Most interesting things about alcohol and other drugs in 2017

Some of the most interesting
things about alcohol and
other drugs in 2017
Andrew Brown
@andrewbrown365

Estimated prevalence of dependence in England
257,000
183,000
595,000
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
Opiate Crack Alcohol

Estimated number of opiate and/or crack cocaine users by age in
England in 2011/12 and 2014/15
32,628
109,124
152,127
30,190
91,808
178,785
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
15 to 24 years 25 to 34 years 35 to 64 years
2011/12 2014/15
Source: Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2014/15: Sweep 11 report (LJMU 2017)

Estimated number of opiate and crack users in England in 2011/12
and 2014/15, by region
16,935
46,337
36,270
24,085
34,329
21,952
54,985
32,935
26,051
17,675
48,814
36,662
25,057
34,822
25,910
52,487
32,734
26,622
-
10,000
20,000
30,000
40,000
50,000
60,000
North East North
West
Yorkshire
and the
Humber
East
Midlands
West
Midlands
East of
England
London South East South
West
2011/12 2014/15
Source: Estimates of the Prevalence of Opiate Use and/or Crack Cocaine Use, 2014/15: Sweep 11 report (LJMU 2017)
Nationally, there was a 2% increase in
the estimated number of OCUs, but this
change was not statistically significant.
The number of OCUs in the East of
England increased by 18%, from 21,952
in 2011/12 to 25,910 in 2014/15, and this
increase of 3,958 was statistically
significant (95% CI: 270 to 7,606).There
was an increase in the point estimate in
the North West of 2,477 – an increase of
5% - but this was not statistically
significant.All other regions saw
increases in the point estimate apart
from a small fall in the South East and a
larger (but still not statistically
significant) fall in London.

Estimated number of children who live with opiate users, by region
-
5,000
10,000
15,000
20,000
25,000
30,000
East of England East Midlands London North East North West South East South West West Midlands Yorkshire and
the Humber
Female Opiate Users
Male Opiate Users
Source: Estimates of the number of children who live with opiate users, England 2011/12 (PHE, 2017)

Estimated proportion of the population who are alcohol dependent
by upper tier local authority
0.00
2.00
4.00
6.00
8.00
10.00
12.00
Wokingham
Surrey
West…
Hampshire
Leicesters…
Wiltshire
Bromley
East…
Essex
Solihull
Bexley
Herefords…
Devon
Shropshire
Bathand…
Enfield
Kent
Staffordsh…
Hounslow
Norfolk
Sutton
Cheshire…
Ealing
Derbyshire
Calderdale
Greenwich
Waltham…
Bury
Cornwall…
Southend-…
Barking…
Torbay
Dudley
North…
South…
Derby
Darlington
County…
Redcar…
Bolton
Oldham
Hackney
Portsmouth
Barnsley
Wirral
Sandwell
Islington
Tameside
Kingston…
Salford
Blackpool
%Dependencerate
Source: Estimates of alcohol dependence in England, including estimates of children living in a household with an adult with alcohol dependence; supplementary tables (PHE, 2017)

Health and drug and alcohol
treatment services

Types of identified substance misuse support for women in England
and Wales
33.7%
33.7%
12.0%
10.8%
9.6%
0.0% 10.0% 20.0% 30.0% 40.0%
Women’s group in generic
service
Substance misuse midwife
Women-only residential
rehabilitation facility
Other type of substance use
support
Women-only non-residential
substance misuse service
N = 83
Data from the National DrugTreatment
Monitoring System (NDTMS) indicates that
currently around a third of people
accessing drug treatment services are
women, with the figure rising to almost
40% in alcohol only support services.
As such, finding that only around half of all
local authority areas in England (n=74,
49.0%) and five unitary authorities in Wales
(22.7% of all authorities in Wales) are home
to localised support specifically for women
experiencing substance use problems is
disappointing.
Source: Holly, J. (2017). Mapping the Maze: Services for women experiencing multiple disadvantage in England and Wales. London: Agenda & AVA.

Number of adults in community drug and alcohol treatment in
England, 2013-14 to 2016-17
155,852
25,570
28,871
91,651
152,964
25,025
28,128
89,107
149,807
25,814
28,187
85,035
146,536
24,561
28,242
80,454
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Opiate Non-opiate only Alcohol and non-opiate Alcohol only
2013-14 2014-15 2015-16 2016-17
 There has been a fall in the
number of adults in treatment
in the community (3% down
on last year).
 This has been particularly steep
in those in treatment for
alcohol alone (5% down from
2015-16), and prevalence
estimates suggest 4 in 5 people
who are alcohol dependent
aren’t having their treatment
needs met.
 The number of individuals
presenting with crack cocaine
problems (not being used
alongside opiates) increased
by 23% (2,980 to 3,657).
Source: Substance misuse and treatment in adults: statistics 2016 to 2017 (PHE, 2017)

NHS hospital finished admission episodes with a primary or
secondary diagnosis of drug related mental health and behavioural
disorders in England
81,904
74,801
68,597
61,142
57,852
51,353
44,585
42,170
40,421
38,170
38,005
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
There were 81,904 hospital admissions with
a primary or secondary diagnosis of drug-
related mental and behavioural disorders.
This is 9% more than 2014/15 and over
double the level in 2005/06 – though the
increase from 2005/06 will be partly due to
improvements in recording of secondary
diagnoses.
The NorthWest had the highest rate of
admissions per 100,000 population for both
males and females at 326 and 141
respectively.The South East had the lowest
rates at 139 for males and 61 for females.
Source: Statistics on Drugs Misuse: England, 2017 (NHS Digital, 2017)

