Young people's substance misuse treatment statistics 2021 to 2022: report

* Office for Health Improvement & Disparities Accredited official statistics YOUNG PEOPLE'S SUBSTANCE MISUSE TREATMENT STATISTICS 2021 TO 2022: REPORT Published 2 February 2023

APPLIES TO ENGLAND CONTENTS * Main findings * Age and sex of young people in treatment * Substances used by young people * Referral routes into treatment * Vulnerabilities of young people in

treatment * Sexual exploitation * Mental health needs * Treatment types * Treatment exits * Trends over time * Background and policy context Print this page © Crown copyright 2023 This

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https://www.gov.uk/government/statistics/substance-misuse-treatment-for-young-people-statistics-2021-to-2022/young-peoples-substance-misuse-treatment-statistics-2021-to-2022-report MAIN

FINDINGS TRENDS IN YOUNG PEOPLE’S TREATMENT NUMBERS There were 11,326 young people (people under the age of 18) in contact with alcohol and drug services between April 2021 and March 2022.

This is a 3% increase from the previous year (11,013) but a 54% reduction in the number in treatment since 2008 to 2009 (24,494). TRENDS IN YOUNG PEOPLE’S SUBSTANCE USE Cannabis remains the

most common substance (87%) that young people come to treatment for. Around half of young people in treatment (46%) said they had problems with alcohol, 8% had problems with ecstasy and 8%

reported powder cocaine problems. The proportion of young people seeking help for codeine is lower than last year, falling by 0.3% (1.2% compared to 0.9% this year). People seeking help for

heroin was very similar to last year (0.35% compared to 0.33% this year). This year also saw a small decrease in young people reporting a problem with benzodiazepines. However, the

proportion (3%) was over 4 times the proportion in 2013 to 2014 (0.7%). VULNERABILITIES AMONG YOUNG PEOPLE IN TREATMENT The most common vulnerability reported by young people starting

treatment was early onset of substance use (80%), which means the young person started using substances before the age of 15. This was followed by polydrug use (55%). Proportionally, girls

tended to report more vulnerabilities than boys, particularly self-harming behaviour (46% compared with 17%) and sexual exploitation (10% compared with 1.5%). MENTAL HEALTH TREATMENT NEED

Nearly half (46%) of young people starting treatment this year said they had a mental health treatment need, which continues the rising trend of the last 3 years (43% in 2020 to 2021, 37% in

2019 to 2020 and 32% in 2018 to 2019). A higher proportion of girls reported a mental health treatment need than boys (60% compared to 38%). Most young people (69%) who had a mental health

treatment need received some form of treatment, usually from a community mental health team. TREATMENT EXITS Of the young people who left treatment, 82% left because they successfully

completed their treatment programme, which is slightly higher than the previous year’s proportion (79%). The next most common reason for leaving treatment (12%) was dropping out before they

completed treatment, which is slightly lower than the previous year (15%). THE EFFECT OF COVID-19 The coronavirus (COVID-19) pandemic has had a lingering effect on drug and alcohol treatment

services, as it has other services. In 2020 to 2021, most services had to restrict face-to-face contact, which affected the types of interventions that service users received. This, and

other changes to service provision during the pandemic, may have affected the data in last year’s report. COVID-19 related restrictions were still in place in early April 2021, but these

began to be gradually relaxed until almost all restrictions were lifted in July 2021. However, COVID-19 had a continued effect on services throughout 2021 to 2022. Effects included: *

service users testing positive for COVID-19 and not being able to access treatment * staff testing positive and not being able to go to work * service users and staff getting ill with

COVID-19 * the above and other factors causing longer waits and reduced access to healthcare So, like 2020 to 2021, the restrictions and COVID-19 itself might have affected the data in this

report. AGE AND SEX OF YOUNG PEOPLE IN TREATMENT There were 11,326 young people in structured treatment with drug and alcohol services between 1 April 2021 and 31 March 2022. Almost

two-thirds were male (63%), a similar proportion to the previous 2 years. The median age was nearly 16 years old for girls and 16 years old for boys. The number of younger children (under

14) in treatment remained relatively low (969, 9%). Figure 1: age and sex of young people in treatment AGE GROUP GIRLS BOYS UNDER 12 8 31 12 YEARS OLD 81 119 13 YEARS OLD 299 431 14 YEARS

