Young people s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March 2014

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1 Young people s statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 March

2 About Public Health England Public Health England exists to protect and improve the nation s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Public Health England Wellington House Waterloo Road London SE1 8UG Tel: Facebook: Prepared by: Carol Lewis For queries relating to this document, contact: evidenceapplicationteam@phe.gov.uk Crown copyright 2015 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. You can download this publication from Published January 2015 PHE publications gateway number:

3 Contents About Public Health England 2 Contents 2 Executive summary 4 1. Background and policy context 5 2. Characteristics of clients Age and gender of all young people Ethnicity of all clients Substance use Education and employment status Accommodation status Source of referral into treatment (for new treatment episodes) Multiple vulnerabilities Access to services Waiting times: for first and subsequent treatment interventions Treatment intervention pathways Treatment interventions Length of latest treatment episode Treatment exits Treatment exits Trends over time Trends in age and numbers in treatment Trends in primary substance Trends in club drug use Trends in treatment exit reasons History Relevant web links and contact details Comparability of data to previous reports Drug treatment collection and reporting timeline Other sources of statistics about drugs Prevalence of substance use among young people International comparisons Youth justice statistics Adult drug and alcohol treatment Drug-related deaths Other statistics Abbreviations and definitions Abbreviations Definitions 33 Appendix A 36 Diagram to show an example young people s pathway 36 References 37 3

4 Executive summary 19,126 young people (under 18 years) accessed specialist substance misuse services in This is a decrease of 906 individuals (4.5%) since and a decrease of 1,562 individuals (7.6%) since The most common routes into specialist substance misuse services were from youth offending teams (27%) and mainstream education (19%) Of the 19,126 young people accessing specialist substance misuse services in , the majority were white British 1 (80%). Two thirds were male (66%). Just over half (53%) were aged 16 or over The majority of young people accessing specialist services did so for problems with cannabis (71%) or alcohol (20%) as their primary substance 1 Over four fifths (82%) of young people accessing specialist services stated they were living with their parents or other relatives. Five per cent (5%) stated their accommodation status was living in care, living in care as a looked after child or living independently as a looked after child 1 Of those entering services in just over half (52%) were in mainstream education. 18% stated they were not in education or employment 1 Less than half of young people entering specialist substance misuse services (41%) did so with zero or one vulnerable factors. The majority of young people entering specialist services reported two to four vulnerable factors (58%) 2 Of the 23,147 first interventions starting in , 22,800 (99%) began within three weeks of referral. The average (mean) wait to commence their first specialist intervention was two days The average (mean) number of days a young person received their latest episode of specialist interventions for during was 151 days (just over five months). Opiate users tended to spend the longest time accessing interventions, on average just under six months (177 days) and cocaine users spent on average the shortest time (138 days) 12,510 young people exited specialist substance misuse services in and 9,852 (79%) of these did so in a planned way no longer requiring specialist treatment 1 Percentages are based on all young people with information completed 2 Ten vulnerable factors are reported in the NDTMS dataset and include substance specific factors (e.g. poly drug use, drinking alcohol daily) or wider factors which may impact on their substance use (such as pregnancy, self-harming or offending). For more details see section 2.7 4

5 1. Background and policy context The statistics in this report present information collected through the National Drug Treatment Monitoring System (NDTMS) about young people (those aged under 18) that are receiving specialist substance misuse interventions in England. The information relates to all substances which young people present to specialist services seeking help for, including alcohol. The statistics are used to: provide evidence about the benefits to young people and their families of attending specialist substance misuse services inform the commissioning of specialist services for young people with drug or alcohol problems monitor national availability and effectiveness of specialist young people s substance misuse services monitor trends and shifts in patterns of drug and alcohol use among young people attending specialist services, to inform future local and national public health policy Specialist substance misuse services for young people are distinct from adult services because young people s alcohol and drug problems tend to be different to adults and need a different response. The role of specialist substance misuse services is to support young people to address their alcohol and drug use, reduce the harm it causes and prevent it from becoming a greater problem as they get older. They should operate as part of a wider network of universal and targeted services (universal services include schools, colleges and youth clubs; targeted services include youth offending teams and non-mainstream education) which support young people with a range of issues and help them to build their resilience. A diagram to illustrate a typical user journey through the treatment system can be found in appendix A. The statistics do not provide an indication of the levels of need for young people s specialist substance misuse services. The main prevalence data for trends in substance use amongst young people is the annual schools survey Smoking, drinking and drug use among young people in England for year olds. Although the latest report for 2013 shows declining trends in substance use overall, some patterns remain concerning. It highlights the increased risk of drug use among pupils who truant or who have been excluded from school and whose circumstances or behaviour already make them a focus of concern. The report can be found here at: A new survey called What about youth has been launched as part of a new government pledge to make improvements to the health of young people. It asks 15-year olds about a range of subjects including what they eat, what they do in their free time, bullying and whether they smoke, drink alcohol or have taken drugs. Local level data will be available from late Other prevalence statistics are included in the Drug misuse: findings from the crime survey for England and Wales. This is a largely adult survey but includes data on young adults aged The latest report for 2013 shows rises in the last year in the proportion of people in the 16 to 24 age group using cannabis and class A drugs (including powder cocaine and ecstasy). However, it s not yet possible to tell if the increases between and signal an end to the long-term downward trends. The report can be found here at: Although surveys of school pupils show a considerable reduction in the proportion of children drinking alcohol and taking drugs of the last decade i there remain serious concerns about some young people s substance use. International comparisons show British children are more likely to get drunk compared to children in most other European countries ii and emerging substances such as new psychoactive substances (often misleadingly called legal highs ) have come to prominence, but the extent of the problems they are causing among young people is still unclear. Public Health England s Child and Maternal Health Intelligence Network (ChiMat) is also available to local authorities and provides a wide-range of authoritative data, evidence and practice related to children's, young people's and maternal health. It can be found here at: The government s 2010 drug strategy called for an evidence-based, life-course approach to reducing the demand for alcohol and drugs. It says that young people with substance misuse problems experience a range of risk 5