Numbers of people admitted to hospital in England recorded as
having a diagnosis of withdrawing from alcohol (broad measure)
10,730
12,620
14,430
16,340
17,960
19,800
21,590 22,030
22,970 22,900
24,270
25,040
26,810
1,270 1,290 1,390 1,400 1,210 1,220 1,230 1,130 1,220 1,230 1,100 1,210 1,300
0
5,000
10,000
15,000
20,000
25,000
30,000
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16
Withdrawal state
Withdrawal state with delirium
Source: Alcohol-related hospital admissions – Statistical tables for England (PHE, 2017)

Admission episode rates for alcohol related conditions and healthy
life expectancy at birth for males in England’s Upper Tier local
Authorities
50
55
60
65
70
75
450 650 850 1050 1250 1450 1650
Malehealthylifeexpectancyatbirth
Admission episode rates for alcohol related conditions
“A proxy measure for the harmful effects of
drinking is the number of occasions where acute
healthcare is required as a result, which can be
measured through Hospital Episode Statistics.The
national rate of alcohol-related admissions in
England for males and females combined during
the financial year ending (FYE) 2015 was 634.7 per
100,000; but there were large differences in the
rate of admission for alcohol-related conditions
across the country…
For example, by comparing the extremes, the rate
of admission episodes among males was more
than three times greater in Blackpool (1,544.0 per
100,000) compared to Wokingham (493.6 per
100,000). These areas are starkly contrasting in
terms of male HLE at birth; men inWokingham
were expected to live 14.2 more years in good
health compared to men in Blackpool in 2013 to
2015.”
Source: An overview of lifestyles and wider characteristics linked to Healthy Life Expectancy in England: June 2017 (ONS , 2017)

Number of admissions and bed days for those diagnosed with
alcohol related mental and behavioural disorders associated with
dependence and withdrawal in hospitals in England in 2015-16
1,300
26,810
320
52,970
1,970
0 20,000 40,000 60,000
Withdrawal state
Psychotic disorder
Dependence syndrome
Amnesic syndrome
Admissions (broad measure)
6,579
74,921
4,731
55,581
19,275
- 20,000 40,000 60,000 80,000
Withdrawal state
Psychotic disorder
Dependence syndrome
Amnesic syndrome
Number of finished consultant episodes bed days
Source: Hospital Admitted Patient Care Activity, 2015-16 (NHS Digital 2016)Source: Alcohol-related hospital admissions – Statistical tables for England (PHE, 2017)

Number and proportion of patients who have an emergency
alcohol-specific readmission to any hospital within 30 days of
discharge following an alcohol-specific admission
21,161
22,016
23,341
24,036
11%
12%
12%
13%
0%
2%
4%
6%
8%
10%
12%
14%
0
5,000
10,000
15,000
20,000
25,000
30,000
April 2011 - March 2014 April 2012 - March 2015 April 2013 - March 2016 April 2014 - March 2017 (Provisional)
Source Clinical Commissioning Group Outcomes Indicator Set (NHS Digital 2017)

Provisional rate (per 100,000 registered patients) of emergency
admissions to hospitals for alcohol related liver disease in 2016-17,
by CCG
NHSTower HamletsCCG, 4.2
All registered patients in
England, 27.7
NHS South Sefton CCG, 93.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
NHSTowerHamletsCCG
NHSPortsmouthCCG
NHSSouthGloucestershire…
NHSBathandNorthEast…
NHSWestHampshireCCG
NHSBarnetCCG
NHSChilternCCG
NHSIpswichandEastSuffolk…
NHSNorthHampshireCCG
NHSEastRidingOfYorkshire…
NHSHighWealdLewes…
NHSEastandNorth…
NHSCroydonCCG
NHSNewburyandDistrictCCG
NHSKingstonCCG
NHSOxfordshireCCG
NHSHounslowCCG
NHSDartford,Gravesham…
NHSNottinghamCityCCG
NHSEalingCCG
NHSShropshireCCG
NHSHorshamandMid…
NHSSouthLincolnshireCCG
NHSCoventryandRugbyCCG
NHSBristolCCG
NHSLeedsNorthCCG
NHSWindsor,Ascotand…
NHSHerefordshireCCG
NHSSouthEastStaffordshire…
NHSNorwichCCG
NHSBarkingandDagenham…
NHSCentralManchesterCCG
NHSNeneCCG
NHSWyreForestCCG
NHSEastStaffordshireCCG
NHSDurhamDales,…
NHSBradfordDistrictsCCG
NHSOldhamCCG
NHSNorthWestSurreyCCG
NHSScarboroughand…
NHSValeRoyalCCG
NHSWalsallCCG
NHSHardwickCCG
NHSSwaleCCG
NHSHartlepooland…
NHSNewcastleGatesheadCCG
NHSSouthCheshireCCG
NHSBlackburnWithDarwen…
NHSGreaterPrestonCCG
NHSKnowsleyCCG
NHSRedditchand…
NHSSunderlandCCG
Source: Clinical Commissioning Group Outcomes Indicator Set (NHS Digital, 2017)

Number of attendances at A&E in England recorded as having
social problems (including chronic alcoholism and homelessness)
39,507
40,867
43,993
46,197
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
2013-14 2014-15 2015-16 2016-17
Source: Accident and Emergency Attendances in England for 2014-15, 2015-16, and 2016-17 NHS Digital