OLD 751 1,089 15 YEARS OLD 1,152 1,856 16 YEARS OLD 934 1,721 17 YEARS OLD 964 1,890 SUBSTANCES USED BY YOUNG PEOPLE When young people enter treatment, they can record up to 3 substances

that they have a problem with. Numbers in this section are based on all substances recorded during their treatment. There were 9,845 young people who said they had a problem with cannabis

(87% of all in treatment) and 5,179 (46%) said they had a problem with alcohol. Eight per cent (937 young people) said they had a problem with powder cocaine and the same proportion (896)

reported a problem with ecstasy. Twelve per cent (1,389) reported a problem with nicotine use (excluding vaping). Other substances reported include ketamine, benzodiazepines, solvents,

codeine, amphetamines, new psychoactive substances (NPS), crack, heroin and other opiates. Figure 2: problem substances reported by young people SUBSTANCE NUMBER OF YOUNG PEOPLE CANNABIS

9,845 ALCOHOL 5,179 NICOTINE 1,389 COCAINE 937 ECSTASY 896 KETAMINE 512 OTHER 374 BENZODIAZEPINES 340 SOLVENTS 329 CODEINE 103 AMPHETAMINES 100 NPS 74 OTHER OPIATES 63 CRACK 58 HEROIN 37 The

section on trends over time in this report shows the numbers of young people in treatment broken down by substance since 2005 to 2006. REFERRAL ROUTES INTO TREATMENT The most common route

for young people to get into specialist treatment services was a referral from education services, with 32% of young people entering this way. This is very similar to the proportion of

education referrals in 2019 to 2020 (32%), but much higher than the proportion in 2020 to 2021 (18%). Education service referrals fell much more during the first year of the COVID-19

pandemic than referrals from other sources. They decreased by 60%, compared to 16% for the other sources combined. They have not returned to pre-pandemic levels, with 2,569 education

referrals in 2021 to 2022 compared to 3,196 in 2019 to 2020. The second most common route for young people to get into specialist treatment services was a referral from social care, making

up 23% of all referrals. This was the most common route in 2020 to 2021, when it made up 28% of referrals, but it was only the third most common route in 2019 to 2020 at 19%, after education

(32%) and criminal justice (22%). Over this period, the number of social care referrals has been fairly stable, decreasing to 1,849 in 2021 to 2022 from 1,937 in 2019 to 2020. Figure 3:

referral routes into treatment REFERRAL ROUTE NUMBER OF YOUNG PEOPLE EDUCATION 2,569 SOCIAL CARE 1,849 YOUTH CRIMINAL JUSTICE 1,435 HEALTH 1,091 SELF, FAMILY AND FRIENDS 847 OTHER 179

SUBSTANCE MISUSE SERVICE 138 VULNERABILITIES OF YOUNG PEOPLE IN TREATMENT Young people often enter specialist substance misuse services with a range of problems or vulnerabilities related to

(or in addition to) their substance use. These include: * using multiple substances (polydrug use) * having a mental health treatment need * being a looked after child * not being in

education, employment or training (NEET) * self-harming behaviour * sexual exploitation * offending * domestic abuse Vulnerabilities are reported here only for young people who entered drug

and alcohol treatment services during 2021 to 2022. The most common vulnerability was early onset of substance use (80%), which means the young person started using substances before the age

of 15. Girls reported this more than boys (82% and 79% respectively). This was followed by young people reporting polydrug use (55%). Again, girls tended to report this more than boys (61%

and 51% respectively). Proportionally, girls tend to report more vulnerabilities than boys, particularly for self-harming behaviours (46% compared with 17%) and sexual exploitation (10%

compared with 2%). Other vulnerabilities that were commonly reported by young people include: * antisocial behaviour (28%), which was more common for boys than girls (36% compared with 16%)

* being affected by domestic abuse (20%) * being affected by others’ substance use (23%) Less commonly reported vulnerabilities include: * opiate or crack use (2%) * being pregnant or a

parent (5%) * housing problems (1%) * injecting (less than 1%) Being involved with social services as a looked after child (11%), a child in need (12%) or having a child protection plan (7%)

were also recorded as vulnerabilities. Figure 4: vulnerabilities among young people starting treatment VULNERABILITY GIRLS BOYS EARLY ONSET OF SUBSTANCE MISUSE 2,482 4,046 POLYDRUG USER

1,861 2,610 MENTAL HEALTH TREATMENT NEED 1,711 1,772 ANTISOCIAL BEHAVIOUR 481 1,821 AFFECTED BY OTHERS’ SUBSTANCE MISUSE 888 995 AFFECTED BY DOMESTIC ABUSE 733 909 SELF-HARM 1,388 851 NOT IN

