Alcohol and drugs is one of the five key priority areas for Public Health England’s Health and Wellbeing Directorate alongside obesity, smoking, HIV and sexual health, and mental health and wellbeing.
Alcohol and drugs misuse is a complex issue. The number of people with a serious drugs dependency is relatively small, with bigger numbers dependent on alcohol or drinking at risky levels. In both cases, someone’s misuse and dependency affects everybody around them, including their families, friends, communities and society.
Alcohol misuse is the third largest cause of avoidable ill health. It’s not only binge drinking or dependent drinking that cause harm. Around nine million (One in five) adults in England are drinking at a level that significantly increases their risk of diseases such as high blood pressure, diabetes, some cancers and depression.
Binge drinking causes acute harms such as injuries from accidents and assaults, and causes anti-social behaviour which impacts on the wellbeing of wider communities. It places an unnecessary burden on the NHS and the police, and impacts on families and workplace productivity.
An estimated 1.6 million adults in England have some degree of alcohol dependence, and of these some 250,000 are believed to be moderately or severely dependent and may benefit from intensive specialist treatment.
People who are dependent on alcohol are at a greatly increased risk of serious diseases such as coronary heart disease, stroke and liver disease and may need specialist help to regain control of their drinking and reduce the accompanying health damage.
The Government’s 2012 Alcohol Strategy identifies a number of evidence-based components that need to be implemented to reduce alcohol-related harm. These range from environmental approaches acting on the promotion and supply of alcohol, to short health interventions aimed at groups of people who are at risk of alcohol health harm and more intensive specialist treatment for those whose alcohol dependency is damaging their health and wellbeing.
The problem of illicit drug use has been one of the key concerns for society during the past 30 years. Many communities across England have experienced the debilitating effects of people using the most destructive substances, heroin and crack – crime, drug litter, the spread of blood-borne viruses, drug-related deaths.
Statistics show that illicit drug use is falling. For example, the Crime Survey for England and Wales (previously the British Crime Survey), has reported that the overall number of people who use drugs has fallen. While cannabis remains the most popular illicit substance by far, even its popularity has waned: whereas 11% of the population used it in 2001, this was down to just 7% in 2011. More importantly, the most recent prevalence figures estimate that heroin and crack use has fallen significantly in recent years: from a peak of 332,090 users in 2005-06 to 298,752 in 2010-11.
These reductions in drug use are mirrored by a fall in the number of people entering treatment for drug dependency. The number of new treatment starts for heroin and/or crack addiction (i.e. people completely new to treatment or those returning) was 64,288 in 2005-06, but 47,210 in 2011-12.
The number of heroin addicts who start treatment for the very first time has declined even more sharply, from 47,709 in 2005-06 to 9,249 in 2011-12.The 2010 Drug Strategy makes clear the government’s aim to create a recovery system that focuses not only on getting people into treatment but into recovery, having overcome their dependence.
Local areas have responded well to this ambition. Record numbers of people in England are completing treatment free of dependence. The overall number of people who have successfully completed their treatment for any drug has gone up from around 11,000 in 2005-06 to just under 30,000 in 2011-12.
Effective treatment is the best way of tackling the harm that drug dependency can cause, helping users overcome their addiction, reducing involvement in crime, sustaining their recovery, and enabling them to make a positive contribution to their family and community
Despite this success there is no room for complacency. On the horizon, the problems of new and prescription drugs and the need to help former drug users find the jobs and houses that will sustain their recovery offer real challenges for local areas and Public Health England to tackle together.
Supporting local action
Local authorities are expected to do annual needs assessments and to provide an appropriate balance of effective provision, in line with both national clinical guidelines and the evidence for what works.
Public Health England promotes a balanced and ambitious system to reduce the harm to health and wellbeing caused by alcohol and drugs. We will support local partners by providing high quality information and intelligence about drugs and alcohol, expertise, bespoke support, and by benchmarking performance and developing and sharing evidence of effective practice.