It is estimated that the following proportion of a GP’s practice (with
2,000 patients) will have…
17.6%
0.4%
6.0% 6.0%
3.0%
8.8%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Common mental health
problems
Psychosis Below diagnositic
threshold for psychosis
Alcohol dependency Drug dependency Personality disorder
Source: Mental health in the West Midlands Combined Authority (Centre for Mental Health and University of Birmingham 2017)

LGA survey of local authorities about providing naloxone in the
community
99%
25% 25%
21%
18%
12%
6% 5%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Drug
treatment
service
Hostels Outreach
workers
Pharmacy
needle and
syringe
programme
Peers (other
people who
use drugs)
Primary
care
Community
pharmacies
A&E Other
Which services or organisations provide take-home naloxone? Nine in ten respondent local authorities (90
per cent) currently made available take-
home naloxone. Six of the fourteen
respondents which did not currently make
naloxone available subsequently
commented that they were either
considering, planning or about to make it
available.
“All service users accessing our local drug
treatment services are offered take home
Naloxone -We have piloted the distribution
of take home naloxone in 3 community
pharmacies providing high level of needle
exchange and are looking to expand this
provision across all needle exchange
pharmacies over the coming year subject
to ratification” (West Midlands).
“Naloxone saves lives and is a very
important tool in tackling DRDs in our
area” (South East).
n = 121
Source Naloxone survey 2017 (LGA 2017)

High risk behaviours and
multiple needs

Characteristics people who inject drugs in 2016
70%
91%
68%
75%
13%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Currently in treatment Ever used a needle exchange Ever been in prison Ever been homeless Ever traded sex for money,
goods or drugs
Source: People who inject drugs: HIV and viral hepatitis monitoring (PHE 2017)

Proportion of people who inject drugs (who had injected in
preceding four weeks) who reported injecting crack, powder
cocaine and amphetamine
35% 35% 35%
29% 29%
32%
36% 37%
40%
46%
53%
16%
19% 18% 17% 18%
23% 22% 23% 24%
17% 17%
12%
12% 11%
8% 7%
9% 9%
7% 8%
10% 10%
0%
10%
20%
30%
40%
50%
60%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Crack Amphetamine Cocaine
“Injection of crack increased in recent years,
with 53% (95% CI, 50%-55%) of those who
had injected in the preceding four weeks
reporting crack injection as compared to 35%
(95%CI, 33%-37%) in 2006.”
“Crack injection also increased among the
recent initiates, with 50% (95%CI, 40%-59%)
of those who had injected in the preceding
four weeks reporting crack injection in 2016,
vs. 28% (95%CI, 22%-33%) in 2006.”
“There was no significant change in the
injection of cocaine (10%, 95%CI 9%-12% in
2016 vs 12%, 95%CI, 10%-13% in 2006) or
amphetamine (17%,95%CI 15%-19% in 2016
vs 16%, 95%CI, 14%-18% in 2006) among
those who had injected in the preceding four
weeks.”

Prevalence of blood borne viruses amongst people who inject drugs
in England, Wales and Northern Ireland
44% 43% 43%
47% 47%
43% 43%
47%
49% 50%
53%
28%
20%
18% 17% 16% 16% 17% 16%
14% 13% 14%
1.3% 1.1% 1.6% 1.5% 1.1% 1.2% 1.3% 1.1% 1.0% 1.0% 0.9%
0%
10%
20%
30%
40%
50%
60%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Hepatitis C Hepatitis B HIV “…data from the main UnlinkedAnonymous
Monitoring Survey of PWID, which is targeted at
people who inject psychoactive drugs, indicate that
the proportion ever infected with hepatitis B has
declined and that the prevalence of HIV remains
stable and low. Hepatitis C remains the commonest
infection among this group and overall prevalence is
currently stable…Whilst the vast majority of those
with HIV were aware of their status, half of PWID with
antibodies to hepatitis C remain unaware of their
infection, even though four-fifths reported having
been tested for hepatitis C infection. After increasing
during the previous decade, the uptake of testing for
hepatitis C infection has changed little over the last
few years. Services should aim to have testing for
blood-borne viruses available for patients at first
assessment. Repeat testing of people who inject drugs
is recommended, and when risk is assessed as high,
testing may be carried out up to once or twice a year.”

Symptoms of an injection site infection (swelling containing pus
(abscess), sore, or open wound at an injection site) among those
who injected during the preceding year
15%
20%
25%
30%
35%
40%
45%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Shortenedaxis
Under 25 25 to 34 35 and over Symptoms of a possible injection site
infection are common among PWID
across England,Wales and Northern
Ireland. In 2016, 36% (95% CI, 34%-
38%) of PWID who had injected during
the preceding year reported that they
had experienced an abscess, sore or
open wound at an injection site – all
possible symptoms of an injection site
infection - during the preceding year.
This is a similar level to 35% (95% CI,
33%-37%) in 2006, but an increase from
28%-29% reported in 2011-2013.The
levels of possible injection site infection
were particularly high among the
under-25 year age group at 43%
(95%CI, 30%-58%), which is higher
than the 27% reported in 2006 (95%CI,
22%-32%).

Proportion of participants in the Unlinked Anonymous Monitoring
Survey (who had injected in preceding four weeks) who reported
injecting in their groin.
35%
32% 32%
35%
34%
35% 35%
38% 38% 38%
40%
25%
27%
29%
31%
33%
35%
37%
39%
41%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
“Injecting into the groin has been
associated with a number of health
problems, including damage to the
femoral vein and artery, infections and
circulatory problems.The proportion of
current PWID who reported injecting into
their groin during the preceding four
weeks varied across England,Wales and
Northern Ireland. By country, the
proportion injecting into the groin in 2016
was as follows: England 40% (95% CI,
38%-43%);Wales, 39% (95% CI, 31%-
48%); and Northern Ireland 60% (95% CI,
39%- 79%). Across England, there are
differences in the proportion reporting
injecting into their groin, ranging from
47% (95% CI, 40%-54%) in the SouthWest
to 33% in the East of England (95% CI,
25%-42%).”