6 factors or vulnerabilities which must be addressed by collaborative work across local health, social care, family services, housing, youth justice, education and employment services. Risk factors include experiencing abuse and neglect, truanting from school, offending, early sexual activity, antisocial behaviour and being exposed to parental substance misuse. The evidence base says that the more risk factors young people have, the more likely they are to misuse substances, be harmed by them and misuse drugs and alcohol as adults. The statistics in this report should therefore be considered as part of a wider picture around the health needs of young people and prevention services for vulnerable young people. 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 at: If 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 can be found here at: PHE has also produced an accompanying publication that provides commentary on the statistics included in this report: 6

7 2. Characteristics of clients During NDTMS reported 19,126 clients aged nine to 17 iii in contact with structured treatment. 2.1 Age and gender of all young people The age and gender of young people at their first point of contact with the treatment system in is reported in table and figure The majority of young people in treatment were male (66%) and this represents a higher percentage than that observed in the general population of nine to 17-year olds where males of the same age account for 51.2% (ONS 2013). 3 Just over half of young people in treatment (53%) were aged 16 or over. Overall, females accessing services were younger, with 19% of males aged under 15 compared to 26% of females. This is comparable to the annual schools survey which shows 21% of females aged 14 have ever tried a drug compared to 15% of males aged 14. Table Age and gender of all clients in treatment Age Female Male Persons n % n % n % Under % 37 0% 46 0% % 151 1% 227 1% % 577 5% % % % % % % % % % % % % % Total clients 6, % 12, % 19, % Figure Age and gender distribution of all clients in contact with treatment ,000 3,500 3,000 Female n Male n 2,500 2,000 1,500 1, Under Annual mid-year population estimates,

8 2.2 Ethnicity of all clients Table shows the ethnicity of young people in treatment. Where reported, most clients (80%) were white British, 3% were white and black Caribbean and 2% other white. This is comparable to ethnicity in the general population where the latest census shows that 78% of young people aged 10 to 17 were white British 4. No other ethnic groups accounted for more than 3% of the total cohort. Table Ethnicity of all clients in treatment Ethnicity n % White British 15,150 80% White and black Caribbean 563 3% Other white 473 2% Caribbean 409 2% Other mixed 314 2% African 285 2% Other black 271 1% Pakistani 270 1% Bangladeshi 225 1% Other Asian 200 1% Other 180 1% White and Asian 155 1% Not stated 129 1% White and black African 126 1% White Irish 109 1% Indian 94 0% Chinese 12 0% Total 18, % Inconsistent/missing 161 Total 19,126 4 Ethnic group by age in England 8

9 2.3 Substance use Table shows the distribution of primary substance use (the substance that brought the young person into treatment at the point of triage/initial assessment) and adjunctive substance use (the secondary or tertiary substance cited by the young person) of clients aged nine to 17 treated in If a young person was seen at multiple service providers or multiple times within the year, the substance(s) recorded at their latest triage in the year is used (for further detail see Quality and methodology information). Seventy one per cent (71%) of young people were primary cannabis users with a further 14% of young people using cannabis as an adjunctive (secondary or tertiary) substance. Alcohol is the second most cited substance with 20% using this as a primary substance and a further 35% using this as an adjunctive substance. Although these are the most commonly cited substances for young people in specialist services, there are still a number of young people citing other substances. Ten per cent (10%) of young people cite the use of amphetamines as either primary or adjunctive use with a further 8% citing the use of cocaine and 6% citing the use of ecstasy as either primary or adjunctive use. Primary cannabis and alcohol users had a median age of 16 (the middle number in an ascending list of all ages). Primary opiate and crack users had a slightly higher median age of 17. The majority of young people in treatment with these primary substances were aged 16 or over (78%). Solvents have the lowest median age at 14. Solvent use was more prevalent in the younger age groups with 34% of all primary solvent use occurring in those under the age of 14 compared to 6% of all primary cannabis use. Table Substance use of all young people in treatment Primary Adjunctive Primary Substance n % n % Median age Opiates 160* 1% 105* 1% 17 Amphetamines 591 3% 1,370* 7% 16 Cocaine 254 1% 1,245* 7% 16 Crack 14 0% 85* 0% 17 Ecstasy 124 1% 960* 5% 16 Cannabis 13,659 71% 2,595* 14% 16 Solvents 134 1% 160* 1% 14 Alcohol 3,776 20% 6,620* 35% 16 New psychoactive substances 120* 1% 200* 1% 15 Other 271 1% 2,528 13% 16 Total 19, % 15,880 83% Missing, misuse free or inconsistent data 21 Total 19,126 * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. 9

10 Figure Primary drug use of all young people in treatment New psychoactive substance (NPS), 120*, 1% Alcohol, 3776, 20% Solvents, 134, 1% Other, 271, 1% Opiates, 160*, 1% Amphetamines, 591, 3% Cocaine, 254, 1% Crack, 14, 0% Ecstasy, 124, 1% Opiates Amphetamines Cocaine Crack Ecstasy Cannabis Solvents Cannabis, 13659, 71% Alcohol New psychoactive substance (NPS) Other 10

11 Table Primary substance use by age of all young people in treatment Substance Under n % n % n % n % n % n % n % Opiates 0 0% 0 0% * *% 9 0% 23 0% 39 1% 87 2% Amphetamines 0 0% 0 0% 14 1% 43 2% 136 3% 184 4% 214 4% Cocaine 0 0% 0 0% 6 1% 10 0% 54 1% 71 1% 113 2% Crack 0 0% 0 0% 0 0% * *% 0 0% * *% 10 0% Ecstasy 0 0% 0 0% 0 0% 6 0% 32 1% 36 1% 50 1% Cannabis 24 52% % % 2,040 73% 3,641 74% 3,701 73% 3,422 68% Solvents 8 17% 19 8% 19 2% 31 1% 22 0% 22 0% 13 0% Alcohol 12 26% 56 25% % % % % 1,010 20% New psychoactive 0 0% * *% 6 1% 8 0% 47 1% 32 1% 27 1% substances Other * *% * *% 10 1% 20 1% 69 1% 71 1% 95 2% Total 45* 100% % 1,005* 100% 2,780* 100% 4, % 5,090* 100% 5, % * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. 11

