ALCOHOL
Blocking
the path
How well is England
doing at getting
people who
need help into
treatment for
their drinking
problems? It matters, because the
more of the in-need population
we treat, the smaller the alcoholdependent
population and the less
the related harm. Drug and Alcohol
Findings conducted an examination
for England in 2014 when the
figures were most reliable (see
https://findings.org.uk/PHP/
dl.php?f=tr_pop_uk.hot&s=dd for
the full story and references).
Then, about 112,000 drinkers
were in specialist treatment. We
found rationales for this representing
just 7.5 per cent of harmful or at
least mildly dependent drinkers, and
up to 43 per cent of those who score
in surveys as at least ‘moderately’
dependent. In between was a 19 per
cent estimate based on a formula
constructed for the Department
of Health. This aimed to exclude
drinkers who, despite a high risk to
What proportion of England’s problem drinkers
are actually in treatment? And are increasing
rates of unmet need the result of austeritydriven
funding cuts? Mike Ashton investigates
health, scored as non-dependent
in surveys, but to include lower-risk
drinkers dependent enough not to
remit, even after an extended brief
intervention.
The population in need of
treatment becomes constricted
further if we take into account
whether prospective patients
actually want or intend to take a
treatment route to curbing their
drinking, and/or are making what
to them seems a rational choice to
continue to drink to excess.
COULD DO BETTER
Though the question of what
proportion of the in-need
population is in treatment has
several answers, what seems sure is
that England could be doing better
– not least because Scotland seems
to be treating proportionately
three times as many of its problem
drinkers. An estimate for Leeds is
that raising treatment access to
that level would cut the alcoholdependent
population by nearly
a fifth over five years, and save a
further 65 lives.
Since 2014, however, things
seem to have got worse (Fig 1).
Initiated in 2010, the government’s
austerity policies are prime targets
for the underlying reason why
alcohol treatment numbers have
been falling despite sustained
levels of need – the chart shows
numbers falling consistently
since 2013-14. The highest
line is the number of patients
whose presenting substance
use problems included alcohol,
the lowest those with alcohol as
their sole presenting substance
use problem. In between are
actual or estimated numbers of
patients treated primarily for their
drinking problems, the basis for the
calculations above.
These figures must be married
with trends in estimated treatment
need to assess whether need is
increasingly failing to be met.
The methodology which yielded
the 19 per cent estimate for 2014
has been used to estimate the
alcohol-dependent population in
England from 2010-11 to 2017-18.
In 2017-18 the estimate was just
1.6 per cent lower than in 2013-14,
yet over the same period the patient
caseload fell by about 17 per cent –
from equivalent to just over 19 per
cent of the in-need population to 16
per cent (see chart). The drop was
within margins of uncertainty, but
was consistent each year from 2013-
14. With a presumed substantial
pool of unmet need, even if there
had been no fall in the proportion
of the in-need population being
treated, a diminishing caseload
would still have been of concern.
HOSPITAL ADMISSIONS
Another statistic used to indicate
need for treatment is hospital
‘Austerity
might increase
unmet need by
obstructing the
main routes for
converting need
into demand for
and entry into
treatment.’
8 • DRINK AND DRUGS NEWS • SEPTEMBER 2020
WWW.DRINKANDDRUGSNEWS.COM