Non-fatal overdoses amongst people who inject drugs
15%
17%
18%
19%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
2013 2014 2015 2016
Among the participants who took part in
the main UnlinkedAnonymous
Monitoring Survey across England in
2016 who had injecting during the
preceding 12 months (recent injectors),
19% reported overdosing in the
preceding year, which has increased
significantly from 15% in 2013.
Self-reported overdose in 2016 was
lowest among those who were currently
in treatment for their drug use (i.e. those
being prescribed a detox or maintenance
drug regime; 16%). Self-reported
overdose was 21% among PWID who had
never been in treatment in 2016, and was
especially high among those who had
previously been in treatment but were
not currently (31%).
Source: Non-fatal overdose among people who inject drugs in England: 2017 report (PHE, 2017)

Annual public spending for those with three severe and multiple
disadvantage profiles, per person 2016-17 prices
£1,916
£6,047
£1,957
£1,235
£5,075
£3,108
£325
£3,108
£-
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
Physical health Criminal justice Mental health Prison Rough sleeping Hostels Benefits Substance use
treatment
Source: Faulty by design. The state of public-service commissioning (Reform, 2017)

Multiple needs of people entering domestic abuse services and
captured by the SafeLives database between April 2014 to March
2017
6%
12%
45%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Drug misuse Alcohol misuse Mental health problems
Needs experienced within the last 12 months In the period April 2014 to March
2017, caseworkers submitted 974
intake forms for clients entering
11 health services across
England and Wales which used
the SafeLives Insights outcome
measurement service.
Where a referral route was
recorded(n = 811), 1% (6 cases)
were from drug and alcohol
services, and 6% (47 cases) were
by mental health services.
Of clients accessing support (n =
515) 28% (143) engaged with
mental health services, 9% (48)
with drug services, and 14% (72)
with alcohol services.
Source: Insights National Dataset Health 2016-17 (SafeLives, 2017)

Proportion of patients treated in general hospitals with serious
mental illness identified as having coexisting drug and alcohol
misuse problems
15%
12%
8%
26%
17%
11% 11%
30%
0%
5%
10%
15%
20%
25%
30%
35%
Schizophrenia Other
psychosis
Bipolar
affective
disorder
Personality
disorder
Drug misuse Alcohol misuse
n = 204 n = 57 n = 142 n = 43
Source: Mental Health in General Hospitals: Treat as One (NCEPOD, 2017)

There were 27,428 appointments made with drug and alcohol
treatment for people who used adult secondary mental health and
learning disabilities services between April and November 2015
78.1%
15.6%
3.7% 2.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Attended Did not attend Appointment cancelled/postponed by
provider
Invalid/missing data
n = 27,428
Source: Mental Health Bulletin: 2015-16 Annual Report (NHS Digital, 2016)

Estimated excess deaths per year below age 70 in England for
people with diagnosed mental health disorder, by diagnosed
disorder
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
Substance use
disorder
Alcohol use
disorder
Schizophrenia Depressive
disorder
Opioid use
disorder
Bipolar
disorder
Personality
disorder
Schizoaffective
disorder
Stress-related
disorders
Anxiety
disorder
Unnatura
l
Source: On the State of the Public’s Health, Baby Boomers: Fit for the Future (Department of Health, 2016)

Use of section 136 in England, 2011/12-2015/16, health and police
based places of safety
14,902
14,053
17,008
19,403
22,965
8,667
7,761
6,028
3,996
1,764-
5,000
10,000
15,000
20,000
25,000
2011/12 2012/13 2013/14 2014/15 2015/16
where PoS was health-
based i.e. a hospital
where PoS was police
cell or custody suite
The use of section 136 ofThe Act (under which people
were brought to hospital as a ‘place of safety’)
increased by 18 per cent since last year, to 22,965.
The increase in uses of Section 136 to take people to a
hospital as a place of safety should also be viewed in
the context of a fall by a similar number in the use of
section 136 where the place of safety is a police cell.
Data released by the police in 2016, and previous years,
shows the number of uses of section 136 where the
place of safety was a police cell in England reducing
from just under 9,000 in 2011/12 to 1,764 in 2015/16, a
fall in number of 6,903 (80%) across that four year
period.
Source: Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment (NHS Digital, 2016)

Associations between diagnosis and being re-detained or admitted
following being detained under Section 136 of the Mental Health
Act
[Across the cohort the] most common primary diagnosis was F20–
F29 schizophrenia, schizotypal and delusional disorders (n=52, 21%),
F60–F69 disorders of adult personality and behaviour (n=50, 21%)
and F10–F19 mental and behavioural disorders due to psychoactive
substance use (n=48, 20%). Fifty-two per cent (n=126) had either a
primary or secondary diagnosis of psychoactive substance use (F10–
F19).
In the year following their original S136 detention, 41 individuals
(17%) were detained again by the police.
Patients with personality disorder were the most likely to be re-
detained under S136, and those with a primary or secondary
diagnosis of substance use were also more likely to be re-detained
multiple times… in around half of the repeat detentions the
individual had been using substances. Substance use should
therefore be a target for interventions to reduce crisis contacts with
health services and police.
36%
50%
27%
17%
13%
75%
6%
64%
2%
30%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Re-detained in follow-up period Admitted in follow-up period
Personality disorder Substance misuse Schizophrenia
Affective disorder Other diagnosis
Burgess JL, White SJ, O’Brien A. Retrospective cohort follow-up study of individuals detained under Section 136. British Journal of Psychiatry Open. 2017 Nov 1;3(6):281-4.