EDUCATION, EMPLOYMENT OR TRAINING 292 691 LOOKED AFTER CHILD 351 561 CHILD IN NEED 420 565 CHILD PROTECTION PLAN 252 351 SEXUAL EXPLOITATION 298 76 HIGH RISK ALCOHOL USER 245 185 OPIATE

AND/OR CRACK USE 62 126 PREGNANT OR PARENT 184 234 HOUSING PROBLEM 20 41 INJECTING 24 24 SEXUAL EXPLOITATION The Department for Education has published guidance that defines child sexual

exploitation (CSE). > Child sexual exploitation is a form of child sexual abuse. It occurs > where an individual or group takes advantage of an imbalance of > power to coerce, 

manipulate or deceive a child or young person under > the age of 18 into sexual activity (a) in exchange for something the > victim needs or wants, and, or (b) for the financial 

advantage or > increased status of the perpetrator or facilitator. The victim may > have been sexually exploited even if the sexual activity appears > consensual. Child sexual 

exploitation does not always involve > physical contact; it can also occur through the use of technology. Overall, 5% (374) of young people who entered treatment in 2021 to 2022 reported

CSE. Broken down by age, the proportion was: * 6% of 17 year olds (107) * 5% of 15 year olds (101) and 16 year olds (83) * 4% of 14 year olds (54) and children under 14 (29) Among the young

people who started treatment in 2021 to 2022, girls reported CSE much more than boys, with 298 girls (10% of all girls) and 76 boys (1% of all boys) reporting CSE. Among girls, 11% of those

aged 15 or older reported CSE compared to 7% of those aged 14 or younger. For boys, the proportion reporting CSE was under 2% for both these age groups. Most girls who reported CSE were aged

15 (83, 28%), 16 (64, 22%) or 17 (89, 30%). Sixty-two girls (21%) who reported CSE were aged 14 or younger. Most boys who reported CSE were 16 years old (19, 25%). Nearly a quarter of boys

who reported CSE (18, 24%) were 17 years old, another 18 boys were 15 years old and the remaining 21 boys were aged 14 or younger. Figure 5: sexual exploitation of young people starting

treatment AGE GIRLS BOYS UNDER 14 YEARS OLD 20 9 14 YEARS OLD 42 12 15 YEARS OLD 83 18 16 YEARS OLD 64 19 17 YEARS OLD 89 18 MENTAL HEALTH NEEDS Over two-fifths (46%, 3,739) of young people

who started treatment in 2021 to 2022 said they needed mental health treatment. A higher proportion of girls reported needing mental health treatment than boys (60% compared to 38%). Of

those reporting a mental health treatment need, 69% were receiving some form of mental health treatment. Overall, a slightly higher proportion of girls who needed mental health treatment

were receiving a form of mental health treatment when they started substance misuse treatment compared to boys (72% compared to 66%). The majority of young people (58%) were already engaged

with community or other mental health services at the start of treatment. Figure 6 shows that 1,109 girls and 1,059 boys were already engaging with community or other mental health services

while in treatment in 2021 to 2022. Smaller numbers received mental health treatment from a GP (165 girls and 186 boys) or within drug or alcohol services (59 girls and 64 boys). Some young

people also received other mental health treatment, either within a health-based place of safety (28 girls and 27 boys) or by engaging with improving access to psychological therapies (38

girls and 25 boys). However, 499 girls and 650 boys (31% overall) had a mental health treatment need identified but either did not receive treatment or refused treatment. Figure 6: mental

health treatment received by young people in alcohol and drug treatment MENTAL HEALTH TREATMENT RECEIVED GIRLS BOYS COMMUNITY OR OTHER MENTAL HEALTH SERVICES 1,109 1,059 NO TREATMENT