12 Table Substance use by age of all young people in treatment Substance Under P A P A P A P A P A P A P A Opiates * * Amphetamines * Cocaine * Crack * * * Ecstasy * Cannabis 24 * , , , , Solvents 8 * 19 * Alcohol 12 * , ,826 1,010 1,716 New psychoactive 0 0 * * substances Other * 5 * Total 45* ,005* 640 2,780* 2,072 4,914 3,996 5,090* 4,427 5,041 4,624 P = primary substance A = adjunctive substance * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. 12

13 2.4 Education and employment status The education and employment situation at presentation to treatment was reported for 13,345* of young people (96%) who entered treatment in Over half (52%) of the young people entering structured treatment were recorded as being in mainstream education (such as schools and further education colleges), followed by a further 19% in alternative education (such as schooling delivered in a pupil referral unit or home setting). A further 18% were recorded as not in education or employment. Education and employment status was reported only for new clients entering specialist services during the year, therefore the total number of young people reported here is lower than the total number of young people in treatment in Table Education and employment status of all young people starting treatment Education and employment status n % Mainstream education 6,907 52% Alternative education 2,580 19% Not in education or employment 1,885 14% Apprenticeship/training 793 6% Not in employment or education or + training (NEET) 587 4% Employed^ 231 2% Persistent absentee 114 1% Regular employment % Temporarily excluded 77 1% Permanently excluded 67 1% Economically inactive health issue 20 1% Economically inactive caring role 6 1% Voluntary work + * *% Total 13,345* 100% Inconsistent data * Missing 489 Total 13,837 * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. + These responses were added to the dataset in November 2013 ^ This response has been removed from the dataset as at November

14 2.5 Accommodation status Young people s housing situation when they presented to treatment was reported for 18,560 young people (97%) who were in treatment during Of these, 15,262 (82%) were recorded as living with their parents or other relatives, while a further 3% reported living independently in settled accommodation. 5% of young people stated that they had an accommodation status of either living in care, living in care as a looked after child or living independently as a looked after child. Table Accommodation status of all young people in treatment Accommodation status n % Living with parents or other relatives 15,262 82% YP supported housing 1,208 7% Independent settled accommodation 585 3% Looked after child in care^ 565 3% Independent unsettled/housing problem 302 2% YP living in care % Looked after child living independently ^ 135 1% Independent no fixed abode 105 1% Young offender in secure care^ 88 0% YP living in secure care % Total 18, % Missing or inconsistent data 566 Total 19,126 + These responses were added to the dataset in November 2013 ^ This response has been removed from the dataset as at November

15 2.6 Source of referral into treatment (for new treatment episodes) Table shows a breakdown of new episodes of treatment starting in the financial year by source of referral (i.e. the routes by which people accessed treatment). Information about source of referral was provided for 21,208 (99.9%) of all new episodes of treatment in Of all recorded referral sources, referrals from youth offending teams (YOTs) were the most common, accounting for 27% of all recorded referrals. The second most common source of referrals came from mainstream education (19%). Self-referrals made up 7% of all recorded referrals, as did referrals from children and family services. Referrals from A&E make up 1% and from CAMHS (child and adolescent mental health services) 3%. Table Source of referral of all new treatment episodes Referral source n % YOT 5,882 27% YP secure estate 187 0% Other 611 2% Youth / criminal justice total 6,680 29% Self 1,467 7% Relative, family, friend or concerned other 911 5% Self, family & friends total 2,378 12% GP 270 1% A&E 294 1% School nurse 283 1% Child mental health services 687 3% Hospital 156 1% Other 82 0% Health total 1,772 7% Mainstream education 3,964 19% Alternative education 776 4% Education service 587 3% Other 37 0% Education total 5,364 26% Children and family services 1,584 7% Looked after child services 395 2% Social services 264 1% Other * *% Social care total 2,245* 10% Targeted youth support 1,137 5% Drug and alcohol services (statutory and non-statutory) 215 0% Connexions 42 0% Outreach 162 1% Non-treatment substance misuse provider 99 0% YP treatment provider 376 2% Other * *% Substance misuse total 2,035* 8% YP housing 399 2% Other 337 2% Total (episodes) 21, % Missing or inconsistent data 21 Total (episodes) 21,229 * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. 15

16 2.7 Multiple vulnerabilities Young people can enter specialist substance misuse services with a range of problems either relating to their substance use (such as poly drug use, drinking alcohol daily) or wider factors which may impact on their substance use (such as pregnancy, self-harming or offending). Ten of these vulnerability factors are identified in the NDTMS dataset and reported on in table 2.7.1: 1. Young person began using primary substance aged under Young person reports involvement in offending behaviour 3. Young person reports self-harming 4. Young person is a looked after child 5. Young person reports using opiates and/or crack 6. Young person is not in education or employment 7. Young person report unsettled accommodation status or has no fixed abode 8. Young person reports using two or more drugs in combination (poly drug use) 9. Young person is pregnant or a parent 10. Young person reports almost daily drinking or drinking in excess of eight units (males) or six units (females) on an average drinking day when drinking 13 or more days of the month Due to changes in the recording of the above factors on 1 November 2013 (see section 6.2 for more detail on this change), table only reports on episodes that start on or before 31 October 2013 and are not comparable to data from previous years. Less than half of young people entering structured treatment (41%) did so with zero or one of these vulnerable factors. The majority of young people entering structured treatment reported two to four vulnerable factors (58%). Multiple vulnerabilities are reported for just new clients entering specialist services during the year, therefore the total number of young people reported here is lower than the total number of young people in treatment in Table Number of vulnerabilities identified of all young people starting treatment April 2013 to October 2013 Multiple vulnerabilities n % 0 (zero)-1 vulnerability 3,265 41% 2-4 vulnerabilities 4,632 58% 5-7 vulnerabilities 68 1% 8-10 vulnerabilities 0 0% Total 7, % 16