Characteristics of patients who died by suicide and had been in
touch with mental health services in the 12 months over the last 10
years
68%
22%
45%
33%
73%
27%
63%
43%
68%
25%
58%
46%
70%
25%
49%
38%
0%
10%
20%
30%
40%
50%
60%
70%
80%
History of self-harm History of violence History of alcohol misuse History of drug misuse
England Northern Ireland Scotland Wales
n = 13,576 n = 778 n = 2,652 n = 817
Source: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Number of patients in contact with mental health services, in the 12
months prior to death by suicide, with a history of alcohol or drug
misuse, in England
544
466
501
561
524
560
624
598
575
515
486
375
356
337
391
357
377
475
431 442
413
389
0
100
200
300
400
500
600
700
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Alcohol Drug
The number of suicides in patients
with a history of alcohol or drug
misuse has fallen since a peak in
2011. Between 2011-2015, 375 (7%)
patients who died were under drug
services, 389 (7%) were under
alcohol services, and 612 (11%)
were under either drug or alcohol
services.
The most common substances
misused in the 3 months prior to
suicide were alcohol (59%),
cannabis (21%), stimulants (15%)
and heroin (13%).The number of
patients misusing alcohol or heroin
fell between 2011 and 2014.

Behavioural characteristics of patients with mental ill health
homicide offenders in England (2005-2015)
50%
53%
77%
73%
78%
71%
80%
88%
100%
89%
58% 58%
86%
91% 92%
61%
46%
75% 74% 74%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
History of self-harm History of violence Any previous convictions History of alcohol misuse History of drug misuse
England Northern Ireland Scotland Wales
n = 641 n = 18 n = 137 n = 39

Estimates of the number of households experiencing core
homelessness in Great Britain, by type, in 2011 and 2016 (rounded)
6,100
5,900
7,900
47,100
10,000
42,900
9,100
8,900
12,100
42,200
19,300
68,300
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Rough Sleepers Car, tent, public
transport
Squatting Hostels, refuges
etc.
Unsuitable
Temporary
Accommodation
Sofa Surfers
2011 2016
Source: Homelessness projections: Core homelessness in Great Britain (Crisis/Herriot Watt University 2017)
“The scale of core homelessness has
increased significantly across Great
Britain (33% between 2011 and 2016).”
“At any one point in time, core
homelessness in 2016 stood at around
160,0002 households in Great Britain
(143,000 in England, 5,100 inWales,
11,800 in Scotland).”
“We estimate that core homelessness
contains 57,000 ‘family’ households
(couples or lone parents) containing
82,000 adults and 50,000 children, so
that the core homeless ‘population’ is
236,000.”

Proportion of people seen rough sleeping in the year, in London,
with alcohol, drug and/or mental health support needs
41%
31%
45%
28%
43%
31%
46%
26%
44%
35%
47%
23%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Alcohol Drugs Mental health No alcohol, drugs or mental health
support needs
2014-15 2015-16 2016-17
Source: Chain Annual Report (Greater London Authority)

Rough Sleeping Statistics Autumn 2016, England
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
2010 2011 2012 2013 2014 2015 2016
England London Rest of England
Rough sleeping counts and
estimates are single night snapshots
of the number of people sleeping
rough in local authority areas. Local
authorities decide whether to carry
out a count or an estimate. They are
encouraged to gain intelligence for
street counts and estimates from
local agencies such as outreach
workers, the police, the voluntary
sector and faith groups who have
contact with rough sleepers on the
street
Source: Rough sleeping in England: autumn 2016 (DCLG, 2017)

Proportion of local authorities reporting how the provision of
specialist support and/or accommodation for the groups of
homeless people/those at risk of homelessness changed since 2010?
21%
11%
32%
21%
30%
14%
24%
17% 16%
20%
10% 13%
21% 22%
28% 31% 33%
38% 39%
44%
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
Migrants Women DV survivors Care leavers 16-17s Ex-prisoners 18-24s Substance
abusers
Alcohol abusers Mental ill
health sufferers
Increased Reduced n = 162
Source: The homelessness monitor: England 2017 (JRF and Crisis, 2017)

The number of offences charged and reaching a first hearing at a
Magistrates’ court in England under section 3 of the Vagrancy Act
1824
1,510 1,465
1,763 1,825 1,889
1,573 1,626
2,771
3,071
2,365
-
500
1,000
1,500
2,000
2,500
3,000
3,500
Source: Rough Sleepers and Anti-Social Behaviour (England) (House of Commons Library, 2016)
“Begging is an offence under section 3 of
theVagrancy Act 1824 (as amended). It is a
recordable offence. The maximum
sentence is a fine at level 3 on the
standard scale (currently £1000). Other
provisions also criminalise begging
behaviour: wilfully blocking free passage
along a highway is an offence contrary to
section 137 of the Highways Act 1980 (as
amended), punishable by a level 3 fine.
Using threatening or abusive words or
behaviour is an offence under section 5 of
the Public Order Act 1986, which also
carries a level 3 fine.”

