. ... 4.2.1 Revisions in the definitions and cod
Adult Alcohol statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014
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Contents About Public Health England
2
Contents
2
Executive summary
4
1.
Background and Policy Context
5
2.
Key findings
6
2.1 Age and gender of all clients 2.2 Ethnicity of all clients 2.3 Source of referral into treatment of new treatment journeys 2.4 Housing situation of new treatment journeys 2.5 Waiting times: for first and subsequent treatment interventions 2.6 Treatment interventions and sub-interventions 2.7 Treatment exits and successful completion 3. Trends in data for structured alcohol treatment in England since 2008-09
6 7 8 9 9 10 11 12
3.1 Total number in treatment 3.2 Age and gender of new treatment journeys 3.3 Waiting times 3.4 Interventions received 3.5 Treatment exit reasons 4. History
12 12 14 14 15 16
4.1 Relevant web links and contact details 4.2 Comparability of data to previous reports 4.2.1 Revisions in the definitions and coding of discharge codes 4.2.2 Revisions in the methodology for grouping referral types 4.2.3 Revisions to the definitions and coding of intervention type 5. Abbreviations and definitions
17 18 18 18 18 19
5.1 5.2
Abbreviations Definitions
19 19
3
Executive summary
There were 114,920 clients aged 18 to 75 in contact with structured treatment who cited alcohol as their primary problematic substance in 2013-14
A further 34,237 clients aged 18 to 75 cited alcohol misuse as an adjunctive problem to a range of other primary problematic substances
Clients’ median age (the number in the middle of a list of all the ages) at their first point of contact with treatment in 2013-14 was 43 (for both males and females) and 64% of clients in treatment were male
Where reported, most clients were white British (87%). No other ethnic group accounted for more than 3% of clients in treatment with a primary substance of alcohol
Where reported, 42% of clients starting treatment were self-referrals and 17% were referrals from GP’s. Onward referrals from statutory and non-statutory substance misuse services together accounted for 7%. Referrals from the criminal justice system accounted for 7%
Where reported, 4% of clients had an urgent housing problem (no fixed abode) on presenting to treatment; a further 10% had other housing problems
93% of all clients waited less than three weeks to commence treatment
Of the 74,291 clients exiting treatment in 2013-14, 43,530 (59%) were no longer dependent on alcohol (had completed treatment successfully), a further 5,914 (8%) were transferred for further treatment within the community, while 1,027 (1%) were transferred into appropriate treatment while in custody
The overall number of clients in treatment in 2013-14 has increased by 5% (5,237 individuals) from 109,683 in 2012-13. The number of new treatment journeys commencing in the year has increased by 7% (5,156 individuals) from 75,773 clients in 2012-13 to 80,929 in 2013-14. The number and proportion of successful completions have also increased from 40,908 (58% of all 70,194 exits) in 2012-13 to 43,530 (59% of all 74,291 exits) in 2013-14
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1. Background and Policy Context The Statistics in this report present information collected through the National Drug Treatment Monitoring System on clients that are receiving specialist interventions for alcohol dependence. Specialist Treatment is one strand of the Government’s Alcohol Strategy, which sets out to address a wide range of health, social and criminal justice harms associated with alcohol misuse. Alongside specialist treatment, there are a wide range of other interventions and responses that can impact on reducing these harms, which include the actions the alcohol industry can take to reduce harm, how local government can use licensing to moderate the drinking environment and how the health, social care and criminal justice systems can identify individuals and intervene early to prevent harm. These statistics are used by government to monitor the national availability and effectiveness of alcohol treatment. They are reported by local treatment providers on a monthly basis and this data is regularly provided to providers and local service commissioners in the form of reports, diagnostic toolkits and Joint Strategic Needs Assessment documents to assist them to monitor their local response to the need for alcohol treatment, improve the outcomes of clients in treatment and to assist in service planning and assuring cost effectiveness and value for money. Information on the total numbers of clients in alcohol treatment in each Local Authority in England, the numbers accessing treatment each year and the numbers leaving treatment can be found here - https://www.ndtms.net/ While these statistics provide information on the numbers of people accessing treatment for alcohol dependency, they do not give an indication on the levels of need for alcohol treatment or the prevalence of alcohol dependency in England. The Local Alcohol Profiles for England (LAPE) http://www.lape.org.uk/ present a more comprehensive picture of local harm and the national harm situation. These treatment data will soon be incorporated into the LAPE to also demonstrate the range of responses. While