RECEIVED 499 650 MENTAL HEALTH TREATMENT FROM GP 165 186 OTHER MENTAL HEALTH TREATMENT 66 52 TREATMENT WITHIN DRUG OR ALCOHOL SERVICES 59 64 TREATMENT TYPES Most young people in treatment

received a psychosocial intervention (11,188 of 11,326, 99%). The small number who did not receive an intervention probably entered treatment at the end of the time period covered by this

report, and so had not started their intervention yet. Psychosocial interventions (also known as talking therapies) use psychological, psychotherapeutic and counselling skills to encourage

behaviour change. Structured harm reduction interventions are a type of psychosocial intervention. They involve support to manage risky behaviours associated with substance misuse. This

might include behaviours that can cause overdose or accidental injury, for example injecting and polysubstance use. In 2021 to 2022, 7,599 young people (68% of those receiving an

intervention) received a harm reduction intervention. Only 29 young people in treatment (less than 1%) received a pharmacological intervention during treatment. These interventions involve

medication prescribed by a clinician and can include detoxification, stabilisation, relapse prevention and substitute prescribing for opiates. Almost all interventions were delivered in a

community setting (97%). A small number of young people received interventions in other settings, such as at home, in residential rehab, or in an inpatient unit. Figure 7: treatment types

received by young people TREATMENT TYPE COMMUNITY OTHER PSYCHOSOCIAL 10,906 335 HARM REDUCTION 7,330 275 PHARMACOLOGICAL 28 5 Note: figures less than 5 have been rounded up to protect

possible identification. TREATMENT EXITS There were 7,314 young people who left treatment in 2021 to 2022. Of those who left, 5,969 (82%) successfully completed their treatment and 888 (12%)

dropped out. A further 3% were referred to another provider for treatment and 2% declined the treatment offered. Figure 8: treatment exit reasons TREATMENT EXIT REASON PERCENTAGE OF YOUNG

PEOPLE COMPLETED 81.6% DROPPED OUT OR MOVED AWAY 12.1% TRANSFERRED ON TO ANOTHER SUBSTANCE MISUSE SERVICE 3.4% TREATMENT DECLINED 2.4% OTHER 0.3% PRISON 0.1% TRENDS OVER TIME TRENDS IN AGE

AND NUMBERS IN TREATMENT The number of young people attending specialist substance misuse services has increased this year after year-on-year falls since a peak of 24,494 in 2008 to 2009.

The number of young people attending treatment services during 2021 to 2022 is 54% lower than this peak, although it is 3% higher than the number in treatment in the previous year. Data from

the Smoking, drinking and drug use among young people in England survey showed a long-term decreasing trend in the proportion of school pupils reporting lifetime drug use until 2014.There

was a significant increase in this proportion in 2016 and it has been falling again since. Figure 9 shows the trends in the numbers and ages of young people in treatment since 2005 to 2006,

split into 3 age groups: * under 14 years old * 14 to 15 years old * 16 to 17 years old The total number of young people coming to treatment increased from 17,105 in 2005 to 2006 to a high

of 24,494 in 2008 to 2009. Since then, the numbers in treatment have steadily fallen until 2020 to 2021, which saw a steep fall to 11,013 young people in treatment. This year, we saw a

slight rise to 11,326 young people in treatment. The 3 age groups shown have largely followed these trends since 2005 to 2006 with the largest proportion being 16 to 17 year olds, followed

by 14 to 15 year olds. The under 14 years old group makes up the smallest proportion year on year. Figure 9: trends in age and numbers in treatment YEAR UNDER 14 14 TO 15 YEARS OLD 16 TO 17

YEARS OLD TOTAL 2005 TO 2006 1,504 6,386 9,215 17,105 2006 TO 2007 1,770 7,858 11,579 21,207 2007 TO 2008 2,060 9,238 12,982 24,280 2008 TO 2009 2,069 9,187 13,238 24,494 2009 TO 2010 1,890

9,206 13,069 24,165 2010 TO 2011 1,643 8,651 12,261 22,555 2011 TO 2012 1,533 8,219 11,497 21,249 2012 TO 2013 1,487 8,151 10,963 20,601 2013 TO 2014 1,275 7,801 10,606 19,682 2014 TO 2015

1,211 7,628 10,026 18,865 2015 TO 2016 1,157 7,205 9,161 17,523 2016 TO 2017 1,337 7,076 8,436 16,849 2017 TO 2018 1,402 6,899 7,601 15,902 2018 TO 2019 1,289 6,529 6,959 14,777 2019 TO 2020

1,204 6,446 6,641 14,291 2020 TO 2021 740 4,280 5,993 11,013 2021 TO 2022 969 4,848 5,509 11,326 TRENDS IN RECORDED SUBSTANCE MISUSE The proportion of young people in treatment who said

that they had problems with cannabis has been between 85% and 90% since 2013 to 2014. The proportion who reported having alcohol problems had fallen steadily from a peak of 68% in 2008 to