Projections for the number of people sleeping rough in England,
Wales and Scotland
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
2011 2016 2021 2026 2031 2036 2041
England Wales Scotland
Source: Homelessness projections: Core homelessness in Great Britain (Crisis/Herriot Watt University 2017)
“A sub-regional housing market model has been
adapted to forecast future levels of homelessness
which has modelled 15 additional variables.*The
model depends on many assumptions but for the
purpose of this analysis it has been fixed on a
relatively neutral/ benign scenario for the economy
and labour market, and current policy settings
including planned welfare reforms.”
*The 15 variables used are rough sleeping, hostel residents,
unsuitable temporary accommodation, sofa surfers, total
core homelessness, homeless acceptances, total homeless
applications, total in temporary accommodation, people
asked to leave household, evictions, wider homelessness,
relative low income poverty after housing costs, crime rates,
welfare reform cuts impact (from Beatty & Fothergill),
households in financial difficulty.

Numbers of adults receiving treatment for drug and alcohol use
disorders in prisons and other secure settings in England in 2015-16
29,146
10,259
12,298
8,551
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Opiate Non-opiate only Non-opiate and
alcohol
Alcohol only
Source: Adults and young people in secure settings in England: data for 2015-16 (PHE, 2017)
In all, 60,254 adults were in contact with
drug and alcohol treatment services within
secure settings during 2015-16, and most
(56,803) of these were within a prison
setting, with 3,124 withinYOIs and 327
within IRCs [Immigration Removal
Centres]. Just under half (48%) of those in
contact with treatment in adult settings
presented with problematic use of opiates,
a further 37% presented with problems with
other drugs (non-opiates) and 14%
presented with alcohol as their only
problem substance.

Numbers of adults in secure settings (prisons, Youth Offending
Institutions, and Immigration Removal Centres) in England being
treated for use of NPS, by type
2,163
1,156
296
83
80
41
0 500 1,000 1,500 2,000 2,500
Predominantly cannabinoid
Other
Predominantly stimulant
Predominantly hallucinogenic
Predominantly sedative/opioid
Predominantly dissociative
6% of all adults in treatment cited New Psychoactive
Substances (NPS) as one of their problem substances,
or their only problem substance. This figure represents
the number of adults presenting for treatment with
problem NPS use and not necessarily a reflection of
overall NPS prevalence in adult secure settings.

Prisoner survey responses on drugs, alcohol, medicines and mental
health
65%
31%
7%
76%
42%
47%
23%
53%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Do you feel you have any
emotional well being/mental
health issues?
Is it easy/very easy to get
illegal drugs in this prison?
Is it easy/very easy to get
alcohol in this prison?
Are you currently taking
medication?
Women Men
“The proportion of new
[male adult] prisoners with
a drug and/or alcohol
problem remained very
high, most noticeably
among those reporting a
mental health problem.”
“Our survey showed an
increase in the proportion
of women arriving in
prison with drug and/ or
alcohol problems.”
Source: HM Chief Inspector of Prisons for England and Wales Annual Report 2016–17

Responses by adult male prisoners in England and Wales about
drugs and alcohol, by ethnicity
21%
12%
40%
20%
9%
6%
32%
21%
49%
24%
13%
9%
0%
10%
20%
30%
40%
50%
60%
Did you have a
problem with
drugs when you
came into this
prison?
Did you have a
problem with
alcohol when you
came into this
prison?
Is it easy/very easy
to get illegal drugs
in this prison?
Is it easy/very easy
to get alcohol in
this prison?
Have you
developed a
problem with
drugs since you
have been in this
prison?
Have you
developed a
problem with
diverted
medication since
you have been in
this prison?
BAME prisoners
White prisoners
Source: HM Chief Inspector of Prisons for England and Wales Annual Report 2016–17
“During the course of the past year I
have seen many prisons and other
institutions operating under
extreme pressure.The challenges
thrown up by the prevalence of
illegal drugs and other contraband,
increasing violence, too many
prisoners suffering from mental
health issues, an ageing prison
population and a prison estate that
in many places is not fit for any
purpose, let alone the decent
detention of human beings, are
stretching hard-working and well-
intentioned staff to their limits.
Reform is overdue.”

Number of community and suspended sentence orders requiring
drug or alcohol treatment, by year
DrugTreatment
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Suspended Sentence - Drug treatment
Community Orders - Drug treatment
AlcoholTreatment
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Suspended Sentence - Alcohol treatment
Community Orders - Alcohol treatment
Source: Offender Management Statistics quarterly: October to December 2016 (MoJ, 2017)

Average custodial sentence (months) in England for drug offences
(shortened axis)
32.6 32.5 32.3
31.5
30.6
29.9
29.6
31.6
33.5 33.7
35.3
26
27
28
29
30
31
32
33
34
35
36
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Averagecustodialsentence(months)
Source: Criminal justice system statistics quarterly (MoJ 2017)
“The requirements for courts to
follow the wide overall offence
guidelines, rather than the
narrower category ranges within
them, mean that the Council can
report high rates of compliance.
In 2014, for drug possession
offences, 84 per cent of
sentences imposed fell within the
guideline offence range for Class
A drugs, over 99% for class B and
89% for Class C.”
Source: The Sentencing Council for England and
Wales: brake or accelerator on the use of prison?
(Transform Justice 2016)
New
sentencing
guidelines

Prison population in England and Wales under immediate
custodial sentence for drug offences by sentence length
88 139
548
3,552
1,399
1,920
1,404
877
711
11
302
57
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Source: Hansard 2017