17 3. Access to services 3.1 Waiting times: for first and subsequent treatment interventions The table below shows a breakdown of waiting times under and over three weeks by first and subsequent intervention. Of the 23,147 first interventions beginning in , 22,800 (99%) began within three weeks of referral. There were 1,546 subsequent interventions (i.e., where a client who is already receiving an intervention is referred to start another type of treatment) occurring before 1 November 2013, of which 1,503 (97%) began within three weeks of referral. Overall the average (mean) wait to commence treatment (first interventions only), was two days. Table Waiting times, first and subsequent interventions Intervention Under three weeks (n) % Over three weeks (n) % Total First intervention 22,800 99% 347 1% 23,147 Second intervention + 1,503 97% 43 3% 1,546 + Note that, owing to changes in the dataset on 1 November 2013, only interventions starting prior to this date are included in subsequent waits 3.2 Treatment intervention pathways As part of a young person s treatment package, an individual may receive more than one intervention (i.e. more than one type of treatment) while being treated at a service and may attend more than one provider for subsequent interventions. Prior to 1 November 2013 there were four structured treatment intervention types, subsequently there were 25 potential combinations of pathways Only the most common are reported here, with smaller numbers being grouped under other interventions. Due to changes in the recording of interventions (see section 6.2 for more detail on this change), table only reports on interventions that start before 1 November 2013 and are not comparable to data from previous years. Looking at all the interventions and combination of interventions received by each young person before 1 November 2013, the majority of young people in specialist services received a psychosocial intervention only (44%) or a psychosocial intervention in combination with a harm reduction intervention (43%). Psychosocial interventions (sometimes known as talking therapies ) use psychological, psychotherapeutic and counselling skills to encourage change. Structured harm reduction includes support to manage injecting, overdose and accidental injury through substance misuse. Ninety-two (92) young people received a pharmacological intervention (0.7%). Pharmacological interventions for young people cover a wide range of medication prescribed by a clinician, as well as substitute prescribing for opiate and alcohol addiction such as prescribing for detoxification, stabilisation, symptomatic relief from substance misuse and relapse prevention. 17

18 Table Intervention pathways of young people in treatment in (interventions starting between 1 April 2013 to 31 October 2013) Intervention pathways n % YP psychosocial intervention only 5,855 44% YP harm reduction only 1,372 10% YP family work only 13 0% YP specialist pharmacological intervention only * 0% YP access to residential treatment only * 0% Psychosocial + family work only 36 0% Psychosocial + pharmacological intervention only 26 0% Psychosocial + family work + pharmacological intervention only * 0% Psychosocial + family work + harm reduction only 73 1% Psychosocial + harm reduction only 5,711 43% Psychosocial + harm reduction + pharmacological intervention only 33 0% Other interventions or intervention combinations (which include pharmacological/prescribing 27 0% interventions) Other interventions or intervention combinations (which do not include pharmacological/prescribing 202 2% interventions) No named modalities 0 0% Total 13, % * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. Note that, owing to changes in the dataset on 1 November 2013, only interventions starting prior to this date are included in the intervention pathways. 18

19 3.3 Treatment interventions From 1 November 2013 the way in which interventions were recorded on NDTMS was changed to include three high-level structured intervention types (psychosocial, harm reduction and pharmacological) and an intervention setting. Table shows the number of clients who received an old intervention type (types that were current prior to 1 November 2013, see section 6.2 for more detail on this change). Clients are counted once for each intervention type they received. Table Interventions received by young people in treatment , old interventions Intervention YP psychosocial intervention 8,095 YP harm reduction 6,624 YP family work 142 Other YP intervention types 257 Prescribing / pharmacological (YP and adult codes combined) 72 Residential rehabilitation (YP and adult codes combined) * Other adult & alcohol codes 199 n * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. Table provides information on new interventions commenced after the changes to the core dataset on 1 November It shows the number of young people who received interventions based on the new intervention codes and intervention setting. If a clients intervention features in table 3.3.2, and can be directly mapped between tables, it is not featured in table above to avoid double counting. Table Interventions received by young people in treatment , new interventions Setting Intervention type Psychosocial Harm reduction Pharmacological Total number of individuals + Community 5,321 1, ,700 Inpatient unit (substance misuse specific) Inpatient unit (not substance misuse specific) * * 0 * Residential unit (substance misuse specific) * 0 0 * Residential unit (not substance misuse specific) 11 8 * 12 Home * 202 Adult setting 3,079 1, ,607 No setting recorded * 489 Total number of individuals + 8,860 3, ,791 + This is the total number of individuals receiving each intervention type and not a summation of the psychosocial and prescribing columns. * All numbers under 5 have been suppressed. Where totals could be derived, figures have been rounded to the nearest five and marked with an asterisk. 19

20 Data from tables and can be summed where overlap exists to arrive at the total number of individuals receiving each intervention in Psychosocial interventions can be summed to give a total number of 16,955 individuals receiving psychosocial interventions. This total individual figure can also be arrived at for harm reduction interventions (10,323 individuals) and pharmacological interventions (157 individuals). Where no overlap exists (for example for family work or previous intervention types) data for these interventions is therefore not comparable to previous years. 3.4 Length of latest treatment episode The average (mean) time that individuals accessed their most recent episode of specialist interventions during was just over five months (151 days). Primary opiate users on average spend the longest time accessing interventions (177 days). The majority of young people s most recent episodes were 26 weeks or less in duration (74%). Table Average length of latest episode by primary substance Substance Average days Opiates 177 Amphetamines 164 Cocaine 138 Crack 147 Ecstasy 159 Cannabis 149 Solvents 175 Alcohol 159 New psychoactive substance 73 All clients 151 Table Length of latest episode Episode length n % 0 (zero) to 12 weeks 8,120 43% 13 to 26 weeks 5,817 31% 27 to 52 weeks 3,533 19% Longer than 52 weeks 1,414 7% Total 18, % 20