waiting time for entry into treatment reported here are low, they are limited to reporting on only those patients who access treatment. They do not reflect the number of individuals referred to treatment who never access treatment and the waits they might have experienced. Perceived longer waits for treatment may discourage some individuals seeking treatment, but we are unable to confirm this either way. Information on the history of the data collection of specialist alcohol treatment can be found in chapter four of this report and chapter five provides an explanation of the abbreviations that have been used throughout the report More detail on the methodologies used to compile these statistics and the processes that are in place to ensure data quality can be found here – https://www.ndtms.net/NDTMSRelated.aspx?page=ns In the circumstance that an error is identified in any of the information that has been included in this report then the processes described in the PHE revisions and correction policy will be adhered to. The policy will be published here: https://www.gov.uk/government/organisations/public-health-england/about/statistics PHE has also produced an accompanying publication that provides more information on the harms associated with alcohol misuse and further commentary on the statistics included in this report – https://www.gov.uk/government/organisations/public-health-england
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2. Key findings During 2013-14 NDTMS reported 114,920 clients aged 18 to 75 and in contact with structured treatment citing alcohol as their primary problematic substance. In addition, there were a further 34,237 clients aged 18 to 75 who cited alcohol misuse as an adjunctive problem to a range of other primary problematic substances. It is expected that these clients will have received treatment for their alcohol misuse alongside treatment for these other problematic substances. This section provides further detail on clients citing alcohol as their primary substance only.
2.1
Age and gender of all clients
The age and gender of clients at their first point of contact with the treatment system in the 2013-14 financial year is reported in table 2.1.1 and figure 2.1.1. The majority of clients in treatment were male (64%) and this represents a higher percentage than that observed in the general population where males of a similar age account for 49.5% (ONS 2014). The median age (the middle number in an ascending list of all ages) of clients in treatment in 201314 was 43 years and this was the same for both males and females. This is a few years older than the estimated projected median age for the entire population, which is 39.9 (ONS 2011). The vast majority of clients in treatment were 35 years of age or older; 74% of males and 75% of females. . Table 2.1.1 Age and gender of all clients in treatment in 2013-14 Age 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-75 Total clients
Female n 2,484 3,218 4,623 5,476 6,882 6,730 5,218 3,328 1,911 1,462 41,332
Male n
% 6% 8% 11% 13% 17% 16% 13% 8% 5% 4% 36%
4,042 6,214 8,703 9,833 12,192 11,880 9,294 5,759 3,253 2,418 73,588
% 5% 8% 12% 13% 17% 16% 13% 8% 4% 3% 64%
Persons n 6,526 9,432 13,326 15,309 19,074 18,610 14,512 9,087 5,164 3,880 114,920
%
6% 8% 12% 13% 17% 16% 13% 8% 4% 3% 100%
Figure 2.1.1 Age and gender distribution of all clients in contact with treatment in 2013-14
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2.2
Ethnicity of all clients
Table 2.2.1 shows clients’ ethnicity. Where reported, most clients (87%) were white British compared to 80% of the English population, 3% were other white compared to 5% of the English population and 2% were white Irish 1 compared to 1% of the English population. No other ethnic group accounted for more than three per cent of the total cohort. Table 2.2.1 Ethnicity of all clients in treatment in 2013-14 Ethnicity
n
%
98,905
87%
White Irish
1,903
2%
Other white
3,422
3%
White and black Caribbean
760
1%
White and black African
230
0%
White and Asian
268
0%
Other mixed
437
0%
1,330
1%
Pakistani
389
0%
Bangladeshi
129
0%
Other Asian
727
1%
Caribbean
776
1%
African
751
1%
Other black
670
1%
36
0%
698
1%
2,393
2%
21
0%
113,845
99%
1,075
1%
White British
Indian
Chinese Other Not stated Unknown Total Inconsistent/missing Total
1
114,920
For ethnicity data please see: 2011 Census: KS201EW Ethnic group, local authorities in England and Wales
7
2.3
Source of referral into treatment of new treatment journeys
Table 2.3.1 shows a breakdown of new presentations to treatment by source of referral (i.e. the routes by which people accessed treatment). Information about source of referral was provided for 80,495 (99%) of all new presentations in 2013-14. Of all recorded referral sources, self-referral was the most common accounting for 42% of all recorded referrals. The second most common source of referral was from GPs (17%). Referrals from the criminal justice system (consisting of: arrest referral/DIP, CARAT/prison, DRR or probation) made up 7% of all referrals; most of which were from the probation service. Referrals from substance misuse services (which reflect movement between treatment agencies) amounted to 7% of the total; 3% were from statutory services while nonstatutory substance misuse services accounted for 4%.