Prison population under an immediate custodial sentence for drug
offenses
9,987
59
341
55
10,582
49
332
45
0
2,000
4,000
6,000
8,000
10,000
12,000
Trafficking in controlled drugs Other drug offences Possession of controlled drugs
(excluding cannabis)
Possession of cannabis
30-Jun-15 30-Jun-16
Source: Hansard 2017

What did people who had a previous conviction for drug offences
get reconvicted for if they reoffended during the period July 2014 to
June 2015?
964
87
211
6,079
118
9,211
767
706
2,873
287
7,804
3,815
498
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000
Violence Against the Person
Sexual
Robbery
Theft
Criminal Damage and Arson
Drug
Possession of Weapons
Public Order
Miscellaneous Crimes Against Society
Fraud
Summary Non-motoring
Summary Motoring
Other
Source: Proven reoffending statistics: July 2014 to June 2015 (MoJ 2017)

Positive drug tests carried out by Liverpool police on arrest, by drug
type (2014-15 vs 2015-16
0
500
1000
1500
2000
2500
2014-15 2015-16
Cocaine only
Opiates only
Both cocaine & opiates
The number of attempted drug tests conducted in
Liverpool’s custody suites halved between 2014-15 and
2015-16, while the number of individuals testing positive
decreased by around two-fifths (41%).The rationale for
targeted testing was to reduce the number of negative
tests in order to reduce police time. Although the positive
drug test rate has increased, it is only by a small proportion
(6%).There are substantially lower numbers of offenders
being imposed with an RA and therefore lower numbers of
drug using offenders coming into treatment. This is where
there is considerable concern by treatment services,
commissioners and the Police themselves. This concern is
greater still for opiate drug users in Liverpool who are not
coming into the treatment system.
Source: Criminal Justice Project: Impact of targeted drug testing on drug using offenders coming into treatment in Liverpool (PHI, 2017)

Reduction in re-offending in the two-years following the start of
treatment, by substance group
-31%
-59%
-44% -44% -44%
-21%
-49%
-36% -35%
-33%
-70%
-60%
-50%
-40%
-30%
-20%
-10%
0%
Opiates Alcohol only
Alcohol & non-
opiates Non-opiates only Total
Offenders Offences
44% of clients did not reoffend in this period [two
years following the start of treatment], and this
resulted in the number of recorded offences
decreasing by 33%. Opiate clients had the lowest
percentage change in recorded offenders and
offences (31% and 21%, respectively), while the
alcohol only client group experienced the
greatest reduction in both offenders and offences
(59% and 49%, respectively).
There was a 55% reduction in clients with one
offence recorded against them, a 45%
reduction in clients with two offences
recorded against them, and this decreasing
trend generally continues.There was a
reduction of only 0.3% in the number of
clients with 15 or more offences recorded
against them.
Source: The impact of community-based drug and alcohol treatment on re-offending (MoJ and PHE, 2017)

Over a quarter (27%) of all shoplifting incidents involved food and
grocery items in 2016, one in seven (14%) involved alcohol.
0%
3%
3%
3%
4%
4%
6%
7%
14%
14%
16%
16%
27%
0% 5% 10% 15% 20% 25% 30%
Electronics toys/DVDs/toys/games
Toiletries
Watches belonging to the business
Personal possessions belonging to employees or customers
Money
Jewellery belonging to the business
Home accessories
Electrical or electronic equipment
Alcohol
Parts, components or small equipment
Clothing
Cosmetics
Food or groceries
There were 3.5 million incidents of shoplifting in 2016.
The 2016 CVS also included new questions for respondents who said
the most commonly stolen items in shoplifting incidents were food
or grocery items. Respondents were asked whether the food or
groceries typically stolen were high value luxury items (e.g.
expensive cuts of meat), lower value day-to-day items (such as
bread or milk) or a combination of these. Responses shows that the
majority of premises (71% for all incidents and 80% for the most
recent incident) typically had low value goods stolen in shoplifting
incidents involving food and grocery items.
Source: Crime against businesses: findings from the 2016 Commercial Victimisation Survey (Home Office, 2017)

Number of offenders issued a Penalty Notice for being drunk and
disorderly aged 16 and over
43,556
46,996
44,411 43,570
37,119 36,001
32,648
27,907
23,679
17,973
13,860
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Source: Criminal Justice System statistics quarterly: December 2016 (MoJ, 2017)

The number of young people entering treatment with a primary
problem with cannabis or alcohol in comparison with all other
drugs
12,784
13,200
13,581 13,659 13,454
12,863
7,054
5,884
4,704
3,776
3,133
2,556
2,021
1,549 1,495 1,668 1,747 1,651
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Cannabis Alcohol All other drugs
“Since 2005-06, young people have been
increasingly likely to seek help for
problems with cannabis compared to
other substances. During 2015-16, 12,863
presented to specialist services with
cannabis as their primary substance (75%
of all those receiving help during the
year). Although there was a 7% fall in the
number of young people in treatment in
2015-16, the proportion of young people
citing primary cannabis use increased
slightly (from 73% in 2014-15 to 75% in
2015-16).”
Source: Young people’s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016 (PHE 2017)

