Teams – reducing acute hospital admissions and improving patient quality of care’, Quality, Innovation, Productivity and Prevention [QIPP], NICE <https://www.evidence.nhs.uk/qipp>

[13] BMJ blogs (May 2017) ‘Colin Drummond: Cuts to addiction services are a false economy’

<http://blogs.bmj.com/bmj/2017/05/25/colin-drummond-cuts-to-addiction-services-in-england-are-a-false-economy/>