21 4. Treatment exits 4.1 Treatment exits Figure reports treatment exit reasons for young people exiting in This year, 12,510 individuals left treatment, with 9,852 (79%) of these exiting in a planned way and no longer requiring specialist treatment. These 12,510 young people represent 65 per cent of the 19,126 young people in treatment in the year, the remaining 6,616 young people (35%) were retained in treatment on 31 March Figure Treatment exit reasons of all young people exiting treatment Prison, 62, 0% Treatment declined by client, 244, 2% Other, 60, 0% Dropped out / left, 1,440, 12% Referred on, 852, 7% Completed Referred on Dropped out / left Prison Completed, 9,852, 79% Treatment declined by client Other 21

22 5. Trends over time 5.1 Trends in age and numbers in treatment In there was a reduction of 906 young people recorded as having been in specialist treatment services compared to and a reduction of 4,927 young people since the peak in Falling alcohol and drug use among young people in general may explain this small decline, iv although it is also possible that cuts in funding for targeted youth support services may have affected the number of referrals. Table Number of young people in treatment by age ( to ) Age n % n % n % n % n % Under % 233 1% 227 1% 193 1% 155* 1% % 457 2% 467 2% 442 2% 380* 2% 13 1,040 6% 1,253 6% 1,476 6% 1,500* 6% % 14 2,380 14% 2,961 14% 3,466 14% 3,550* 15% 3,300* 14% 15 3,884 23% 4,953 23% 5,658 24% 5,574 23% 5,770 25% 16 4,347 26% 5,315 25% 5,987 25% 6,133 25% 5,823 25% 17 4,780 28% 6,019 28% 6,624 28% 6,663 28% 6,701 28% Total 17, % 21, % 23, % 24, % 23, % Age n % n % n % n % Under % 110 1% 56 0% 46 0% % 323 2% 310 2% 227 1% 13 1,234 6% 1,129 5% 1,130 6% 1,008 5% 14 3,092 14% 3,009 15% 2,936 15% 2,785 15% 15 5,445 25% 5,097 25% 5,097 25% 4,922 26% 16 5,657 26% 5,297 26% 5,040 25% 5,092 27% 17 6,084 28% 5,723 28% 5,463 27% 5,046 26% Total 21, % 20, % 20, % 19, % 22

23 5.2 Trends in primary substance Figure reports the number of young people in treatment in each given year and the primary substance recorded when they presented to treatment. The number of young people presenting to treatment services with cannabis problems has been increasing since Prevalence estimates do not indicate that cannabis use in the general population of young people is rising. Alcohol use in treatment is falling in line with the prevalence statistics as is opiate use, which is falling across all ages but especially in the younger groups. Figure Number of young people in treatment by primary substance ( to ) Cannabis Alcohol All other substances Cannabis Alcohol All other substances

24 Figure reports in more detail the young people above citing all other substances and the substances they cite. Figure Number of young people in treatment by primary substance (not including primary cannabis or primary alcohol use, to ) Opiates Amphetamines Opiates Cocaine Ecstasy Amphetamines Cocaine Crack Ecstasy Solvents Other Solvents Other 100 Crack

25 Table Number of young people in treatment by substance ( to ) Substance n % n % n % n % n % Opiates 881 5% 755 4% 651 3% 547 2% 480* 2% Amphetamines 332 2% 323 2% 346 1% 230* 1% 256 1% Cocaine 453 3% 655 3% 806 3% 745* 3% 457 2% Crack 200 1% 137 1% 155 1% 110 0% 50* 0% Ecstasy 325 2% 432 2% 438 2% 210* 1% 90* 0% Cannabis 9,043 55% 10,824 52% 12,021 51% 12,642 53% 13,123 56% Solvents 210 1% 301 1% 305 1% 284 1% 274 1% Alcohol 4,886 30% 7,039 34% 8,589 36% 8,799 37% 8,227 35% New psychoactive substances Other 174 1% 183 1% 241 1% 270* 1% 399 2% Substance n % n % n % n % Opiates 320* 1% 211 1% 175* 1% 160* 1% Amphetamines 639 3% 493 2% 755* 4% 591 3% Cocaine 350* 2% 301 1% 245* 1% 254 1% Crack 35* 0% 40 0% 27 0% 14 0% Ecstasy 65* 0% 79 0% 130* 1% 124 1% Cannabis 12,784 58% 13,200 64% 13,581 68% 13,659 71% Solvents 263 1% 236 1% 163 1% 134 1% Alcohol 7,054 32% 5,884 29% 4,704 24% 3,776 20% New psychoactive substances * 1% Other 349 2% 189 1% 210* 1% 271 1% 25

26 5.3 Trends in club drug use Figure reports the number of clients aged under 18 in treatment in each of the years to , where the person reported using one or more club drug(s). For the report Club drugs: emerging trends and risks ( a club drug user was defined as a person citing any of the following substances, either as a primary or adjunctive drug: GHB/GBL, ketamine, ecstasy, methamphetamine or mephedrone. This report extends the analysis carried out for that report, which covered through to , using data from and The number of clients in treatment for a club drug in has changed very little from and the small fall in young people citing a club drug this year (a drop of 140 young people from ) can be largely ascribed to a drop in numbers citing use of mephedrone which has decreased from 1,788 young people last year to 1,519 this year, a drop of 15%). However, the number of young people citing any other club drug has increased compared to last year, with numbers citing ketamine increasing by 74 people (an increase of 21%) and ecstasy increasing by 87 people (an increase of 9%). Although the number of young people citing GHB/GBL and methamphetamine are not presented below because the numbers are so small, there were six young people who cited GHB/GBL in and 14 citing methamphetamine. Figure Number of young people in treatment by club drug use ( to ) Ecstasy Mephedrone Ketamine Ecstasy Mephedrone 500 Ketamine Table Trends in numbers presenting to treatment citing club drug use Substance Ketamine Ecstasy 1,511 2,112 2,281 1,644 1, Mephedrone ,065 1,788 1,519 Any club drug cited 1,534 2,168 2,390 1,831 1,556 1,975 2,007 2,834 2,694 Percentage of all in treatment citing a club drug A code for mephedrone was added to the NDTMS core data set in Any clients reporting mephedrone prior to this are counted in the Any club drug cited total but no separate total is given for mephedrone. 26