Table 2.3.1 Source of referral into treatment for new journeys in 2013-14 Referral source
n
%
A&E (Accident & Emergency)
1,268
2%
Arrest referral/DIP
1,406
2%
403
0%
3,120
4%
130
0%
Connexions
23
0%
DRR
59
0%
Hospital
4,711
6%
Substance misuse service non-statutory
3,232
4%
Substance misuse service statutory
2,374
3%
26
0%
170
0%
13,864
17%
8
0%
Other
8,560
11%
Probation
3,943
5%
Psychiatry
1,422
2%
34,260
42%
1,516
2%
80,495
99%
434
1%
CARAT/Prison Community Alcohol Team Community care assessment
Education Service Employment service GP LAC (Looked After Children)
Self Social services Total Inconsistent/Missing Total inc Inconsistent/Missing
80,929
8
2.4
Housing situation of new treatment journeys
The housing situation at presentation to treatment was reported for 77,120 clients (95%) who started a new treatment journey (i.e. a new spell of treatment) in 2013-14. Of these, 3,044 (4%) reported an urgent housing problem (where they have no fixed abode), while a further 7,588 (10%) reported a housing problem (such as staying with friends or family as a short-term guest or residing at a short-term hostel). A further 66,058 (86%) reported no housing problem. Table 2.4.1 Housing situation of new treatment journeys in 2013-14 Housing situation
n
%
Urgent housing problem
3,044
4%
Housing problem
7,588
10%
66,058
86%
Other
430
1%
Total
77,120
95%
3,809
5%
No problem
Inconsistent/missing Total inc inconsistent/missing
2.5
80,929
Waiting times: for first and subsequent treatment interventions
Table 2.5.1 shows a breakdown of waiting times up to and over three weeks by first and subsequent intervention. Of the 83,771 first interventions beginning in 2013-14, 77,629 (93%) started within three weeks of referral. There were 31,658 subsequent interventions, of which the vast majority, (90%) began within three weeks of referral. Table 2.5.1 Waiting times, first and subsequent interventions in 2013-14 Intervention First Intervention Subsequent Intervention
Three weeks and under 77,629 28,543
9
% 93% 90%
Over three weeks 6,142 3,115
%
Total
7% 10%
83,771 31,658
2.6
Treatment interventions
As part of a treatment journey, a client may receive more than one intervention (i.e. more than one type of treatment) while being treated at a provider and may attend more than one provider for subsequent interventions. Before 1 November 2012 there were six structured treatment intervention types. However from 1 November 2012 the way that interventions were recorded on NDTMS was changed to include three high-level intervention types: psychosocial, pharmacological and recovery support, and an intervention setting. Table 2.6.1 provides information on old intervention types for clients in treatment in 2013-14. These are interventions which occurred as part of a client’s on going treatment prior to the changes which were implemented in November 2012. Table 2.6.2 shows the number of clients who received each of the new intervention types by setting. To avoid double counting, if a client’s intervention features in table 2.6.2, the same intervention (for interventions that can be directly mapped between tables) is not featured in table 2.6.1. Table 2.6.1 Interventions received by clients in treatment in 2013-14, old interventions Total number of individuals
Intervention Inpatient detoxification
1,153
Residential rehabilitation
465
Prescribing (including key working)
0
Structured psychosocial intervention
7
Structured day programme
1,374
Other structured intervention
6472
Total
9,471
Table 2.6.2 Interventions received by clients in treatment in 2013-14, new interventions
Psychosocial
Prescribing
Total number of individuals*
100,525
16,096
101,782
Inpatient Unit
5,884
8,546
8,885
Primary Care
3,712
2,079
4,948
Residential
3,686
1,277
3,903
Recovery House
170