2009 to 41% in 2020 to 2021, to a slight rise this year (46%). The proportion of young people in treatment whose main problem substance was something other than cannabis or alcohol has

consistently been around 10% for the past 10 years of reporting. Figure 10: trends in primary substance The proportion of people treated for ecstasy has fluctuated from around 10% between

2005 and 2008, decreasing to 4% between 2010 and 2012 before rising to a peak of 14% between 2017 and 2019. In 2021 to 2022, the proportion decreased to 8%. The proportion of young people in

treatment for amphetamine use decreased slightly between 2005 and 2010 before increasing quickly to a peak of 12% in 2012 to 2013. Since then, there has been a trend of decreasing

proportions of young people in treatment for amphetamine use (0.9% this year). Cocaine use among young people in treatment peaked in 2008 to 2009 (13%), falling to 7% in 2012 to 2013. Since

this point, the number has remained similar year-on-year (8.3% this year). The number of young people reporting NPS has continued to fall. This was first reported on in 2013 to 2014 and rose

to a peak of 6% in 2015 to 2016 before falling to under 1% in 2020 to 2021 which is still the case this year. The number of young people in treatment for ketamine problems was consistently

low (under 2%) between 2005 and 2018. It has since increased from under 1% in 2015 to 2016 to 5% in 2020 to 2021, which it has remained at this year. The proportion of young people who

reported benzodiazepines as a problematic substance was also consistently low (under 1%) between 2005 and 2017. Since 2018 to 2019, it has consistently been over 3%, which is the proportion

in 2021 to 2022. This was more than 4 times the proportion in 2013 to 2014 (less than 1%). The proportion of young people seeking help for heroin has remained stable since 2017 to 2018.

However, there have been recent increases in young people getting help for codeine (another opiate), at 0.9% this year, up from a low of 0.1% in 2014 to 2015. This is still a decrease from

1.2% in 2020 to 2021. The number of young people reporting solvent use has remained stable compared to the previous year (from 2.8% to 2.9%). The data tables for this year’s young people’s

substance misuse treatment statistics also contain trends by the primary substance. This is the main substance that the young person reported problems with when they entered treatment.

Figure 11: trends in amphetamine, cocaine and ecstasy misuse Figure 12: trends in benzodiazepines, ketamine and new psychoactive substances misuse BACKGROUND AND POLICY CONTEXT BACKGROUND TO

THE DATA This report presents statistics on the availability and effectiveness of young people’s alcohol and drug treatment in England and the profile of those accessing treatment. The

statistics in this publication come from analysis of the National Drug Treatment Monitoring System (NDTMS). The NDTMS collects data from sites providing structured substance misuse

interventions to young people in every local authority in England. The data collected includes information on the demographics and personal circumstances of young 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 NDTMS annual statistics quality and methodology

information paper. POLICY CONTEXT Specialist substance misuse services for young people are normally separate from adult treatment services because young people’s alcohol and drug problems

tend to be different from adults’ and need a different response. This includes: * being child-centred * considering the age and maturity of young people * acting on safeguarding concerns *

making sure the young people do not mix with adults who use drugs These services support young people, help them to reduce the harm their alcohol or drug use causes them and try to prevent

it from becoming a bigger problem as they get older. Services should be part of a wider network of local prevention services that support young people with a range of issues and help them to

build their resilience. Young people’s alcohol and drug treatment in England is commissioned by local authorities using the public health grant. They are responsible for assessing local

need for treatment and commissioning a range of services and interventions to meet that need. The public health grant conditions for 2022 to 2023 make it clear that: > A local authority 

must, in using the grant: have regard to the need > to improve the take up of, and outcomes from, its drug and alcohol > misuse treatment services based on an assessment of local need 

and a > plan which has been developed with local health and criminal justice > partners. The Office for Health Improvement and Disparities works with local authorities and provides

them with bespoke data, guidance, tools and other support to help them commission services more effectively. Guidance for alcohol and drug treatment is available in the Alcohol and drug

misuse prevention and treatment guidance collection. A wide range of NDTMS data is available on the NDTMS website including some data reports that are only available to local authority

commissioners (via login). The government’s strategy for drug treatment and prevention includes actions and funding for young people’s treatment. Young people’s substance misuse services

need to ensure that they are responding appropriately to child sexual exploitation and county lines exploitation. There is guidance that can help with this, including: * guidance on how

public health leaders can prevent and intervene early in cases of child sexual exploitation * guidance for frontline professionals on dealing with county lines Back to top