27 5.4 Trends in treatment exit reasons Table reports treatment exit reasons for clients in the years to In 2009 a new discharge coding system was introduced which clarified the coding of referrals within the treatment system, and tightened the way treatment completed was recorded. For further details see Quality and methodology information. These changes mean it is not possible to directly compare treatment exit data for some codes from onwards with previous years. Table Trends in treatment exit reasons Treatment exit reason n % n % n % n % Complete 4,105 48% 5,726 50% 8,073 57% 9,546 65% Referred on 572 7% 701 6% 938 7% 510 3% Dropped out/left 2,525 29% 2,902 25% 2,529 18% 2,253 15% Prison 200 2% 285 2% 339 2% 371 3% Treatment declined by client * 0% 246 2% 703 5% 620* 4% Not known 102 1% 202 2% 98 1% 71 0% Other 1,108 13% 1,448 13% 1,401 10% 1,250 9% Total 8,615* 100% 11, % 14, % 14,620* 100% Treatment exit reason n % n % n % n % n % Complete 10,160 69% 10,507 75% 10,118 77% 10,208 79% 9,852 79% Referred on 856 6% 793 6% 841 6% 760 6% 852 7% Dropped out/left 2,408 16% 1,851 13% 1,630 12% 1,530 12% 1,440 12% Prison 183 1% 139 1% 97 1% 66 1% 62 0% Treatment declined by client 529 4% 440 3% 326 2% 278 2% 244 2% Not known 51 0% 16 0% 0 0% 0 0% 0 0% Other 478 3% 260 2% 175 1% 105 1% 60 0% Total 14, % 14, % 13, % 12, % 12, % 27

28 6. History This report presents information relating to young people (those aged under 18) attending specialist substance misuse services in England. The statistics are derived from data that has been collected through the National Drug Treatment Monitoring System (NDTMS). The NDTMS collects activity data from drug and alcohol treatment services so that the benefits to both the young people attending specialist services and their families can be evidenced the profile of young people accessing substance misuse interventions can be understood and can be utilised to inform service provision trends and shifts in patterns of drug use amongst young people can be monitored, to inform future policy locally and nationally the impact of substance misuse interventions as a component of the wider public health service may be measured they can demonstrate their accountability to their service users, local commissioners and communities through the outcomes achieved NDTMS figures for England are produced by The National Drug Evidence Centre (NDEC) at Manchester University, which also collates these with those for Scotland, Wales and Northern Ireland, into a UK return for use by the European Monitoring Centre for Drugs and Drug Addiction (see and for the United Nations. Separate statistics on young people accessing substance misuse services were first published by the National Treatment Agency for Substance Misuse (NTA) for Previously, reliable statistics on under-18s receiving specialist support for drug and alcohol misuse were scarce. Responsibility for managing NDTMS was transferred from the Department of Health (DH) to NTA on 1 April From that point, arrangements were put in place to start recording complete data for young people as part of the general NDTMS returns from drug treatment services in England. Consequently NDTMS annual reports for and contained some information about clients aged under-18, who then comprised about 6% of the total treatment population. Information was provided about interventions for young people, discharge rates, primary drug trends and regional differences. However this information was restricted to drug services, and did not include young people with primary alcohol problems. DH commissioned NTA to start collecting complete data on alcohol treatment services (through the National Alcohol Monitoring System) from 1 April Meanwhile in June 2007, the Department for Children, Schools and Families transferred responsibility for assuring the delivery of young people s specialist substance misuse services in England to NTA. This was underpinned by a memorandum of understanding between the two organisations, and an expansion of specialist services funded by a dedicated element of the pooled treatment budget. This new generation of services covered specialist drug and alcohol interventions for young people, and are different from their adult drug treatment counterparts. In the light of these changes, NTA decided to separate out the available data for young people from the annual publication of drug treatment statistics, and to publish a separate and comprehensive set of statistics about young people for the first time. Reports on substance misuse among young people were published for , , and , each of which included a statistical annexe setting out the available data for the year and trends going back to In November 2011, the UK Statistical Authority served notification under Section 16 of the Statistics and Registration Services Act (2007) that its view was that both young people s data and alcohol data should be put forward for assessment as National Statistics. The Secretary of State for Health submitted a formal assessment request in February Meanwhile the NTA and PHE have worked with DH Statistics head of profession to ensure that the reports since , including this report for , is produced in accordance with the code of practice for Official Statistics. On 1 April 2013, responsibility for production of these statistics transferred from NTA, to Public Health England. 28

29 6.1 Relevant web links and contact details Monthly web-based NDTMS analyses National Drug Evidence Centre (NDEC) Public Health England General enquiries For media enquiries, call or For technical enquiries, Policy Drug policy team, PHE Data and statistics Jonathan Knight head of evidence application team, PHE Carol Lewis senior information analyst, PHE Andrew Jones research fellow, NDEC 6.2 Comparability of data to previous reports Since 1 November 2013, PHE made substantial changes to the core dataset with regards to young people and the coding of intervention type. Prior to this, intervention codes were restricted to the eight categories: harm reduction, pharmacological, psychosocial (counselling), psychosocial (cognitive behaviour therapy), psychosocial (motivational interviewing), psychosocial (relapse prevention), psychosocial (family work). These categories did not allow for recording the setting where the interventions were being delivered. Following consultations with clinicians, treatment providers and other key stakeholders a new method of recording interventions types and setting was introduced alongside the ability for providers to record the non-structured multi-agency working interventions that they were delivering. These changes will enable a better understanding of the different interventions being provided nationally and in local areas which will in turn benefit commissioning and service planning as well as influencing national policy setting. As part of the changes in the coding of intervention type, from 1 November 2013 all registered young people s treatment providers are registered with a setting type. There are seven settings: community, home, secure estate, in-patient (substance misuse specific), in-patient (not substance misuse specific), residential (substance misuse specific) and residential (not substance misuse specific) which have now been incorporated to PHEs regular reporting. Clients in a secure estate setting are not reported on in this document. Definitions of these settings can be found in section 7.2 and the business definitions guide at Intervention types have been split in to four high-level categories: pharmacological interventions, psychosocial interventions, harm reduction interventions and multi-agency working interventions. Multi agency working interventions are not reported on in the present report. Due to these implemented changes, some reporting of interventions in this report is limited to those with 29

