Is disinvestment from alcohol and drug treatment services associated with treatment access, completions and related harm? An analysis of English expenditure and outcomes data

By Suzie Roscoe et al. / Drug and Alcohol Review

Despite the wealth of evidence that alcohol and drug treatment are effective at reducing health and social harms [1–4], there has recently been substantial disin- vestment from publicly-funded treatment systems in various countries [5–9]. Worldwide each year, over 3 million lives are lost due to the misuse of alcohol and the non-medical use of opioids is associated with pre- mature deaths [4,10]. Global disability-adjusted life years attributable to alcohol and drugs are over 99 mil- lion and almost 32 million, respectively [11]. Due to the recognised burden, reducing the harm from the misuse of alcohol and drugs, through prevention and treatment, are global health priorities [12].

Public health investment provides a good return on investment in terms of health outcomes [13,14]. Effec- tive substance use treatment improves health and social outcomes for individuals, families and commu- nities [15,16]. This includes reduced consumption and abstinence [17], a reduction in risk-taking behav- iour [18], reduced offending [19,20] and reduced mortality [4,21,22].

In England, the majority of treatment services are publicly funded via the Public Health Grant [23]. The Health and Social Care Act 2012 transferred many public health responsibilities from the National Health Services, and an allocated Public Health Grant, to 152 England local government areas. Each local authority, serving a mean population of 297286 (SD 226761), were made responsible for the adminis- tration of the grant. Included within the transfer of responsibilities was the commissioning of alcohol and drug treatment services, and the protected status of the alcohol and drug budget—which prevented it being spent on other public health priorities—was removed [24].

At the same time, England experienced a national government-led austerity program, resulting in sustained reductions in total local authority funding. This amounted to estimated losses of £9.8 billion (
38%) between 2009/2010 and 2018/2019 [25], including a £700 million (15%) reduction between 2015/2016 and 2019/2020 in the Public Health Grant [26].