Alcohol treatment in 2018: PHE inquiry explores continued falls

Public Health England (PHE) have released the latest national statistics for substance misuse, confirming a further fall in the number of people receiving alcohol treatment despite no significant change in estimated prevalence.

The new 2017/18 figures show 75,787 people received alcohol only treatment in England, down 6% from 80,454 on the previous year and down 17% from the peak of 91,651 in 2013/14. An additional PHE release also updates the estimated number of people with alcohol dependency deemed in need of treatment, indicating little change in national prevalence of 589,101.

New figures on mental health needs are also contained within the report, with those in treatment for combined alcohol and non-opiate drug use having the highest level of mental health support need (47%) followed by those with alcohol only substance use (41%). The release also now includes figures on parental status, with 49% of alcohol only service users being parents, 20% (10,060) currently living with children. The number of children living with parents currently receiving alcohol treatment was 20,904, with 7,453 children living with parents receiving alcohol and non-opiate drug use treatment. Currently an innovation fund to support up to eight local authorities in addressing the needs of children of dependent drinkers is underway.

PHE inquiry: insights into changes in treatment

PHE say 4 out of 5 alcohol-dependent adults are not getting the treatment they need and have also published results from a recent inquiry to investigate possible causes behind the fall. Some in the field may feel the answer is obvious - continued cuts to treatment budgets (put at 26% for adult and 41% for youth services) have inevitably led to less resources and a changing landscape with very few alcohol only services remaining, described as a "crisis" in alcohol treatment. Indeed PHE's inquiry identifies 'financial pressures and service reconfiguration' as its main finding, meaning substance services in the majority of areas had been reconfigured from having separate drug and alcohol services into single integrated systems.

As part of the inquiry, fourteen local areas were selected for a 'deep dive' to explore significant changes in alcohol treatment including focus groups with a range of stakeholders. Nine of the selected areas had seen falls in alcohol treatment, eight of which saw budget reductions between 15% and 35% and seven of which had seen alcohol services integrated into a wider treatment system.

PHE state that because some areas had seen rises in alcohol treatment numbers, the integration of services 'can improve cost effectiveness, streamline commissioning and service delivery, and improve treatment pathways'. Areas that had achieved increases identified a number of factors thought to underlie this, including leadership commitment to alcohol service improvement, improving the accessibility of services, attention to the promotion of and pathways into alcohol support and effective local partnerships.

However in areas where numbers had fallen, stakeholders identified a number of issues and unintended consequences, including:

• a loss of focus on the specific needs of alcohol users
• a prioritisation of limited resources on opioid substitute treatment
• barriers to alcohol users approaching the service, including a perception that the service focused on the needs of drug users
• barriers to alcohol users engaging in treatment after initial contact, including a lack of alcohol specific treatment pathways within integrated services and a loss of alcohol treatment expertise among staff
• referral pathways and multi-agency working had become less effective

PHE's conclusion states the commissioning and delivery of alcohol and drug treatment is 'changing rapidly and further service reconfigurations are likely to take place over the next few years, aiming to improve cost effectiveness'. Further falls are also expected 'unless local areas ensure that their strategic and commissioning plans, service specifications and referral pathways meet alcohol-specific treatment needs'. 

PHE indeed appear to be treading cautiously around the extent to which falls in alcohol treatment are being driven by funding cuts. As a Government body, it is no doubt under some degree of political pressure not to draw attention to the impacts of austerity on such issues. At the same time, commissioning and delivery of services will still impact on the scope of treatment services irrespective of what is happening to budgets, and indeed a small minority of areas have managed to increase numbers against the tide albeit there may be other factors at play.

Earlier this year Alcohol Concern/Alcohol Research UK released a report “The hardest hit: addressing the crisis in alcohol treatment services”, calling for action to address the many issues arising from funding cuts and other challenges facing the sector. A number of recommendations included calls for an independent review of alcohol commissioning, and that Government partners 'establish effective systems for transparently monitoring the scale of ongoing investment.' Health groups were recently disappointed by the latest budget having called for rises to alcohol duties to fund treatment. Hopes for further investment now rest on the release of the forthcoming new national alcohol strategy expected next year, will calls made in a recent charter for it to reflect a the PHE evidence review.