30 intervention codes that were valid prior to 1 November Therefore, the validity of comparing data to previous years, particularly in tables 3.2.1, and is limited. One result of the change in the method of recording types of intervention is that many clients had new modalities opened (and old modalities closed) within the year to align with the new methodology, despite being in continuous treatment. Within standard analyses these replacement modalities would appear falsely as subsequent interventions with associated waits. For this reason, subsequent waits in this report (table 3.1.1) are only shown prior to 1 November Other changes to the core dataset with regards to young people also occurred in the dataset change on 1 November Valid responses to the fields accommodation status and education and employment status were changed and so comparing data for these responses for previous years is limited (for more details please see the latest business definitions at The final change following the consultations with clinicians, treatment providers and other key stakeholders was to introduce a new set of questions to capture vulnerabilities, risk and resilience factors at the start of treatment. These changes meant that a lot of the fields used to create the multiple vulnerabilities (section 2.7) were changed and superseded from 1 November For this reason, this section only reports on episodes that start on or before 31 October 2013 and are not comparable to data from previous years. 6.3 Drug treatment collection and reporting timeline 1989 to March 2001 Regional Drug Misuse Database (RDMD) statistics reported in six monthly bulletins by DH from 1993 to 2001 April 2001 to March 2004 NDTMS statistics reported annually by DH April 2004 to March 2013 NDTMS managed by NTA reporting statistics annually up to March 2012 April 2013 to date NDTMS managed by PHE reporting statistics annually from April Other sources of statistics about drugs Prevalence of substance use among young people Information is available relating to the prevalence of drug use among secondary school pupils aged 11 to 15 from Smoking, drinking and drug use among young people in England. This is a survey carried out for the NHS Information Centre by the National Centre for Social Research and the National Foundation for Educational Research. The annual survey interviews school pupils, and has included questions on drug use since The data and further information are available at An annual estimate of the prevalence of drug use is undertaken through the Crime Survey for England and Wales (formerly the British Crime). This section of the survey has been in place since 1996, annually since 2001, and has tracked the prevalence of the use of different drugs over this time. This does not include information on all young people but does show the data for the age group A second method for estimating the prevalence of crack cocaine and heroin use is produced for each local authority area in England by Liverpool John Moores University. Estimates are available for , , and The estimates are produced through a mixture of capture-recapture and Multiple Indicator Methodology (MIM), and rely on NDTMS data being matched against and/or analysed alongside probation and Home Office data sets. Again, these estimates include a sub-sample of young people reporting on those aged The data and further information are available at 30

31 6.4.2 International comparisons The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) publish an annual report that describes and compares aspects of drug use and drug policy within European states, as well as providing detailed comparative statistics. This can be found here: The centre also produces a treatment demand indicator (TDI), which is a collection of comparative statistics relating to individuals seeking treatment. This can be found at The European School Survey Project on Alcohol and Other Drugs (ESPAD) collects comparative data on substance use among year old students across a number of European countries. The results of these surveys can be found at The United Kingdom (UK) Focal Point on Drugs is the national partner of EMCDDA and provides comprehensive information to the centre on the drug situation in England, Northern Ireland, Scotland and Wales. The UK Focal Point on Drugs is now part of PHE. Focal Point works closely with the Home Office, other government departments and the devolved administrations. In addition to contributing to the EMCDDA annual report, it collates an extensive range of data in the form of standard tables and responses to structured questionnaires, which are submitted regularly to EMCDDA. It also contributes to other elements of EMCDDA s work such as the development and implementation of its five key epidemiological indicators, the Exchange on Drug Demand Reduction Action (EDDRA) and the implementation of the council decision on new psychoactive substances. The most recent reports can be found at The Welsh government publishes substance misuse statistics, which include treatment statistics from the Welsh National Database for Substance Misuse, as well as other information available from other routine data sources. Age groups of and are included in this report. The most recent statistics can be found at wales.gov.uk/topics/people-and-communities/safety/substancemisuse/impact/stats/?lang=en Statistics about drug misuse in Scotland (under 20s) are published by Drug Misuse Information Scotland and can be found at Statistics about drug misuse treatment in Northern Ireland (under 18s) are published by the Northern Ireland s Executive s Department of Health, Social Services and Public. The most recent of these can be found at /news-dhssps publication-of-statistics.htm NDTMS figures for England are collated by NDEC, with those for Scotland, Wales and Northern Ireland, into a UK return for use by EMCDDA (see and for the United Nations. While comparisons to alcohol treatment statistics from other countries can be made, care needs to be taken as the data is unlikely to be directly comparable due to differences in the definitions and methodologies that are used in collecting the data and in subsequently in reporting it Youth justice statistics The Ministry of Justice and the Youth Justice Board for England and Wales publish annual statistics that detail the number of young people (aged 10-17) arrested, along with proven offences, criminal history, characteristics of young people, the number sentenced, those on remand, those in custody, re-offending and behaviour management. These can be found at 31

32 6.4.4 Adult drug and alcohol treatment PHE also publishes annual reports regarding adults accessing drug and alcohol treatment. These can be found at It should be noted that young people s figures are not comparable with statistics relating to adult drug or alcohol treatment. This is because access to specialist services for young people requires a lower severity of drug use and associated problems. v Drug-related deaths The Office for National Statistics publish an annual summary of all deaths related to drug poisoning (involving legal and illegal drugs) and drug misuse (involving illegal drugs) in England and Wales. This covers all ages with young people forming part of the under 20 age group. This can be found at deaths-related-to-drug-poisoning-in-england-and-wales html Other statistics The NHS Information Centre produced an annual report on drugs and drug use. The report draws on statistics from a number of sources including treatment statistics from NDTMS, and has three sections: drug misuse in young adults, drug misuse among children and outcomes of drug misuse. The latest report can be found at 32