Substance use of all young people in treatment in secure settings, in
England in 2015-16
91%
51%
19%
19%
9%
8%
8%
4%
2%
1%
1%
0% 20% 40% 60% 80% 100%
Cannabis
Alcohol
Nicotine
Cocaine
Amphetamines
NPS
Ecstasy
Other
Opiates
Solvents
Crack
There were 1,541 young people in specialist
substance misuse treatment in a secure setting in
2015-16.The majority (69%) of young people in
treatment in secure settings reside inYOIs, with a
further 16% residing in Secure Children’s Homes
(SCHs), 12% in SecureTraining Centres (STCs) and
3% inWelfare Only Homes (WOHs).
Cannabis was the most commonly cited problem
substance amongst young people in treatment in
secure settings (91% of all in treatment). Around half
cited problematic alcohol use (51%). Other
substances reported by young people included
nicotine (19%), cocaine (19%), amphetamines (9%),
ecstasy (8%) and NPS (8%).Two percent of young
people cited problematic opiate use.
n = 1,541

Diagnosis of alcohol abuse or dependence by age of onset of alcohol
use amongst adolescents who had consumed alcohol in the past 3
months visiting Emergency Departments in England (n=609)
247
221
94
23
0
50
100
150
200
250
300
Age of onset before age 15 Age of onset age 15+
No diagnosis Diagnosis
Among adolescents who had consumed
alcohol in the past 3 months, 15%
screened positive for alcohol abuse or
dependence (using MINIKID).
“The prevalence of a diagnosis of
alcohol abuse or dependence was
considerably higher among participants
who started drinking before the age of
15 years, with almost 1 in 3 meeting the
criteria for alcohol abuse or
dependence.”
Source: Donoghue, Kim et al. Alcohol Consumption, Early-Onset Drinking, and Health-Related Consequences in Adolescents Presenting at Emergency Departments in England, Journal of
Adolescent Health

Number of looked after children aged 16 to 17 years identified with
substance misuse needs and the proportion refusing intervention
760 750
790
450 480
510
0%
10%
20%
30%
40%
50%
60%
0
200
400
600
800
1,000
1,200
1,400
2014 2015 2016
Proportionrefusingintervention
Numberidentifiedwithsubstanceuseneed
Male Female Refused intervention Any young person who is at increased risk of
substance misuse, including those who are
leaving care, should be provided with
targeted prevention support which focuses on
reducing risks and strengthening resilience.
Through commissioning of public health
services, local councils should ensure they
have clear referral pathways into specialist
substance misuse services for those young
people who are assessed as requiring
structured drug and alcohol interventions.
Source: Healthy futures; Supporting and promoting the health needs
of looked after children (LGA, 2016)
Source: Children looked after in England including adoption: 2015 to 2016 (DfE, 2016)

Selected individual vulnerabilities identified among all young
people starting treatment in England in 2015-16
-
500
1,000
1,500
2,000
2,500
3,000
Affected by
others'
substance
misuse
Affected by
domestic
abuse
Mental
health
problem
Self-harm Sexual
exploitation
Pregnant
and/or
parent
Injecting
Female Male “Young people do not develop substance misuse
problems in isolation.The 2015-16 data shows that a
significant proportion of young people who entered
specialist treatment services also had other multiple
problems or vulnerabilities that were linked to their
substance misuse.
“For some young people these wider issues may be
the cause of their substance misuse problems, and
for others, a consequence. So it is vitally important
that young people’s treatment services are working
closely with a wide range of other children and young
people’s health and social care services, to ensure
that vulnerable young people have all their needs
supported.”

Age and gender breakdown of young people starting treatment in
England in 2015-16 who reported sexual exploitation
0
20
40
60
80
100
120
140
160
180
200
Under 14 14-15 15-16 16-17 17-18
Female Male
“Overall, 6% of young people (704) reported
sexual exploitation. However, the proportion
is much higher among females (14%) than
males (just over 1%). Although these figures
suggest a large difference between sexual
exploitation experienced by boys and girls,
research from Barnardo’s has highlighted
difficulties in identifying sexual exploitation
of boys and young men because they often
do not disclose abuse. The median age of
young people reporting sexual exploitation
was 15, compared to 16 for all new
presentations, reflecting the high proportion
who were female.”

Distal risk indicators of child sexual exploitation
50%
34%
26%
24%
23%
20%
16%
16%
16%
15%
14%
13%
11%
10%
5%
3%
0% 10% 20% 30% 40% 50% 60%
Criminal prosecutions prior to 2013
Living in care
Truancy / disruptive behaviour at school
Neglectful parents
Unrelated sexual assault
Mental health issue / learning disability
Physical / emotional abuse from family
Domestic violence within family
Family links to OC
Parents drug and / or alcohol abuse
Links to gangs or OCGs (not family)
Sexual abuse within family
Physical / emotional abuse by adult (not family)
Aggressive behaviour
Excluded from services
Has contracted STIs
Source: The impact of organised crime in local communities (Police Foundation, 2017)
“The victims of CSE are some of the most
vulnerable children in society. With an
average age of 15, most come from highly
dysfunctional families, half have a
criminal record and a third live, or have
lived, in care. Some are repeatedly
abused by multiple perpetrators over long
periods of time.The multiple risks they
are exposed to are not dissimilar to those
experienced by adult sex workers; they
include physical, psychological and
emotional trauma, sexually transmitted
diseases, educational failure and
problematic substance misuse.”

Selected Antecedents of Suicide In Under 20s And 20-24 Year Olds
22%
34%
43%
52%
57%
16%
11%
9%
42%
51%
47%
41%
55%
10%
8%
3%
0%
10%
20%
30%
40%
50%
60%
Excessive
alcohol use
Illicit drug use Academic
pressures overall
Previous self-
harm
Suicidal ideas Family history of
mental illness
Family history of
substance
misuse
Witness to
domestic
violence
Under 20 (n=285)
20-24 (n=106)
Source: Suicide by Children and Young People (NCISH, 2017)

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