33 7. Abbreviations and definitions 7.1 Abbreviations A&E ACMD CAMHS DP EMCDDA NDEC NDTMS NTA PHE YOT YP Accident and emergency department Advisory Council on the Misuse of Drugs Child and adolescent mental health services Drug partnership European Monitoring Centre for Drugs and Drug Addiction National Drug Evidence Centre (University of Manchester) National Drug Treatment Monitoring System National Treatment Agency for Substance Misuse Public Health England Youth offending team Young people 7.2 Definitions Agency/provider Agency/provider code Adjunctive drug use Attributor Client Community setting Discharge date Drug partnership Episode Episode of treatment A provider of services for the treatment of substance misuse. They may be statutory (i.e., NHS) or non-statutory (i.e., third sector, charitable). A unique identifier for the treatment provider (agency) assigned by the regional NDTMS centres for example L0001. Substances additional to the primary substance used by the client, NDTMS collects secondary and tertiary substances. A concatenation of a client s initials, date of birth and gender. This is used to isolate records that relate to individual clients. A drug or alcohol user presenting for treatment at a structured treatment service. Records relating to individual clients are isolated and linked based on the attributor. A young person s drug and alcohol service where residence is not a condition of engagement with that service. This will include all providers delivering interventions in a non-residential setting. This is usually the planned discharge date in a client s treatment plan, where one has been agreed. However, if a client's discharge was unplanned, then the date of last face-to-face contact with the provider (agency) is used. The partnerships responsible for delivering the drug strategy at a local level (also known as drug and alcohol action team, or DAAT). A period of contact with a treatment provider (agency): from referral to discharge. A set of interventions with a specific care plan. A client may attend one or more interventions (or types) of treatment during the same episode of treatment. A 33

34 client may also have more than one episode in a year. A client is considered to have been in contact during the year, and hence included in these results, if any part of an episode occurs within the year. Where several episodes were collected for an individual, attributes such as ethnicity, primary substance etc. are based on the first valid data available for that individual. Family work intervention Harm reduction intervention In contact Interventions using psychosocial methods to support parents, carers and other family members to manage the impact of a young person s substance misuse and enable them to better support the young person in their family. Specialist harm reduction interventions should include services to manage injecting, overdose and substance misuse related accidental injury Clients are counted as being in contact with treatment services if their date of presentation (as indicated by triage), intervention start, intervention end or discharge indicates that they have been in contact with a provider during the year. Inpatient unit (substance misuse specific) setting An inpatient unit provides assessment, stabilisation and/or assisted withdrawal with 24-hour cover from a multi-disciplinary team who have had specialist training in managing addictive behaviours. Such as paediatric ward, adult ward, child and adolescent mental health ward etc. Inpatient unit (not substance misuse specific) setting An inpatient unit provides assessment, stabilisation and/or assisted withdrawal with 24-hour cover. Such as a hospital unit. Intervention First/subsequent intervention Home setting Looked after child Opiate Pharmacological intervention Poly drug use Presenting for treatment Primary care setting Primary care trust A type of treatment, e.g., structured counselling, community prescribing etc. 'First intervention' refers to the first intervention that occurs in a treatment journey. 'Subsequent intervention' refers to interventions, within a treatment journey, that occur after the first intervention. The young person is being supported with specialist substance misuse interventions in his/her home by the treatment provider. The definition of a looked after child (from the Children Act 1989 vi ) is Children looked after includes all children being looked after by a local authority including those subject to care orders under section 31 of the Children Act 1989 and those looked after on a voluntary basis through an agreement with their parents under section 20 of the Children Act 1989 A group of drugs including heroin, methadone and buprenorphine Interventions that include prescribing for detoxification, stabilisation and symptomatic relief of substance misuse as well as prescribing to prevent relapse. For young people this intervention includes a wide range of medication prescribed by a clinician, not solely substitute prescribing for opiate addiction. The reporting of using two or more drugs in combination The first face-to-face contact between a client and a treatment provider. Structured substance misuse treatment is provided in a primary care setting by a general practitioner, often with a special interest in addiction treatment. A PCT was a type of NHS trust, part of the NHS in England. PCTs were largely administrative bodies, responsible for commissioning primary, community and secondary health services from providers. 34

35 Primary drug/substance Psychosocial Intervention Referral date The substance that brought the client into treatment at the point of triage/initial assessment. These interventions use psychological, psychotherapeutic, counselling and counselling based techniques to encourage behavioural and emotional change; the support of lifestyle adjustments and the enhancement of coping skills. They include motivational interviewing, relapse prevention and interventions designed to reduce or stop substance misuse, as well as interventions that address the negative impact of substance misuse on offending and attendance at education, employment or training. The date the client was referred to the provider for this episode of treatment. Residential unit (substance misuse specific) setting Anywhere where a young person is receiving interventions in their residence and that residence has been set up specifically to deal with substance misuse. Residential unit (not substance misuse specific) setting Anywhere where a young person is receiving interventions in their residence but that residence has not been set up specifically to deal with substance misuse, such as children s homes, supported housing etc. Structured treatment Triage Triage date Waiting times Young people YP secure estate Structured treatment follows assessment and is delivered according to a care plan, with clear goals, which are regularly reviewed with the client. It may comprise a number of concurrent or sequential treatment interventions. An initial clinical risk assessment performed by a treatment provider. A triage includes a brief assessment of the problem as well as an assessment of the client s readiness to engage with treatment, in order to inform a care plan. The date that the client made a first face-to-face presentation to a treatment provider. This could be the date of triage/initial assessment though this may not always be the case. The period from the date a person is referred for a specific treatment intervention and the date of the first appointment offered. Referral for a specific treatment intervention typically occurs within the treatment provider, at or following assessment. Under 18 years old. Establishments that house young offenders who have been remanded or sentenced, they include young offender institutes (YOIs), secure training centres and secure children s homes. Note: full operational definitions can be found in the NDTMS core data set documents on 35

36 Appendix A Diagram to show an example young people s pathway This diagram illustrates a typical journey through a young people s specialist substance misuse service. It is provided to give an indication of a possible pathway and the interventions received. Pathways will vary depending on the substances used, the support requirements of the young people, their general health needs and any other relevant issues. Young people with substance misuse problems will usually have a number of other issues that they are receiving help with, but this pathway focuses on the substance misuse. 36